Legislative Update
from National FV:
Tax Bill - Repeal of ACA's Individual Mandate and More
The House and Senate have each passed a version of a tax bill. Now representatives of the two chambers are meeting in a "conference committee" to negotiate a compromise bill. (Conferees are listed below.) Most of the negotiations will take place behind the scenes, although a formal meeting of the conference committee is scheduled to take place on Wednesday, December 13. Each chamber must pass the conference agreement without amendments. These votes are expected to take place either late this week or next week. See This Week: Gop Seeks to Finish Tax Overhaul (The Hill, 12/11/17).
The final bill (conference "agreement" or "report") could include any the provisions from the House or Senate bills. The net effect of the final tax bill will vary for each family. Both bills have provisions that would reduce some taxes but increase others. There are, however, some provisions in play that could have a disproportionate impact on children and youth with special health care needs (CYSHCN) and their families - most notably:
Good summaries of the bills' provisions can be found at: Important Differences Between the House and Senate Tax Reform Bills Heading into Conference (Tax Foundation, 12/2/17); Here's what's in the Senate tax bill - and how it differs from the House's bill(CNN Money, 12/2/17).
Regardless of the particulars, the final tax legislation will greatly increase the federal deficit, prompting congressional efforts to then reduce the deficit by cutting Medicaid, SSI, food stamps (SNAP), and other important safety net programs. In fact, congressional leadership and the president have all said they would like to move on to "entitlement reform" after the tax bill. See GOP Eyes Post-Tax-Cut Changes to Welfare, Medicare and Social Security (Washington Post, 12/1/17).
The members of the tax-bill conference committee are:
From the Senate:
From the House:
Outlook. The president and Republicans in Congress are very determined to get this tax legislation enacted, and chances are great that they will succeed. There is not expectedto be a problem passing the bill in the House, although it is possible that a significant number of conservative House Members will have objections. In the Senate, only three NO votes will kill the bill. Only Senator Corker (R-TN), voted against the Senate version, but Senator Collins and others may have concerns about the final bill that emerges from the conference committee.
Senator Collins (R-ME) said earlier that she would not vote for the conference agreement unless two other bills are enacted first - the Alexander-Murray bill to stabilize the individual insurance market, and a Collins-Nelson reinsurance bill. See Collins' Obamacare deal faces moment of truth (Politico 12/8/17). While these bills will somewhat mitigate the negative impact of repealing the individual mandate, they will not do so completely or permanently. See The Avalere Study of the Impact of Murray-Alexander and Collins-Nelson Bills on Insurance Premiums: What It Says and Does Not Say. At the moment, there are mixed messages about whether House conservatives will be willing to vote for those bills. Even if Senator Collins does not vote for the final bill, it can still pass the Senate - with the vice-president breaking a tie - unless one more Republican decides to oppose it, and that is always a possibility.
Medicare cuts. Some reports about the tax legislation mention that the deficits it creates will lead to an automatic $25 billion cut in Medicare and some other entitlement programs (not Medicaid or SSI). Although that is true in theory, Congress can vote to stop these cuts. This would require 60 votes in the Senate, meaning that all Republicans and at least eight Democrats would have to vote to do so, but it is expected that there will be enough votes to avert the cuts.
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 CHIP FUNDING - UPDATED
As reported in earlier Updates, federal CHIP funding expired on September 30. So far, states have managed to keep their CHIP programs up and running, but some states will deplete their CHIP funds soon; Virginia and Colorado have started starting to notify beneficiaries that they may lose coverage. (See No Set Federal Notice Period for CHIP - States Decide How Much Notice to Give Families Losing Coverage.) The temporary spending bill enacted on December 8 included a provision allowing the administration to re-allocate left-over CHIP funds to the states that need it most urgently. (See What Does the Continuing Resolution Mean for CHIP?) Child health advocates and governors have been urging Congress to approve the bipartisan, five-year CHIP extension that has been agreed to by the House and the Senate Finance Committee - but without the House bill's offsets for the cost of the CHIP extension. The next opportunity to do so is on the temporary spending bill that must be enacted no later than December 22 (see below). Advocates will be making a hard push for Congress to include the CHIP extension in that legislation. Whether that push will be successful is difficult to predict at this time. If the CHIP funding is not extended, more states may need to scale back or eliminate their CHIP programs. States with CHIP incorporated into their Medicaid programs will receive less funding than they do now to cover the CHIP population. See State Plans for CHIP as Federal CHIP Funds Run Out (Kaiser Family Foundation, 12/6/17); Frequently Asked Questions about the Children's Health Insurance Program (CHIP)(National Academy for State Health Policy, updated 12/8/17; a very clear explanations of what states can do if CHIP funds run out.)
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