What Could Reconciliation Mean for Medicaid: Reviewing HR 3762

By: Cindy Mann
– Georgetown University Health Policy Institute

President-elect Trump and leaders in Congress have proposed a major restructuring of the Medicaid program, but very significant changes to Medicaid coverage and financing could be adopted even before that debate begins as part of a reconciliation bill aimed at repealing various provisions of the Affordable Care Act. An ACA “repeal” bill is expected to take center stage as soon as the new Congress convenes in early January 2017. The current Congress has passed ACA repeal bills before; most recently a reconciliation bill (HR 3762) passed in late 2015 and was vetoed by President Obama. HR 3762 is likely to be the starting point for the legislation Congress will take up in January. Of note, the provisions repealed in HR 3762 would not have taken effect until January 2018, purportedly allowing time for Congress to develop and enact a replacement for the ACA. A major question for Congress and President-elect Trump is whether they will proceed with a repeal bill without a “replacement” bill in hand. Without such a bill, the future of coverage for some 20 million people, the insurance reforms that have affected countless others, and the impact of the changes ahead on states, healthcare providers and health plans will be highly uncertain.

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