Tag Archives: Individual Mandate

UPDATE: CMS seeks expansion of short-term plans to sidestep ACA

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https://www.healthcaredive.com/news/cms-seeks-expansion-of-aca-skirting-short-term-plans/517399/

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Dive Brief:

  • HHS issued a proposed rule on Tuesday that expands the availability of short-term health insurance by allowing the purchase of plans providing coverage for up to 12 months, the latest in the Trump administration’s plans to weaken the Affordable Care Act. The action builds off a request for information by HHS last June on ways to increase affordability of health insurance.
  • The current maximum period for such plans is less than three months, a change made by the Obama administration in 2016. The proposed rule would mark a return to the pre-2016 era, but CMS noted that it is seeking comment on offering short-term plans for periods longer than 12 months.
  • Short-term plans are not required to comply with federal rules for individual health insurance under the ACA, so the plans could charge more for those with preexisting conditions and not provide what the ACA deemed essential health benefits like maternity care.

Dive Insight:

The proposed rule builds off of an executive order President Donald Trump signed in October, which instructed the federal government to explore more access to association health plans, expanding short-term limited duration plans and changes to health reimbursement arrangements or HRAs.

Consumers buying these short-terms plans could lose access to certain healthcare services and providers and experience an increase in out-of-pocket expenditures for some patients, according to the proposal.

The short-term plans “would be unlikely to include all the elements of ACA-compliant plans, such as the preexisting condition exclusion prohibition, coverage of essential health benefits without annual or lifetime dollar limits, preventive care, maternity and prescription drug coverage, rating restrictions and guaranteed renewability,” according to the proposed rule.

The Trump administration argues that expanding access to short-term plans is increasingly important due to rising premiums in the individual markets.

But if young and healthy people leave the individual market for short-term plans, it could contribute to an unbalanced risk pool. HHS itself states that the exodus of young and healthy exchange members could contribute to rising premiums within the ACA exchange markets.

“If individual market single risk pools change as a result, it would result in an increase in premiums for the individuals remaining in those risk pools,” the proposed rule stated.

But when asked about concerns that the idea might hurt the stability of the ACA marketplaces by siphoning healthy people away, CMS Administrator Seema Verma argued there would be little impact.

“No, we don’t think there’s any validity to that — based on our projections only a very small number of healthy people will shift from the individual market to these short-term limited duration plans. Specifically, we estimate that only 100,000 to 200,000 people will shift. And this shift will have will have virtually no impact on the individual market premiums,” Verma said on a press call.

But the insurance lobby cautioned that the action could increase insurance prices for the most vulnerable.

The American Hospital Association and Association for Community Affiliated Plans also slammed the short-term plans, saying they would increase the cost of comprehensive coverage.

“Short-term, limited-duration health plans have a role for consumers who experience gaps in coverage. They are not unlike the small spare tire in a car: they get the job done for short periods of time, but they have severe limitations and you’ll get in trouble if you drive too fast on them,” ACAP CEO Margaret Murray said in a statement.

“While we are reviewing the proposed rule to understand its impact on the people we serve, we remain concerned that expanded use of short-term policies could further fragment the individual market, which would lead to higher premiums for many consumers, particularly those with pre-existing conditions,” said Kristine Grow, SVP of communications at America’s Health Insurance Plans.

HHS anticipates most individuals switching from individual market plans to short-term coverage plans would be relatively young or healthy and not eligible to receive ACA’s premium tax credits.

CMS said the proposal is one to help the 28 million Americans without health insurance, pointing to the 6.7 million who chose to pay the individual mandate penalty in 2015 as evidence that ACA-compliant plans are too expensive.

“In a market that is experiencing double-digit rate increases, allowing short-term, limited-duration insurance to cover longer periods gives Americans options and could be the difference between someone getting coverage or going without coverage at all,” Verma said in a statement.

Senate HELP Committee Chair Lamar Alexander, R-Tenn., praised the action, but cautioned that states still have a responsibility to protect consumers.

“Millions of Americans who are between jobs and who pay for their own insurance will welcome this extended option for lower-cost, short-term policies. States will have the responsibility for making sure these policies benefit consumers,” Alexander said in a statement.

Democrats largely oppose the move, arguing it will further destabilize the market for millions of Americans in the ACA exchanges. “Widespread marketing of these bare bones, junk plans will further destabilize health insurance markets, and will lead to higher premiums for everyone,” a group of House Democrats said in a joint statement.

As Republicans are not likely to take up ACA repeal again any time soon, the Trump administration has been working to pare back the law in the past several months. It halved the enrollment period and stopped paying cost-sharing reduction payments to insurers. Also, the recent tax overhaul included a repeal of the law’s requirement that most people have coverage.

KHN’s ‘What The Health?’ What Do The Budget, Idaho And FDA Chief Scott Gottlieb Have In Common?

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President Donald Trump released his first full budget proposal this week, with many recommended cuts and some major changes to health programs. But Congress has already agreed on most spending levels for next year, so this budget is even more likely to be ignored than a typical presidential budget plan.

Meanwhile, states are trying to cope with last year’s changes to the Affordable Care Act in very different ways. Several states, mostly led by Democrats, are considering whether to set penalties for people who don’t have insurance — a provision of the ACA that Congress repealed in December. Idaho, meanwhile, is offering to let insurers sell plans that don’t cover the ACA’s required set of benefits and discriminate against people with preexisting health conditions.

Plus, Scott Gottlieb, commissioner of the Food and Drug Administration, talks about getting generic drugs to market faster and how the agency is working with Congress on ways to help patients with terminal illnesses get easier access to experimental treatments.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Paige Winfield Cunningham of The Washington Post and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s podcast:

  • Even though few of the proposals in Trump’s budget are likely to be enacted, it does lay down some important markers for the administration. Those include backing sweeping changes to Medicaid and eliminating many of the ACA’s coverage requirements.
  •  Blue states considering stepping into the void left by Congress’ repeal of the individual insurance mandate penalties have limited time to act. Insurers start making decisions about whether to participate in the individual market in the spring.
  • The FDA’s Gottlieb tells Rovner and KHN’s Sarah Jane Tribble he expects there will be a compromise on Capitol Hill on “right-to-try” legislation that would make it easier for patients with terminal illnesses to gain access to experimental therapies.
  • Idaho is moving forward on its plan to allow insurers to offer policies that do not comply with the requirements of the Affordable Care Act. On Capitol Hill this week, Health and Human Services Secretary Alex Azar would not say whether the federal government will step up to stop them.

What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013–2016

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http://www.commonwealthfund.org/publications/issue-briefs/2017/dec/states-progress-health-coverage-and-access

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Abstract

  • Issue: Given uncertainty about the future of the Affordable Care Act, it is useful to examine the progress in coverage and access made under the law.
  • Goal: Compare state trends in access to affordable health care between 2013 and 2016.
  • Methods: Analysis of recent data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System.
  • Findings and Conclusions: Between 2013 and 2016, the uninsured rate for adults ages 19 to 64 declined in all states and the District of Columbia, and fell by at least 5 percentage points in 47 states. Among children, uninsured rates declined by at least 2 percentage points in 33 states. There were reductions of at least 2 percentage points in the share of adults age 18 and older who reported skipping care because of costs in the past year in 36 states and D.C., with greater declines, on average, in Medicaid expansion states. The share of at-risk adults without a recent routine checkup, and of nonelderly individuals who spent a high portion of income on medical care, declined in at least of half of states and D.C. These findings offer evidence that the ACA has improved access to health care for millions of Americans. However, actions at the federal level — including a shortened open enrollment period for marketplace coverage, a failure to extend CHIP funding, and a potential repeal of the individual mandate’s penalties — could jeopardize the gains made to date.

Background

The year 2017 marked a turning point in the implementation of the Affordable Care Act. Republicans in Congress attempted to repeal and replace the Affordable Care Act numerous times, ultimately failing but promising to try again. In addition, the Trump administration significantly cut funding for outreach and enrollment activities during 2018’s open enrollment period for the marketplaces, and disrupted markets by declining to pay insurers money owed to them for providing cost-reduced plans for lower-income enrollees. In December, Senate Republicans passed a tax bill that included a provision to repeal the ACA’s individual mandate penalties, paid by most people who do not have health insurance. Given these developments, many Americans are confused about the ACA’s status, which could reduce the number of people who enroll in health plans for the coming year, despite strong enrollment thus far.

It is useful to assess the changes in coverage and access that happened across states under the law before this tumultuous year. Between 2013, the year before the ACA’s major coverage expansions took effect, and the end of 2016, the number of uninsured Americans under age 65 fell by an estimated 17.8 million.1 Uninsured rates declined in every state and the District of Columbia (Exhibit 1).

In this issue brief, we examine the extent to which health care access and affordability improved from 2013 to 2016 for residents in each of the 50 states and D.C. We use six indicators: uninsured rates for working-age adults and for children, three measures of adults’ access to care, and the percentage of individuals under age 65 with high out-of-pocket medical costs relative to their income (Exhibit 2). These measures align with those reported in the Commonwealth Fund’s ongoing series of Health System Performance Scorecards.

Implications

After three years of the ACA’s major coverage expansions, the number of uninsured working-age adults and children in the United States had fallen to a record low. This historic decline was accompanied by widespread reductions in cost-related access problems and improvements in access to routine care for at-risk adults, particularly in states that expanded Medicaid. If the 19 states that have not yet expanded Medicaid decided to expand, they could see similar positive effects for their residents.

There is no deadline for adopting the Medicaid expansion. In November, Maine residents voted to expand Medicaid under a citizen-initiated ballot referendum, indicating that popular support for expanding the program may exist in states where elected officials have rejected it. While implementation in Maine could face hurdles because of opposition from the state’s governor, similar efforts are now under way in other nonexpansion states.

Actions at the federal level could, however, jeopardize the gains made under the ACA. Recent actions by the Trump administration, including a shortened open enrollment period for marketplace coverage and deep cuts in advertising and outreach, could reduce enrollment for 2018.10 In addition, Congress has yet to extend funding for the Children’s Health Insurance Program, which expired at the end of September. In the absence of an extension, more than half of states are projected to run out of federal CHIP dollars by March 2018.11 The result could be a loss of coverage for millions of children.12

Further, the tax bill passed by Senate Republicans included a repeal of the ACA’s individual mandate penalties, which would mean a cancellation of the penalties owed by people who do not take up insurance. The Congressional Budget Office estimated that repealing the penalties would reduce the number of Americans with health insurance by 13 million by 2027 and significantly increase premiums for plans purchased in the individual market. This is because healthy individuals would be the most likely to forgo coverage, leaving sicker people (who are more expensive to insure) in the risk pool.13

People who buy their own coverage on the individual market and who have incomes above 400 percent of the federal poverty level (about $48,200 for an individual and $98,400 for a family of four) — the threshold for ACA premium subsidies — would face the brunt of the premium increase.14 A recent Commonwealth Fund analysis estimates that a 40-year-old buying unsubsidized individual market coverage in one of the 39 states that uses the federally facilitated marketplace would face an average dollar increase in premiums ranging from $556 in North Dakota to $1,264 in Nebraska (Exhibit 10).15

9 states considering individual mandate rules: report

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9 states considering individual mandate rules: report

9 states considering individual mandate rules: report

Nine states are considering laws that would require their residents to purchase health insurance, the The Wall Street Journal reported Saturday.

The proposals come less than two months after Republicans, as part of a sweeping tax code overhaul, voted to repeal the Affordable Care Act’s (ACA) mandate requiring individuals to have health insurance.

Lawmakers in Maryland are considering a law requiring residents to buy health insurance. California, Connecticut, Hawaii, Minnesota, New Jersey, Rhode Island, Vermont and Washington, as well as the District of Columbia, are also considering similar proposals, according to the Journal report.

The ACA’s individual mandate was implemented as a way to keep premiums low by requiring everyone to have insurance. Proponents of the mandate say that, without it, healthy people are less inclined to buy insurance, causing premiums to rise for those who need it the most.

But Republicans have long argued against the idea that people should be forced to purchase health coverage.

The decision to repeal the mandate as part of the GOP tax bill was touted as a victory in Republicans’ effort to repeal the ACA. While the provision did not do away with the entire law, it was a blow.

The proposals to impose health coverage mandates in some states marks a shift of authority over health care from the federal government to the states, possibly leading to significant coverage differences between red states and blue states.

“The federal government has just stalled. They don’t accomplish the basics, and that leaves states with a great opportunity to step up and craft policy,” Connecticut state Rep. Sean Scanlon (D), who sits on a health-care working group, told the Journal.

 

5 Key Healthcare Points From Trump’s State of the Union

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http://www.healthleadersmedia.com/leadership/5-key-healthcare-points-trump%E2%80%99s-state-union?utm_source=edit&utm_medium=ENL&utm_campaign=HLM-Daily-SilverPop_02022018&spMailingID=12862476&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1340163930&spReportId=MTM0MDE2MzkzMAS2#

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The president outlined healthcare accomplishments from his first year in office, addressing a closely watched issue for many Americans.

President Donald Trump delivered his first State of the Union address Tuesday night, highlighting policy goals while welcoming a “new American moment.”

Over the course of 90 minutes, Trump discussed several healthcare-related legislative achievements, including adjustments to the Affordable Care Act as well as new care accountability measures for the Department of Veterans Affairs (VA).

Below are five key takeaways from the president’s speech to Congress:

1. ‘The individual mandate is now gone.’

Trump touted the repeal of the individual mandate penalty, calling the eliminated provision “an especially cruel tax.”

The measure, which required Americans without health insurance to pay a fine, was removed as part of the tax reform bill passed late last year.

The penalty is $695 or 2.5% of an individual’s income, whichever amount is greater, and remains in effect for 2018. The elimination will take place next year.

Though Trump did not call for a renewed effort to repeal the ACA in its entirety, he said the Republican-controlled Congress successfully repealed “the core of disastrous Obamacare.”

2. No mention of upcoming funding deadline or community health centers.

Trump did not acknowledge the recent six-year extension granted to the Children’s Health Insurance Program (CHIP), which was part of the continuing resolution that reopened the government last week after a three-day shutdown.

There was also no mention of the February 8 deadline to pass another continuing resolution or pass an omnibus budget package. Such action would likely have to address the fate of over 10,000 community health center (CHC) sites across the country. Federal funding for CHCs lapsed on October 1, so they have been funded by temporary spending packages since then.

Despite the next deadline coming in little more than a week, Trump did not speak on the issue last night.

3. Will call for unity result in bipartisan solutions?

The president’s speech centered on a call for unity among Americans and members of Congress alike. Such bipartisanship will be important in order to avoid a second government shutdown in as many months and to address lingering healthcare policy concerns.

There are two bills in the Senate with bipartisan cosponsors seeking to stabilize the federal insurance exchange markets: Alexander-Murray and Collins-Nelson. Trump’s call for bipartisanship in the final crafting and debate over these measures will play a role in determining their road to passage.

Newly confirmed Health and Human Services Secretary Alex Azar applauded the speech in a statement released late Tuesday night.

“I commend President Trump for delivering a speech that celebrated the economic boom we have seen under his leadership, which has brought new opportunity and prosperity to the American people,” Azar said. “A healthier economy means a healthier America, and we look forward to more such success in the coming year, including through reforms to make healthcare more affordable and accessible for all Americans.”

4. Reduce price of prescription drugs, endorse “right to try.”

Continuing with a campaign promise to lower prescription drug costs, Trump said the FDA is following his administration’s lead to approve more generic drugs and medical devices.

“One of my greatest priorities is to reduce the price of prescription drugs,” Trump said. “In many other countries, these drugs cost far less than what we pay in the United States. That is why I have directed my Administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down.”

Trump also urged Congress to take up the issue of the “right to try,” a policy allowing terminally ill patients to access experimental treatments without having to leave the U.S.

“President Trump says reducing price of prescription drugs is one of his highest priorities,” tweeted Bob Doherty, senior vice president for government affairs and public policy at the American College of Physicians. “Doctors and patients certainly hope so and will be glad to do their part.”

5. Signed VA healthcare accountability bill into law.

Trump promised to ensure veterans have a choice in their healthcare decisions, after reports of substandard care at VA medical facilities surfaced in recent years.

In June, Trump signed the VA Accountability Act, which eased restrictions on removing employees who were accused of wrongdoing while also protecting whistleblowers.

The president said the VA has already fired more than 1,500 employees who “failed to give our veterans the care they deserve.”

VoteVets, a progressive veterans advocacy group, criticized Trump’s remarks Tuesday night. The organization highlighted the push by Republican lawmakers to cut $1.7 trillion from federal healthcare programs, which 1.75 million veterans rely on for coverage.

 

Podcast: ‘What The Health?’ The State Of The (Health) Union

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https://khn.org/news/podcast-what-the-health-the-state-of-the-health-union/

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In his first State of the Union Address, President Donald Trump told the American public that “one of my greatest priorities is to reduce the price of prescription drugs.” But that message could barely begin to sink in before other health news developed: The director of the Centers for Disease Control and Prevention was forced to resign Wednesday after conflict-of-interest reports.

Meanwhile, outside the federal government, Idaho is proposing to allow the sale of individual insurance policies that specifically violate portions of the Affordable Care Act. And three mega-companies — Amazon, Berkshire-Hathaway, and JPMorgan Chase — say they will partner to try to control costs and improve quality for their employees’ health care.

This week’s “What The Health?” panelists are Julie Rovner of Kaiser Health News, Alice Ollstein of Talking Points Memo and Julie Appleby and Sarah Jane Tribble of Kaiser Health News.

Among the takeaways from this week’s podcast:

  • Despite Trump’s strong rhetoric in the State of the Union Address, the president has taken few actions during his first year in office to reduce drug prices.
  • The president touted that Republicans had repealed the health law’s requirement that individuals get health insurance or pay a penalty. But that change in the law doesn’t go into effect until 2019, so his comments could be confusing to some taxpayers.
  • Idaho officials have announced that they are going to allow insurers to issue policies that don’t meet all the criteria of the federal health law. But it’s not clear that insurers are interested in participating in the experiment.
  • “Alexa, send me my Lipitor!” Can Amazon’s announcement that it and two other corporate behemoths are taking on employees’ health care create a new formula for keeping costs down and improving quality?

 

SOTU Healthcare Speed-Read

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In State of the Union address last night, President Trump did mention a couple things about health care (not much new).

Key SOTU quotes:

  • “We repealed the core of disastrous Obamacare — the individual mandate is now gone.” (Fact check: The mandate is not gone yet; it disappears next year.)
  • “We must get much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge. My administration is committed to fighting the drug epidemic and helping get treatment for those in need.”
  • “Patients with terminal conditions should have access to experimental treatments that could potentially save their lives … It is time for the Congress to give these wonderful Americans the ‘right to try.'”
  • “One of my greatest priorities is to reduce the price of prescription drugs. In many other countries, these drugs cost far less than what we pay in the United States. That is why I have directed my administration to make fixing the injustice of high drug prices one of our top priorities for the year. And prices will come down substantially.”

Yes, but: Standard caveats apply on drug prices — those other countries pay less, in many cases, because of government-imposed price controls that Republicans staunchly oppose implementing here.

Notable: There was no push, even rhetorically, to repeal the rest of the Affordable Care Act.

Under Obamacare, Out-Of-Pocket Costs Dropped But Premiums Rose, Study Finds

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http://www.wbur.org/commonhealth/2018/01/23/obamacare-household-spending

Isabel Diaz Tinoco (left) and Jose Luis Tinoco speak with Otto Hernandez, an insurance agent from Sunshine Life and Health Advisors, as they shop for insurance under the Affordable Care Act at a store setup in the Mall of Americas on Nov. 1, 2017 in Miami, Fla. The open enrollment period to sign up for a health plan under the Affordable Care Act runs until Dec. 15. (Joe Raedle/Getty Images)

Passing the Affordable Care Act was always much more about extending coverage than cutting costs. Still, as the landmark law faces one challenge after another, new data are giving a better picture of how the law has played out. That includes a new study that looks at how Obamacare affected household medical spending.

The short answer: On average, Obamacare did not affect household medical spending very much — but it definitely did cut costs for poorer people more than it did for people with more money. Here’s our discussion on Radio Boston, edited:

Host Meghna Chakrabarti: So what did this study find?

Carey Goldberg: The study was looking for how Obamacare was affecting our medical spending. As with everything with Obamacare, it’s complicated. But here we go: In a nationally representative sample of over 80,000 adults, overall, in the first couple of years after Obamacare really kicked in — 2014 and ’15 — out-of-pocket payments dropped by an average of $74.

And by out-of-pocket payments, you mean co-pays and payments you have to make because you haven’t hit your deductible yet.

Right, or procedures that aren’t covered. And meanwhile, the insurance premiums that households paid rose by an average of $232. So it’s a funny little coincidental parallel — out-of-pocket payments dropped by 12 percent, but premium payments rose by 12 percent.

But I’d imagine the effects really varied depending on a household’s income level?

They did. The ACA was meant mainly to help households with lower incomes, and it did. The study found that 6.5 percent of the population became newly insured after the ACA kicked in, and overall, the ACA predominantly helped lower-income people.

Here’s Dr. Anna Goldman, from Cambridge Health Alliance and Harvard Medical School, the lead author on the study: ‘The big picture is that the ACA did make real progress by reducing out-of-pocket spending, especially for poor and low-income households. But even in light of this progress, many American households still continue to face burdensome medical costs.’

On those ‘burdensome costs,’ this study also looked at what’s called ‘high-burden spending,’ which is defined as paying more than 5 or 10 percent of your income on out-of-pocket medical expenses. Premiums can be considered ‘high burden,’ too — that cut-off is if you’re paying more than 9.5 percent of your income.

So if I’m earning 20,000 a year, and I’m hit with out of pocket medical expenses of over $,1,000, that would be considered ‘high-burden’ or a premium that runs me close to $ 2,000 a year.

Right. So on these ‘high burden medical expenses, the good news is that out-of-pocket, high-burden spending fell by 20 percent overall — and it especially dropped for poor people. The not-so-good news for better-off folks is that among middle-income households, there was a 28 percent increase in high-burden spending on premiums.

Because premiums have been getting steeper and steeper. Does this study suggest the ACA is to blame?

No. Dr. Goldman says a better way to look at it is that while the ACA did help with out-of-pocket costs, it didn’t stem from the rise in premiums that was already underway.

I have to admit this is a little underwhelming. We have devoted so much attention and so much political wrangling to Obamacare over the last years, and this study is telling us that at least in the first couple of years, and in terms of household costs, it’s been something of a wash.

I feel the same way. What Dr. Goldman, the lead researcher, commented about that is, look, the ACA was the biggest reform of the health care system since 1965, and to get passed it had to involve a lot of political compromise:

‘It was nowhere near as radical as it could have been,’ she said. ‘I think that a single-payer plan, for example, which many Democrats on the more progressive side of the party were advocating for, would have been much more effective in reducing medical spending by all American households, certainly for people in poor and low-income households — no co-payments, no deductibles, no premiums.”

This isn’t news either, but a single-payer system apparently in this country has not been in the realm of the politically possible.

I would think the ACA as it is right now isn’t even within the realm of political possibility at the moment. The individual mandate is already out.

It’s on its way out. Although not here in Massachusetts, we should note. But what this study also tells us is that as the individual mandate and other aspects of the ACA get phased out, it will be largely the poorer people who will mostly lose out.

In the study’s conclusions the authors write that without the individual mandate, the numbers of people without insurance will go back up again, as will out-of-pocket costs, and premiums will likely rise, too, because healthier people won’t be buying insurance.

The final sentence of the paper says that international experience shows that a universal, comprehensive national health insurance program would be the most effective way to reduce household spending on medical expenses and the gaps between rich and poor.

 

ObamaCare repeal fades from GOP priorities list in new year

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ObamaCare repeal fades from GOP priorities list in new year

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The chances of repealing ObamaCare this year are fading further, with top Republicans saying they hardly discussed repeal of the law during a Camp David retreat last weekend focused on their 2018 agenda.

Meanwhile, Republicans say talk of welfare or entitlement reform this year is also narrowing down to an emphasis on things like job training, not the broad overhaul of Medicare, Medicaid and other entitlements that Democrats have warned against.

While some conservative groups and select lawmakers are pushing for ObamaCare repeal in 2018, President Trump and GOP leaders have signaled a desire to move on, at least for now, after unsuccessful repeal efforts sucked up months of the legislative calendar in 2017. Trump also declared after signing the GOP tax overhaul in December, which did away with the mandate that most people buy health insurance or face a tax penalty, that Republicans had “essentially repealed ObamaCare.”“There’s some work we need to do on the health-care front, but I would hope we’re in a position to do things on a bipartisan basis,” said Sen. John Cornyn (R-Texas), one of the GOP leaders who huddled with Trump at Camp David to discuss the 2018 agenda.

Asked if ObamaCare repeal was discussed in the meetings over the weekend, Cornyn — the Senate’s No. 2 Republican — replied flatly, “No.”

A source familiar with the conversations at Camp David confirmed that ObamaCare repeal was hardly discussed, except for Senate Majority Leader Mitch McConnell (R-Ky.) saying that he did not want to do a partisan bill like ObamaCare repeal or entitlement reform through the fast-track process of reconciliation this year.

ObamaCare repeal has largely fallen off the GOP agenda for 2018, in part due to the realities of a narrower Senate majority than one that already failed to pass a repeal bill. Reopening the divisive issue in an election year would also be tough.

McConnell’s office pointed to his comments at a press conference at the end of December. The GOP leader said then that he wanted to focus on areas of bipartisan agreement in 2018.

When asked about trying to repeal ObamaCare again, McConnell responded that 51-49 is a “pretty tight majority” and noted that “the sensitivity of entitlements is such that you almost have to have a bipartisan agreement in order to achieve a result.”

Democrats have also pointed to comments Speaker Paul Ryan (R-Wis.) made late last year about reining in entitlement spending to warn that Republicans could try to cut Medicare and Medicaid in 2018.

But the source familiar with the Camp David meetings said any welfare or entitlement push this year would likely not be through the fast-track reconciliation process aimed at preventing a Democratic filibuster in the Senate.

Instead, the push would be narrower and focus on areas like job training that could potentially get bipartisan support, not Medicare or Medicaid changes.

“It was a little different than what I anticipated,” Cornyn said of the Camp David discussions on welfare reform. “In other words, it’s not Medicare, Social Security, entitlement reform; it is more, workforce training.”

Ryan outlined this emphasis in a press conference on Tuesday, where he made no mention of ObamaCare, Medicare or Medicaid in talking about an agenda for 2018.

Instead, Ryan said, “We’ve got more work to do to work on people, getting them the skills they need so they can get the careers that they want so they can get the lives that they deserve.”

Trump likewise pushed aside the idea of partisan welfare reform in a press conference at Camp David, which was dominated by the president lashing out at a new, critical book about his young administration.

“We’ll try and do something in a bipartisan way, otherwise we’ll be holding it for a little bit later,” Trump said when asked about welfare reform.

It is still possible, though, that some Republican lawmakers could push to bring back ObamaCare repeal this year. Sen. Lindsey Graham (R-S.C.), for example, pushed back against McConnell last month when McConnell suggested moving on from repealing the law.

“To those who believe — including Senate Republican leadership — that in 2018 there will not be another effort to Repeal and Replace Obamacare — you are sadly mistaken,” Graham said on Twitter last month.

Kevin Bishop, a spokesman for Graham, said on Tuesday that those comments still stand.

Conservative groups are also pressuring Republicans to try again on ObamaCare repeal this year. A range of leading groups, including Heritage Action, Club for Growth and Americans for Tax Reform, wrote to Trump last week urging him to push for ObamaCare repeal this year.

The groups want the fast-track reconciliation process, which is needed to avoid Democrats blocking a bill with a filibuster, to be used for ObamaCare repeal. That is essentially the only way to give repeal a chance of passing.

However, it is in doubt whether the reconciliation process can even be used for anything this year. Using the process requires first adopting a budget, which would be hard for Republicans to agree on, especially in an election year.

With ObamaCare repeal out of focus for 2018, most of the law, including its Medicaid expansion and subsidies to help people buy coverage, remains in place.

Republicans have hailed their victory in repealing ObamaCare’s individual mandate as part of the tax bill, which takes out a central feature of the law and one of the most unpopular parts. Still, some experts have warned that removing the mandate will destabilize markets and cause premium increases.

It is possible that Congress could pass measures aimed at stabilizing ObamaCare in the coming weeks, though House conservatives are opposed to those bills.

Podcast: ‘What The Health?’ While You Were Celebrating …

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The year in health policy has already begun: The Trump administration Thursday released a long-awaited regulation aimed at making it easier for small businesses and others to form “association health plans.” Now advocates and opponents will be able to weigh in with more specific recommendations.

Meanwhile, in December, the health policy focus was on the tax bill and its repeal of the Affordable Care Act’s “individual mandate” penalty for most people who don’t have health insurance. But some recent key court decisions could reshape the benefits millions of people receive as part of their health coverage.

This week’s “What the Health?” guests are Julie Rovner of Kaiser Health News, Paige Winfield Cunningham of The Washington Post, Alice Ollstein of Talking Points Memo and Margot Sanger-Katz of The New York Times.

They discuss these topics, as well as the prospects for pending health legislation on Capitol Hill.

Among the takeaways from this week’s podcast:

  • The Trump administration’s decision to expand association health plans faces a number of obstacles, including the lack of good oversight in many states and the poor track record of many past plans.
  • Consumer advocates fear that growth of association plans could leave many consumers without adequate benefits because some plans will not cover the same essential benefits that Obamacare plans guarantee. They also are concerned that healthy customers will migrate to the new plans and leave the ACA’s marketplace plans with an abundance of enrollees who are ill.
  • The prospects of the bill to stabilize the individual insurance market sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) appear to be dimming.
  • Two federal judges have ruled against the Trump administration rule to change the ACA’s contraception mandate. The decisions, though, are not based on the policy but on faulty rule-making.
  • In another highly watched court case, a federal judge has ruled that the Equal Employment Opportunity Commission has until 2019 to set new rules on what employers can require of workers in their wellness programs.