Weekend update

Following up on Friday afternoon’s post, here’s a link to the House-Senate conference report on the Tax Cuts and Jobs Act, H.R. 1, which was released late Friday afternoon. The report starts out with the final statutory language which is followed by an explanation which breaks down each provision into current law, House version, Senate version, and Conference agreement.

In terms of healthcare, the noteworthy change is that the law will zero out the Affordable Care Act’s individual shared responsibility mandate effective January 1, 2019.  See Conference Report at 153. The Washington Post has a fair analysis of this change here.

As the Washington Post report explains the ACA’s tax penalty for failing to carry minimum essential coverage falls principally on lower income people who are eligible for ACA premium and cost sharing subsidies or perhaps even Medicaid. When this change takes effect in 2019, the ACA marketplace will work like the FEHBP did from 1960 to 2013 — no pre-existing condition limitations, annual open season, and eligible people who fail to enroll during the Open Season cannot enroll until the next Open Season except in the event of a special enrollment event. No mandate.

A tax law change that marginally affects the FEHBP is Congress’s decision to base tax law inflation adjustments, such as health saving account maximum annual deposits, on the Bureau of Labor Statistic’s chained consumer price index for urban consumers instead of the regular CPI-U.  Bloomberg provides background on the chained CPI-U here.

The House and Senate are expected to approve H.R. 1 this week and to extend the current continuing resolution funding the federal government into January. Then Congress will take a break until the new year which is only two weeks or so away. Here’s a link the The Week in Congress’s report on other Capitol Hill actions that occurred last week.

On Thursday, the Office of Management and Budget (“OMB”) issued its Fall 2017 unified federal regulatory agenda. The unified agenda provides an update on each federal department and agency’s regulatory plans. Here’s a link to OPM’s plans.  OMB reports that

The Agenda represents ongoing progress toward the goals of more effective and less burdensome regulation and includes the following developments:

  • Better than 2:1 – Agencies plan to finalize three deregulatory actions for every new regulatory action in FY2018.
  • 1579 Withdrawn or Delayed Actions – Agencies continue to eliminate, delay, or streamline regulatory actions in the pipeline. In this Administration, agencies withdrew or delayed 1579 planned regulatory actions, reflecting all such changes from Fall 2016 to Fall 2017.

Unfortunately, the FEHBP, in the FEHBlog’s view, has not seen any reduction in regulatory burden this year. The FEHBlog attributes this to the problems encountered in installing new political leadership at the agency.

In other news,

  • Healthcare Finance News reports that Cigna has purchased a digital health startup called Brighter.
  • The United Health Foundation, which United Healthcare created, updated for 2017 it annual report on America’s health rankings.  The report ranks the states based on the health of their populations. 
  • The Blue Cross Blue Shield Association released a Moody’s Analytics report on understanding health conditions across the U.S.   

The report [which is based on the BCBS Health Index] shows that social determinants of health drive larger differences in the impacts for common chronic conditions such as hypertension, diabetes and coronary artery disease. In addition, the analysis shows these determinants drive smaller differences in the impact of other conditions such as cancer, substance use disorder and mental health, which are influenced more by individual factors such as family health history and personal lifestyle choices. The analysis also shows that relative to broader social determinants, differences in local health care system characteristics have a more modest association with the health impact of disease on a community’s commercially insured population.