Tag Archives: ACA

Essential Facts About Health Reform Alternatives: Eliminating Cost-Sharing Reductions

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http://www.commonwealthfund.org/publications/explainers/2017/apr/cost-sharing-reductions?omnicid=EALERT1202020&mid=henrykotula@yahoo.com

How do cost-sharing reductions work?

Americans with low or moderate incomes can get their out-of-pocket health care expenses reduced if they have purchased a silver plan in the Affordable Care Act’s (ACA) health insurance marketplaces. The ACA’s cost-sharing reductions (CSRs) mean lower copayments and deductibles for people in households earning between 100 percent and 250 percent of the federal poverty level (about $12,000 to $30,000 for an individual, and about $24,000 to $60,750 for a family of four).1 The federal government reimburses insurers for providing the subsidies, which in 2016 totaled $7 billion.2

Those who use health care the most see the largest savings. A 2016 Commonwealth Fund analysis of marketplace plans in 38 big-city markets found that without CSRs, a 40-year-old man with a silver plan who is a high health care user and earns $35,000 a year—too much to qualify—might face up to $6,500 in out-of-pocket expenses.3 But for someone earning $17,000 who is also a high user of care, projected out-of-pocket spending would be no higher than $650—a savings of nearly $6,000 compared to the average silver plan. In other words, instead of potentially spending more than a third of his income on health care expenses, he spends no more than 3.8 percent of his income with CSRs.

What’s the backstory?

In 2017, 7 million people qualified for CSRs—58 percent of all marketplace enrollees.4 But the subsidies face challenges on several fronts. In 2014, Republicans in the U.S. House of Representatives sued the Obama administration, alleging that the U.S. Department of Health and Human Services’ payments to insurers were unlawful because Congress had not appropriated funds to pay for them.5 A May 2016 ruling by a federal judge in favor of the GOP would have stopped payment of the subsidies, but the Obama administration appealed. The case, now known as House v. Price, has been paused since the November election.

The Trump administration has indicated that, at least for now, it will continue making payments to insurers.6 And some congressional Republicans, wishing to preserve the subsidies, are willing to appropriate the necessary funds.7 However, the GOP’s recent health care reform proposal—the American Health Care Act—would eliminate cost-sharing reductions entirely.

How would eliminating cost-sharing reductions affect consumers?

If the Trump administration decides at some point to stop defending the lawsuit to end cost-sharing reductions and Congress fails to appropriate funds for them, payments to insurers would end. While insurers have signed contracts with federal and state regulators to offer health coverage, some might seek to terminate them early because of the loss of payments. Doing so would throw consumers off their coverage midyear.8

Insurance costs would rise as well, as companies opting to remain in the market would be forced to increase premiums to make up for the lost government payments. Analysts say that marketplace insurers across the country would likely raise premiums for silver plans by anywhere from 9 percent to 27 percent.9 This also would increase federal spending above what the CSRs cost, since higher premiums mean larger premium tax credits.10

How would eliminating cost-sharing reductions affect insurance markets?

Eliminating cost-sharing reductions could destabilize insurance markets. The insurers relying most heavily on cost-sharing reduction payments could see their current 7 percent profit margins turn into 25 percent losses, on average.11 Since marketplace insurers would need to substantially raise premiums, there is a risk of further market instability as healthy individuals earning too much to be eligible for the ACA’s tax credits decide to drop out of the market entirely.12

Given the magnitude of their prospective losses, many insurance companies may opt to exit the ACA marketplaces altogether. Ending the cost-sharing reductions also would discourage insurers from participating in future years. Carriers must decide before June 21, 2017, whether they will sell plans on the marketplaces in 2018. Uncertainty surrounding the payment of cost-sharing reductions is already dissuading some insurers from participating.13

Ultimately, insurers might sue the federal government to recover cost-sharing reduction payments promised under the ACA. Such litigation would be expensive and time-consuming, with the legal costs likely passed on to consumers in the form of higher premiums and out-of-pocket costs.14

What’s in the GOP’s latest deal to repeal Obamacare

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http://www.politico.com/tipsheets/politico-pulse/2017/04/whats-in-the-gops-latest-deal-to-repeal-obamacare-219988

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It’s here: Republicans’ latest Obamacare repeal-and-replace proposal dropped last night, as top House conservatives and a prominent moderate try to jump-start the stalled American Health Care Act.

WHAT’S IN REPUBLICANS’ LATEST DEAL — The eight-page amendment to the AHCA, which was hammered out by House Freedom Caucus Chairman Mark Meadows and Tuesday Group Co-Chair Tom MacArthur and scooped by POLITICO on Tuesday night, would allow states to opt out of Obamacare’s regulations on essential health benefits, community rating requirements and how much older Americans are charged for coverage.

It also would permit states to reject the continuous coverage provision that Republicans have proposed in their replacement bill. See the legislative text.

House Republicans exempted themselves from the proposal, Vox’s Sarah Kliff flagged first.

WHAT STATES WOULD NEED TO DO TO OPT OUT — Frankly, not that much. The amendment says that states would need to propose at least one of the following five to receive a waiver from HHS:

1) Reduce average premiums for coverage
2) Increase enrollment
3) Stabilize the market
4) Stabilize premiums for individuals with pre-existing conditions
5) Increase the choice of health plans

Based on the waiver, states also would have to set up a high-risk pool, presumably to push back on expected criticisms that the GOP plan would harm the sickest patients.

THE PRACTICAL IMPLICATIONS — The amendment dismantles major elements of the ACA that Republicans’ previous proposal would’ve kept, which had been a sticking point for wary conservatives. But cutting those protections means that even more Americans stand to lose coverage, which was already a no-go for many moderates.

Notably, the Congressional Budget Office projected last month that Republicans’ bill would result in 24 million fewer Americans having coverage in a decade. That number would likely increase under this amendment, a former CBO analyst told PULSE.

Expect quick reaction on the proposal: Both the Tuesday Group and the Freedom Caucus have meetings with their members today. But ahead of that …

 

The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments

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The Effects of Ending the Affordable Care Act’s Cost-Sharing Reduction Payments

Controversy has emerged recently over federal payments to insurers under the Affordable Care Act (ACA) related to cost-sharing reductions for low-income enrollees in the ACA’s marketplaces.

The ACA requires insurers to offer plans with reduced patient cost-sharing (e.g., deductibles and copays) to marketplace enrollees with incomes 100-250% of the poverty level. The reduced cost-sharing is only available in silver-level plans, and the premiums are the same as standard silver plans.

To compensate for the added cost to insurers of the reduced cost-sharing, the federal governments makes payments directly to insurance companies. The Congressional Budget Office (CBO) estimates the cost of these payments at $7 billion in fiscal year 2017, rising to $10 billion in 2018 and $16 billion by 2027.

The U.S. House of Representatives sued the Secretary of the U.S. Department of Health and Human Services under the Obama Administration, challenging the legality of making the cost-sharing reduction (CSR) payments without an explicit appropriation. A district court judge has ruled in favor of the House, but the ruling was appealed by the Secretary and the payments were permitted to continue pending the appeal. The case is currently in abeyance, with status reports required every three months, starting May 22, 2017.

If the CSR payments end – either through a court order or through a unilateral decision by the Trump Administration, assuming the payments are not explicitly authorized in an appropriation by Congress – insurers would face significant revenue shortfalls this year and next.

Many insurers might react to the end of subsidy payments by exiting the ACA marketplaces. If insurers choose to remain in the marketplaces, they would need to raise premiums to offset the loss of the payments.

We have previously estimated that insurers would need to raise silver premiums by about 19% on average to compensate for the loss of CSR payments. Our assumption is that insurers would only increase silver premiums (if allowed to do so by regulators), since those are the only plans where cost-sharing reductions are available. The premium increases would be higher in states that have not expanded Medicaid (and lower in states that have), since there are a large number of marketplace enrollees in those states with incomes 100-138% of poverty who qualify for the largest cost-sharing reductions.

There would be a significant amount of uncertainty for insurers in setting premiums to offset the cost of cost-sharing reductions. For example, they would need to anticipate what share of enrollees in silver plans would be receiving reduced cost-sharing and at what level. Under a worst case scenario – where only people eligible for sharing reductions enrolled in silver plans – the required premium increase would be higher than 19%, and many insurers might request bigger rate hikes.

 

 

GOP senators not so keen on House’s Obamacare repeal

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http://www.politico.com/story/2017/04/27/senate-republicans-obamacare-repeal-237656

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The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured.

The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.

Not to mention that some Senate conservatives still seem opposed to the emerging House deal.

“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”

Phil Novack, a spokesman for Sen. Ted Cruz , also indicated that the conservative Texas firebrand isn’t sold, saying “significant work remains” in the Senate, “specifically to address Obamacare’s insurance mandates and enact major patient-centered reforms that will further reduce the cost of health care.”

Sources say it may take more than a month for any House health care bill to run through the traps in the Senate, including internal party discussions and an analysis of how the measure would affect the deficit and insurance rolls. No committee hearings are planned because Republicans don’t want to give Democrats a public forum to bash an effort they are not involved in. And similar to the Senate’s dim view of the House’s proposal, the lower chamber may not ultimately be able to pass whatever the Senate is able to produce on Obamacare.

Plus, a procedural rift is beginning to emerge within the GOP, with several Republicans questioning whether reconciliation — the fast-track legislative process that circumvents a filibuster, and thus the need for Democratic support — is even the best avenue for health care overhaul efforts.

Few Senate Republicans are currently engaged in the health care efforts. Several GOP senators declined Wednesday to wade in to the specifics of the revised plan drafted by Rep. Tom MacArthur (R-N.J.) and Freedom Caucus Chairman Mark Meadows (R-N.C.), taking pains to note that senators will probably have to rewrite it anyway.

“It isn’t discussed a lot over here,” said Sen. Chuck Grassley (R-Iowa). “Except for the hard work of [Susan] Collins and [Bill] Cassidy, there’s hardly anything being done.”

Senate Majority Whip John Cornyn (R-Texas), the party’s chief vote counter, also downplayed any notion that the new House version of an Obamacare replacement will sail through the Senate intact.

“Once they pass a bill, my assumption is, the Senate’s going to take a look at it but not necessarily be rubber-stamping what they’re proposing,” Cornyn said. “So I would anticipate that we’ll do what we used to do all the time which is, the House will pass a bill, we’ll pass a bill and then we’ll reconcile those in a conference committee.”

Weeks after the spectacular collapse of Obamacare repeal efforts last month, MacArthur and Meadows struck a deal with new language that would allow states to opt out of several key Obamacare provisions, such as its ban on charging sick people higher premiums and the so-called essential health benefits mandate that requires insurers to provide a set of minimum benefits.

The new language was enough to earn the formal endorsement of the Freedom Caucus, but House moderates who were opposed to the previous plan remain wary of backing a proposal that could cause constituents with pre-existing conditions to lose affordable health care coverage. In fact, the new plan may be having the reverse effect on some centrists: Rep. Mike Coffman (R-Colo.) had supported the initial Obamacare replacement but now says he’s a “maybe.”

Influential Senate Republicans also raised doubts about whether the new House proposal is workable.

What individual insurance market trends mean for providers

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http://www.fiercehealthcare.com/finance/implications-individual-insurance-market-trends-for-providers?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWTJFNU1EQm1aREUyWW1FMSIsInQiOiJlVnd2K1hXVFcwN1wvUTMzTGpkR1lxV3huNGNnXC9IN2c2eEpxNFZBTDBuWmtIR1wvV0RSQXpBOFJnbEs1cHB0UUJJcEFKQnhhYUQ4UDcxNUxTZldTekNBalJMeGpDcWVZa2lpdVJxTHJVZSs5TmRvMWVqSGl0N1V2OUV4azBcL2R3M2QifQ%3D%3D

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Amid uncertainty about the future of healthcare reform, hospitals and health systems must be aware of and prepare for the potential challenges posed by the individual health insurance marketplaces.

Costs in the individual marketplaces have been volatile, so one way providers can support patients who have those plans is to understand the total costs associated with treating them, writes Paul Keckley, Ph.D., health policy analyst and editor of the Keckley Report, in an article for Hospitals & Health Networks.

Until now, much of the discussion from the provider side on the future of healthcare reform has centered on proposed changes to Medicaid. States that expanded Medicaid saw uncompensated care costs drop significantly, and provider groups largely came out against Republican efforts to repeal and replace the Affordable Care Act as well as proposed sweeping cuts to Medicaid.

But, Keckley writes, providers need to monitor trends in the individual market as well, which may result in more problems for them. For example, higher copays and deductibles may put preventive care, including key tests and screenings, out of reach for this patient population. Furthermore, the individual market is likely to grow as more employers push responsibility for insurance costs on employees, which in turn could push more costs of care onto providers.

“Hospitals must prepare for two realities: The individual market will grow, and the risks associated with its management will be challenging,” according to Keckley.

One solution that some hospitals are considering is to offer sponsored health plans that target individual market enrollees. But this could backfire, Keckley writes, as premiums will likely increase significantly. Just because a big hospital name is on the plan, that doesn’t mean it will attract more enrollees if premiums are too high to draw interest. Instead, he suggests providers engage in greater advocacy on these issues with state and local leaders.

 

S&P report: ACA individual market is fragile, but not in a ‘death spiral’

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http://www.fiercehealthcare.com/aca/s-p-report-aca-individual-market-fragile-but-no-death-spiral

Wall Street

Based on 2016 results and enrollment so far in 2017, the Affordable Care Act’s individual market is not in a “death spiral” as some have claimed—but it also isn’t on very stable footing, according to a new report from Wall Street analysts.

The report, from the ratings agency Standard & Poor’s, noted that 2016 brought the first signs that the ACA’s marketplaces could be manageable for insurers after a rough 2014 and 2015.

For example, the weighted average of the medical loss ratios of Blue Cross Blue Shield plans included in the analysts’ study dipped below 100% for the first time last year. That’s a positive sign, but insurers with MLRs above 90% still generally face an underwriting loss after factoring in administrative costs, suggesting more room for improvement.

This year, the analysts believe that meaningful premium increases, product and network changes, as well as “regulatory fine-tuning” of ACA rules, will get insurers closer to breaking even. But it will take another year or two of improvements for most to get to their target profitability levels.

Notably, the premium hikes insurers put in place didn’t result in a major drop in enrollment—and potential death spiral—the analysts wrote. In fact, open-enrollment signups dropped only slightly from 2016 to 2017, in part because the ACA’s subsidies increase along with premiums.

Looking ahead, the analysts expect premiums to rise in 2018, but “at a far lower clip” than they did this year. If the ACA’s rules stay largely intact, they predict low-single-digit growth in individual market membership next year, with most counties continuing to have at least one insurer. Recent insurer exits, however, might leave certain counties with no options on the exchanges.

But the analysts note that their predictions for the rest of this year and 2018 won’t hold if there is a major legislative overhaul of the marketplaces, like an ACA repeal. In addition, much depends on whether insurers will get clarification about cost-sharing subsidies, and whether the Trump administration will continue to conduct enrollment outreach and enforce the individual mandate.

The market still needs time to mature, the report argues, and “every time something new (and potentially disruptive) is thrown into the works, it impedes the individual market’s path to stability.”

What You Need to Know About High-Risk Insurance Pools

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http://time.com/money/4748384/high-risk-insurance-pools/?xid=homepage

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High-risk health insurance pools are back in the news after it was reported House Republicans are considering making them a component of their plan to repeal and replace the Affordable Care Act.

The GOP is toying with the idea of allowing states to seek a waiver to the ACA’s prohibition on charging sick people higher premiums if the states set up high-risk pools. Insurers would still be prohibited from denying people coverage outright, but they would be able to jack up premiums for people with a range of conditions and illnesses, effectively pricing them out of the individual market. Instead, people with pre-existing conditions—which ran the gamut, from cancer to high blood pressure, in the pre-ACA days—would be segregated into “high-risk pools.”

Many states had these pools in place before the passage of the ACA, and research showed that they did not keep costs down. So what exactly are high-risk pools, and why didn’t they work before? Here’s what you need to know.

5 Things to Know About Health That Could Shut Down the Government

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http://www.realclearhealth.com/articles/2017/04/26/5_things_to_know_about_health_that_could_shut_down_the_government_110565.html?utm_source=RC+Health+Morning+Scan&utm_campaign=5d3df6bbc3-EMAIL_CAMPAIGN_2017_04_26&utm_medium=email&utm_term=0_b4baf6b587-5d3df6bbc3-84752421

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Congress must pass a bill this week to keep most of the government running beyond Friday, when a government spending bill runs out. It won’t be easy.

The debate over a new spending bill focuses on an esoteric issue affecting the Affordable Care Act.

The question is whether Congress will pass — and President Donald Trump will sign — a bill that also funds subsidies for lower-income people who purchase health insurance under the law. These “cost-sharing reductions” (CSR) have become a major bargaining point in the negotiations between Republicans and Democrats, because the spending bill will require at least some Democratic votes to pass.

Here are five things to know about these cost-sharing subsidies:

How are these subsidies different from the help people get to purchase insurance?

There are two types of financial aid for people who buy insurance from an ACA exchange. People with incomes up to four times the poverty line, or $81,680 for a family of three, are eligible for tax credits to help pay their premiums.

In addition to that help, people with incomes up to two-and-a-half times the poverty line, or $51,050 for a family of three, get additional subsidies to help pay their out-of-pocket costs, including deductibles and copayments for care, as long as they purchase a silver-level plan. Insurance companies are required in their contracts with the government to provide these cost-sharing reductions to eligible people, then get reimbursed by the government.

Why are cost-sharing reductions suddenly front and center?

The fight dates to 2014, when Republicans in the House of Representatives filed suit against the Obama administration, charging that Congress had not specifically appropriated money for the cost-sharing subsidies and therefore the administration was providing the funding illegally.

A year ago, a federal district court judge ruled that the House was correct and ordered the payments stopped. However, she put that ruling on hold while the Obama administration appealed. That’s where things stood when Trump was inaugurated.

If the Trump administration drops the appeal, the funding would cease. However, Congress could also opt to approve funding the payments, which is what Democrats are pushing in the spending bill.

What would happen if these subsidies are stopped?

First, Do No Harm to Patients With Pre-Existing Conditions

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http://www.realclearhealth.com/articles/2017/04/26/first_do_no_harm_to_patients_with_pre-existing_conditions__110567.html?utm_source=RC+Health+Morning+Scan&utm_campaign=5d3df6bbc3-EMAIL_CAMPAIGN_2017_04_26&utm_medium=email&utm_term=0_b4baf6b587-5d3df6bbc3-84752421

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The recent U.S. House decision to pull the first iteration of the American Health Care Act (AHCA) off the floor doesn’t necessarily mean efforts to reform health care are at an end. As members of Congress work to develop legislation that will change the current health care system, they must develop policy that ensures people with pre-existing conditions will receive coverage without additional costs in premiums, deductibles or coinsurance for their pre-existing condition.

As it stands, the Affordable Care Act (ACA) prohibits insurers from denying coverage to Americans with pre-existing conditions – no matter how severe or costly their medical care might be. Had the AHCA passed, a new provision would have required that patients with pre-existing conditions maintain continuous coverage without a lapse of more than 63 days.

Theoretically, this provision should ensure all Americans have constant coverage. In reality, however, it’s possible many patients with pre-existing conditions would have difficulty meeting this requirement. For starters, many individuals with chronic conditions, such as spina bifida or sickle cell disease, often earn lower incomes precisely because of their medical needs – which in turn makes it difficult for them to afford meaningful insurance that covers their care. Further, millions of sick patients with chronic diseases rely on Medicaid for coverage. Any health reform legislation must ensure that these patients don’t lose coverage altogether by 2020.

These changes could inflict grave harm on Americans. A recent report from the Department of Health and Human Services estimates that anywhere from 61 million to 133 million non-elderly Americans have pre-existing conditions. All of these Americans could have been denied coverage, or offered coverage at extraordinarily steep prices, had they needed to shop for individual health insurance before 2014, when the ACA’s coverage provisions went into effect. In fact, between 2010 and 2014, the number of uninsured Americans with pre-existing conditions fell by 22 percent – a clear sign of the impact of the ACA’s market reforms.

The ACA is not perfect. Changes such as reducing prescription costs, addressing cost barriers created by high deductible plans and reducing unnecessary administrative burdens on physicians and patients would improve the law.

However, the current law’s provisions like the ban on discriminating against Americans with pre-existing conditions have led to an historically low number of uninsured Americans – estimated at 8.9 percent last November. In turn, that coverage, combined with access to primary physicians, leads to more timely prevention and treatment of disease and, ultimately, improved public health for all Americans.

Family physicians serve on the front lines of our health care system, and we know how important it is that chronically ill patients receive the care the need to get healthy. We have witnessed firsthand the positive effects of the ACA’s prohibition on discriminating against Americans with pre-existing conditions, and we urge our leaders in Washington – both in Congress and in the administration – to continue to protect them.

Moderates mum on repeal bill changes that would strip consumer protections

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http://www.politico.com/story/2017/04/24/obamacare-repeal-consumer-protections-237541

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While hardline House conservatives are falling in line behind the latest Republican Obamacare repeal bill, there’s ominous silence from most moderates whose support is also essential to getting the measure passed in the House.

The latest version would allow states to opt out of several key Obamacare protections, allowing insurers to charge older and sicker people more than younger and healthier people, according to a summary obtained by POLITICO. So far, none of the moderates who opposed an earlier repeal bill have publicly committed to supporting the latest version.

“This amendment doesn’t do anything to change my position on the health care bill,” said Rep. Charlie Dent (R-Pa.), who co-chairs the centrist Tuesday Group. “This amendment seems too much about meeting an artificial 100-day timeline,” he added, referring to President Donald Trump’s upcoming milestone date.

A proposal from Tom MacArthur (R-N.J.), and negotiated with the leader of the Freedom Caucus, would allow states to decline to require insurers to offer a minimum set of benefits and provisions allowing health plans to charge people more based on their age and health status. States can also opt out of enforcing a 30 percent surcharge for people who don’t maintain insurance coverage, according to a brief update sent to Energy and Commerce members.

The legislative text had been expected over the weekend. But the House has no plans to take up a repeal measure this week, despite the White House’s urging last week to do so. Republicans are expected to remain focused on funding the government past a Friday deadline for a new spending bill, with Obamacare repeal discussions likely continuing in the background. Members of the Freedom Caucus are expected to review the legislation together on Tuesday or Wednesday.

So far, moderates have largely remained mum on the latest changes to the repeal bill. Several moderates who opposed the bill said Monday through spokespersons that they hadn’t yet seen the legislative text.

“That hurts any timeline of [a vote] this week or next week,” said an aide to one lawmaker.

MacArthur is one of three co-chairmen of the Tuesday Group. At least some of the group of moderate Republicans would have to support the repeal bill if it has any chance of getting through the House.

“It’s our party, frankly, that has to get together and really realize sometimes you can’t vote for a perfect bill,” Rep. Adam Kinzinger (R-Ill.) said. “We need to work together, and that’s a learning process, I think, for Republicans in the House right now.”

MacArthur spent the congressional recess negotiating the deal directly with Freedom Caucus Chairman Mark Meadows (R-N.C.), leaving the Tuesday Group largely out of the loop. Indeed, some members had not seen any of the proposal’s details until drafts of the amendment were leaked out through the press.

States would be allowed to opt out of several of Obamacare’s consumer protections as long as they have set up high-risk pools, where consumers with costly medical expenditures would presumably be able to get coverage.

The waivers would strongly encourage people to maintain continuous coverage — even more than prior versions of the Republican repeal bill. In states that get a waiver, people who don’t stay insured can be charged more for insurance policies based on their health status.

The latest changes appear to preserve Obamacare’s requirement that insurers accept anyone regardless of their pre-existing conditions. But critics of the repeal bill argue that allowing insurers to charge sicker people more could in effect shut out those individuals because insurers will be able to charge whatever they want.

Under the Affordable Care Act, insurers had to charge sick and healthy consumers the same, with only a limited number of exceptions, including for age and tobacco use.

And with the House set to return to Washington on Tuesday, members of the Tuesday Group said there hasn’t been any coordination aimed at building support for the changes.

“Mr. LoBiondo has tweeted his thoughts thus far on the discussion — nothing additional to add at this point,” said an aide to Frank LoBiondo (R-N.J.), who tweeted Friday he’ll continue to oppose the bill. “I’m sure Politico will have any copy of the legislative text before members do.”