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RSC budget revives conservative health priorities

Mar 20, 2024
Illustration of a medical red cross under spotlights on a stage.

Illustration: Annelise Capossela/Axios

The Republican Study Committee today laid out a budget proposal that suggests a health policy blueprint if the GOP controls the White House and at least one chamber of Congress next year.

Why it matters: While it's largely symbolic, the RSC counts the majority of House Republicans as members, giving extra heft to priorities like repealing Medicare drug price negotiations, implementing block grants in Medicaid and imposing site-neutral hospital payment policies.

  • It also newly includes reforms across all areas to balance the budget in seven years.

What's inside: The health care section not only calls for killing the Inflation Reduction Act and its drug price provisions but would also strike enhanced ACA exchange subsidies that are due to expire at the end of 2025.

  • Some have speculated that the subsidies could be a bargaining chip in a divided government and could be extended in exchange for an extension of tax cuts that are also due to expire next year.
  • The RSC document also calls for codifying two Trump administration rules on expanding association health plans and individual coverage health reimbursement arrangements.
  • Bills that would codify ICHRAs and loosen requirements on AHPs already passed out of the House on party line votes last year.
  • As in years past, it calls for Medicare premium support and giving private insurers a bigger role competing with traditional Medicare. But it notably doesn't mention raising the Medicare eligibility age.

The policy document also endorses reforming the 340B discount drug program to ensure that savings "go where intended," but doesn't elaborate on how that policy should be implemented.

  • It would eliminate the ban on physician-owned hospitals, noting how the ban increased hospital consolidation.
  • It would remove many of the Affordable Care Act's protections for pre-existing conditions, in what it says is an attempt to incentivize insurers to issue lower premiums for younger, healthier people.
  • People with high-risk medical conditions would still have access to coverage through state-run guaranteed coverage pools, with states having the final say on how much insurers can weigh the health risks for determining premiums.
  • It again backs block grants in Medicaid and CHIP, but would create five different block grants for groups such as low-income children, the elderly, pregnant women and for the guaranteed coverage pools.
  • And it calls for implementation of site-neutral payment policies for Medicare outpatient care.

What they're saying: "The RSC Budget does not cut benefits or raise premiums for Medicare beneficiaries," RSC chairman Kevin Hern said in a statement. "We make plans to compete for their seniors' hard-earned money and find other savings that have nothing to do with premiums or benefits."

Context: The House Budget Committee already approved a FY2025 budget resolution earlier this month. It balances the budget in 10 years and re-ups ideas on addressing Medicare solvency issues and implementing Medicaid work requirements.

The big picture: These budgets are among the raft of measures that are aimed at helping to write a health care script for a potential new GOP administration.

  • It's still much too early to tell what a second-term President Trump would actually pursue, though he's recently reiterated his call for repealing the ACA.
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