August 2, 2013
As Congress heads into its August District Work Period, the Affordable Care Act (ACA) continues to be an issue of considerable partisan dispute. The House voted today for the 40th time to repeal the ACA on a partisan vote with the support of Congressional Republicans. H.R. 2009, the bill voted on, would prohibit enforcement of the ACA by the IRS. The bill passed 232 -- 185 along partisan lines (with 4 Democrats -- Reps. Barrow (D-GA), Matheson (D-UT), McIntyre (D-NC) and Peterson (D-MN) -- crossing lines to vote in favor and 16 Members not voting). The roll call vote (no. 447) can be found here. Additional anti-ACA votes may take place before the end of the day.
Despite these actions, the Democratic-majority Senate will not hold a similar vote to defund the ACA. Additional conservative hostility to the ACA emerged in the Senate when Senator Ted Cruz (R-TX) stated that appropriations negotiations centered on funding the government by its October 1st deadline were the final opportunity to derail the act before it became a "permanent feature of the American economy." Although Senator Cruz called for a government shutdown if the ACA was not defunded, he was only able to attract 12 Republican Senators to sign a letter to Senate Majority Leader Harry Reid (D-NV) stating that they would actually vote against an appropriations bill. It should be noted that a larger group of 66 House Republicans (28% of the 234 Republican Members of the House) sent a similar letter to Speaker John Boehner (R-OH).
Despite the ongoing political pressure, the law is unlikely to be overturned as long as Mr. Obama is the President. For its part, the administration and its allies are engaged in efforts to roll out the ACA and to enroll as many people as possible in plans in the state marketplaces. Enroll America, a 501(C)(3) organization launched by national health, insurance and pharmaceutical groups, has created a new campaign to convince people to join the insurance marketplaces after enrollment begins on October 1st.
As implementation nears, the Health Resources Service Administration (HRSA) yesterday released policy clarifications regarding several issues related to the interaction of the Ryan White Program with the ACA, notably on payer of last resort rules, use of Ryan White Program funds for premiums and cost-sharing for Medicaid and private insurance in the market place, and eligibility for private insurance and post-implementation issues. HRSA will be offering a technical assistance webinar regarding the new policy guidance, "Preparing for 2014: Overview of Ryan White Program Policy Updates & Guidance" on August 14th at 2:30 p.m. Eastern time. Additional information can be found on HRSA's website about the interaction between the Ryan White Program and ACA, which is steadily gaining content and worth reviewing.
No matter what happens over the summer, the implementation is around the corner and will likely be a lot of work for the HIV community. We must ensure that people with HIV, including those not yet diagnosed, are able to easily access and enroll in Medicaid or private insurance in the new marketplace, that the services provided cover all needed drugs and medical visits, that the Ryan White Program helps to complete coverage for premium and cost-sharing payments, and that the Ryan White Program continues its important function in helping people to actually use their coverage including adherence services that help people to reach an undetectable viral load. This is a tall task and likely to remain the work of the HIV community for many years. So don't forget to meet with your Members of Congress!
The HRSA policy clarifications can be found here: