Dems refocus on Obamacare without clear policy path

House Democrats this week brought the Affordable Care Act back to the forefront as a top priority, albeit without clear and near-term policy implications.

The legislation announced in a key House health panel hearing on Wednesday targets the Trump administration policies that affect the law. The bills aren't likely to go anywhere this Congress with the Senate and White House still in Republican control, but lawmakers once again highlighted the divide in the Democratic and GOP approach to the law, particularly around how states should administer their exchanges.

The hearings came one day after the president in his State of the Union address called for legislation to bring down drug prices and improve transparency across the healthcare industry. It remains unclear whether the two parties will strike a deal with one another and with the administration on substantive drug pricing proposals—a stated priority from all sides.

The legislation announced Wednesday by House Energy and Commerce Health Subcommittee Chair Anna Eshoo (D-Calif.) would restore federal funds to market and establish outreach for individual market open enrollment; to roll back the Trump administration's expansion of short-term plans; and to invalidate guidance to give states more leeway on their individual market design.

The panel will hold a hearing next week on these bills, Eshoo said.

Also Wednesday, two leading Democrats wrote to the Government Accountability Office comptroller general to ask if last year's HHS guidance loosening requirements for the ACA's 1332 State Innovation Waivers could be overturned under the Congressional Review Act. The filibuster-proof law allows Congress to invalidate federal regulation.

The letter from Energy and Commerce Chair Frank Pallone (D-N.J.) and Senate Finance Committee ranking member Ron Wyden (D-Ore.) criticizes the guidance as potentially weakening insurance protections in some states.

The GOP-majority Senate won't likely invalidate the guidance, but like Wednesday's committee-level action the letter shows the fundamental disagreement over how the individual market should operate, five years into implementation of the law as exchange insurers are starting to turn high profits.

The House Energy and Commerce health panel was convened for a discussion of what would happen if a federal judge's decision in a Texas lawsuit to overturn Obamacare stands. It's a consequence most legal analysts don't believe will happen, as acknowledged by Pallone in his opening remarks at the hearing.

Eshoo stated that the committee wanted to bring the Texas v. Azar case "front and center" as the law's protections of coverage for people with pre-existing conditions proved to be the "single-most important issue" for voters in the 2018 elections.

The health panel's top Republican, Rep. Michael Burgess of Texas, criticized Democrats for not bringing any proposal that could potentially end the lawsuit, such as a full repeal of the individual mandate or re-imposing the monetary penalty zeroed out by the GOP's 2017 tax law.

The health panel for the House Appropriations Committee also held a hearing Wednesday to scrutinize Trump's HHS administration of Obamacare, with a focus on the regulations that expanded access to plans that don't comply with the ACA, halted cost-sharing reduction payments for low-income enrollees and eliminated the individual mandate penalty.