Democrats Score Gigantic Win As Major Parts Obamacare Repeal Will Require 60 Senate Votes

• Abortion Restrictions for Tax Credits: Two separate provisions contain Hyde Amendment language to prevent premium tax credits and small business tax credits from being used to purchase health insurance that covers abortion. (Sec. 102(d)(1) and Sec. 103(b))

• Sunset of Essential Health Benefits Requirement for Medicaid: This provision states that, beginning in 2020, states no longer have to cover essential health benefits in their Medicaid alternative benefit plans. (Sec. 126(b))

• Funding for Cost-Sharing Subsidies: This section replicates current law by providing funding for the subsidies through 2019. (Sec. 208)

• Stabilizing the Individual Insurance Markets (“Six Month Lock Out”): This section imposes a six-month waiting period for individuals attempting to enroll in coverage in the individual market who cannot demonstrate that they have maintained continuous coverage. (Sec. 206)

• Medical Loss Ratio: This section allows states to determine how much insurers are allowed to spend on administration, marketing, and profits versus health care. (Sec. 205)

• Availability of Rollover Funds: This provision allows states that spend less than their targeted block grant amount to rollover funds to the following year and to use funds for nonhealth purposes, specifically repealing the provision of the Social Security Act that prohibits states from using Medicaid funds to build roads, bridges, and stadiums. (Sec. 134 –1903B(c)(2)(D)) (Note: this provision has been removed from the most recent draft).

• Decrease in Target Expenditures for Required Expenditures by Certain Political Subdivisions (“Buffalo Bailout”): This provision limits the ability of New York State to require counties other than New York City to contribute funding to the state’s Medicaid program. (Sec. 133 – 1903(c)(4))

• Grandfathering Certain Medicaid Waivers; Prioritization of HCBS Waivers: This section says that the Secretary will encourage states to adopt Medicaid Home and Community Based Services (HCBS) waivers but does not set forth any actual details for this plan. (Sec. 136)

• Reporting of CMS-64 Data (T-MSIS): This provision requires the Secretary of HHS to submit a report on Congress recommending whether expenditure data from the Transformed Medicaid Statistical Information System (T-MSIS) is preferable to data from state CMS-64
reports for making certain Medicaid decisions. (Sec. 133 – 1903(h)(5))