After repeated pledges to repeal and replace the Affordable Care Act (ACA) by both President Trump and Congressional Republicans, it appears that, for the foreseeable future, Obamacare will remain the law of the land.
Propping Up the ACA
The Senate’s failure to pass any repeal legislation represents a setback for the Trump administration’s policy agenda, and the path for bipartisan progress on health care appears to be narrow at best.
Some efforts are under way to tackle various issues related to the ACA. Shortly after the failure of Senate Majority Leader McConnell’s attempt to repeal the ACA, leaders of the Senate Health, Education, Labor, and Pensions (HELP) committee announced their intention to launch a bipartisan effort to stabilize the ACA’s individual insurance exchanges. Chairman Lamar Alexander of Tennessee and Ranking Member Patty Murray of Washington announced a hearing to address the issues affecting those who purchase their insurance through the ACA exchanges, tentatively scheduled for the first week in September. Two key policy proposals have emerged from the HELP committee leadership’s public discussions:
- Make cost-sharing reduction subsidies — which lower out-of-pocket costs for low-income policyholders — permanent and not subject to White House discretion
- Allow all exchange participants to purchase certain high-deductible, low-premium plans (a policy currently limited to those under 30).
While the ultimate success of these efforts is uncertain due to the unprecedented nature of a bipartisan approach to the ACA, its launch signifies that the ACA repeal effort by Senate Republicans is likely dead for the foreseeable future. In June, PAEA submitted a letter to Senate leadership urging Senators McConnell and Schumer to work to maintain the coverage expansion achieved through the ACA.
PAEA Policy Priorities
As the Senate shifts its attention to different legislative priorities, such as tax reform and infrastructure, questions remain regarding the likely path forward for PA education policy in this Congress. Below is an update on where some of PAEA’s policy priorities currently stand.
- Appropriations (Title VII): In July, the PAEA Government Relations team achieved a significant victory when the House Appropriations Committee advanced funding for Title VII programs that benefit PA education at a level consistent with Fiscal Year 2017 levels. While the timeline for the Senate Appropriations Committee to approve funding bills for the upcoming fiscal year is short, the likelihood of cuts to these Title VII programs is significantly reduced due to the action taken by the House. Congress must take action on appropriations by the end of September to prevent a government shutdown on October 1, and the Government Relations team has made outreach to Senate appropriators a priority.
- Clinical Training Sites: In June, the Centers for Medicare and Medicaid Services included a provision in its proposed rule for performance year 2018 of the Quality Payment Program that would grant practice improvement activity credit under the Merit-Based Incentive Payment System to preceptors of PA students. This means that preceptors would be eligible for a new financial incentive to help boost their Medicare Part B revenue. In the legislative arena, this provision is also included in H.R. 1605, the PA Education Public Health Initiatives Act, a bill supported by PAEA. The PAEA Government Relations team has launched a grassroots comment campaign — which so far has garnered hundreds of comments — to express support for the provision prior to the end of the comment period on August 21. The final rule is expected to be released by the end of 2017.
- The GOOD Act: After a sustained advocacy effort led by AAPA, on July 28, the U.S. House of Representatives unanimously approved H.R. 3262, an amended version of the Grow Our Own Directive (GOOD): PA Employment and Education Act of 2017. The GOOD Act will now go to the Senate for consideration. This bill would direct the VA to establish a pilot program that provides educational assistance to members of the armed services seeking to train as PAs in exchange for a commitment to serve at a VA facility for a period following their graduation. The House and Senate also advanced a provision from the original bill (S. 114) that would establish competitive pay grades for PAs serving at VA facilities. PAEA Director of Government Relations Athena Abdullah has worked diligently to support AAPA where needed and is committed to continuing work to ensure this legislation is passed in the Senate and sent to the president for his signature. Grassroots participation in this effort will be critical, and the Government Relations team will be putting out additional information and encouraging advocates to take action in the coming weeks.
As the debate over the repeal of the ACA transitions to bipartisan negotiations on how to best improve our health care system, the Government Relations team will continue its efforts to advance the interests of PA education.