introduced an amendment that provides
an additional $8 billion in funding over
five years to people with pre-existing
conditions. Critics have said additional
funds are not enough resources to be
effective for patients. However, it appeased enough moderate Republicans
to narrowly pass the bill by a vote of
217 to 213 on May 4. The House voted
without a report on the cost of the bill
from the Congressional Budget Office
(CBO), which was the subject of much
last minute contention. Twenty Republican representatives voted against the
measure and no Democrats voted in
favor of the bill.
Senate Majority Leader Mitch McCo-nnell (R-KY) acknowledged much work
is still to be done, while the President
expressed optimism that health care
reform would pass the Senate. Senate
Majority Whip John Cornyn (R-Texas)
said that the House bill will be the starting point for the Senate’s deliberations.
There is no timeline for the consideration of the bill in the Senate, though it
may face procedural hurdles in its current form. As this article goes to print in
the second week of June, the Senate is
anticipating a vote on a final bill by July
4 recess. NASS will continue to keep
members apprised of new information
through regular email communication.
Repeal or modification of the ACA
hinges on one component for its suc-
cess: the stabilization of the insurance
market. Eliminating uncertainty around
cost sharing reduction payments to the
insurance industry and enforcement of
the individual mandate to carry insur-
ance are the two threats to insurance
market stability. Regardless of where
the revenue is generated and which
cost items are cut, providing affordable
health care to as many in the population
as possible requires predictable stabili-
zation of the insurance platform.
Though it may take Republicans a
while longer to fully repeal the ACA,
the Trump Administration has tools at
its disposal to stabilize the insurance
market system and modify if not remove
regulatory barriers relegated to the Sec-
retary of Health and Human Services
(HHS) under the ACA.
In April 2017, the Centers for Medi-
care and Medicaid Services (CMS) (an
agency under HHS) released the “Pa-
tient Protection and Affordable Care
Act; Market Stabilization final rule” to
address uncertainty among insurers
and the insured concerning insurance
markets in the context of potential ACA
repeal and replace legislation. Accord-
ing to a CMS release, changes include
shortening the 2018 open enrollment
period, promoting program integrity,
promote continuous coverage, empow-
ering states and reducing duplication. 8
Repeal of the ACA is more difficult
than expected even with one party
majority in Congress and the executive
office. Components of the act, including
coverage for the uninsured, pre-existing
conditions and age-related premiums,
need attention prior to reaching an
agreement within and between parties.
The goal is to find a platform that meets
the needs of patients, while understand-
ing the asks of the multiple stakeholders,
all at a financial budget plan palatable
for the next generation.
1. Reconciliation 101. Committee for a
Responsible Federal Budget. December
6, 2016. Available at: http://www.crfb.
May 4, 2017.
2. Reich D, Kogan R. Introduction to Budget
"Reconciliation." Center on Budget and
Policy Priorities. Available at: http://
Accessed May 4, 2017.
3. 2 U.S. Code § 644 Extraneous matter
in reconciliation legislation. Legal
Information Institute. Available at:
text/2/644. Accessed May 4, 2017.
4. A Better Way. Available at: https://www.
Accessed May 4, 2017.
5. H. R. 1628 American Health Care Act of
2017. Congress.gov. Available at: https://
house-bill/1628. Accessed May 4, 2017.
6. Summary of the American Health
Care Act. The Henry J. Kaiser Family
Foundation. Available at: http://files.kff.
Accessed May 4, 2017.
7. Compare Proposals to Replace The
Affordable Care Act. The Henry J. Kaiser
Family Foundation. Available at: http://
the-affordable-care-act/. Accessed May
8. CMS issues final rule to increase choices
and encourage stability in health
insurance market for 2018. Centers
for Medicare & Medicaid Services.
Available at: https://www.cms.gov/
items/ 2017-04-13-2.html. Accessed May
CH Cho: Board of Directors: North American
Spine Society (Nonfinancial).
M Maxwell: Nothing to disclose
J Abushawish: NASS employee
M Kroll: NASS employee
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