Week Ending May 10, 2019

House of Representatives Acts to Protect Affordable Care Act from Administrative Attack

• Protecting Obamacare

• House Appropriations Committee Passes Labor-Health, Human Services-Education Funding Bill

Protecting Obamacare

The House approved, on a party-line vote of 230-183, a bill to stop actions by the Trump administration to undermine the consumer protections in the Affordable Care Act (ACA).  The “Protecting Americans with Preexisting Conditions Act of 2019” (H.R. 986) stops the implementation of the Trump administration’s Oct. 22, 2018, guidance related to Section 1332 of the ACA. Under that provision, the Department of Health and Human Services can approve state waivers to try strategies to provide residents with health coverage that delivers at least the same level of protections guaranteed under the ACA. The administration’s guidance radically redefines key terms and criteria for approving waivers to allow setting up substandard plans that endanger protections for individuals with pre-existing conditions.

• Administration Guidance Undermines ACA – Last fall, the Trump administration issued guidance on Section 1332 of the ACA, removing a requirement on states that health coverage plans be comprehensive, affordable, and that they protect patients with pre-existing conditions. Instead, the administration’s guidance encouraged states to allow junk insurance plans that do not protect Americans with pre-existing conditions.
• AFSCME Opposition – AFSCME sent a letter to the House urging Congress to oppose the efforts to undermine basic protections for individuals with pre-existing conditions and weaken the ACA marketplaces and to urge support for passage of H.R. 986.

What You Need to Know: The Trump administration’s guidance is designed to undermine the ACA. This guidance would raise the costs of comprehensive health coverage by driving up premiums for Americans who are older, sicker or have pre-existing conditions. The guidance lets states set up and subsidize insurance markets with fewer rules. States will also be  allowed to offer short-term health plans alongside ACA-compliant plans. These short-term plans are designed to provide skimpy coverage and can be renewed to become longer-term coverage. Insurers offering these plans can deny or fix price coverage based on a person’s pre-existing conditions or age. As a result, insurers will steer healthy consumers to less-regulated coverage. This will drive up premiums for people with pre-existing conditions as more people with costlier conditions and fewer healthier individuals will be in ACA-compliant plans. By splitting the risk pool by health status, age or other factors, this will undermine the stability of ACA marketplaces, particularly for older and vulnerable Americans.

House Appropriations Committee Passes Labor-Health, Human Services-Education Funding Bill

This week, the House Appropriations Committee approved the Labor-Health and Human Services-Education (Labor-HHS-Education) Funding Bill for fiscal year (FY) 2020 (which starts on Oct. 1). The Labor-HHS-Education funding bill is the most important of the 12 annual appropriations bills for AFSCME members, providing funding for job training, health care, child welfare, services for the elderly, education and other important public services. 

• Funding Increased: Adjusted for inflation, funding for Labor-HHS-Education programs declined by a remarkable $16 billion from 2010 to 2019. The consequences of this underfunding are parents without access to affordable, early-learning opportunities for their children; unemployed adults without access to job training programs they need to gain skills and re-enter the workforce; public health officials without the resources they need to address the opioid epidemic and other critical public health issues; and countless other problems stemming from inadequately funded public services.
• AFSCME Priority: AFSCME is fighting for significant increases in funding for Labor-HHS-Education programs. While we believe that even more resources are needed to break the cycle of disinvestment that is harming our communities, the legislation approved by the House Appropriations Committee is a step in the right direction. The bill provides $189.8 billion in funding – $11.7 billion over the amount Congress provided for FY 2019 and $47.8 billion more than the president requested in his 2020 budget. Specifically, the legislation includes:
• Department of Labor: $13.3 billion for labor programs, $1.2 billion above the amount enacted in 2019. It includes significant increases in funding for critical job training and employment programs that ensure people have the skills and the opportunities they need to succeed in the workplace. It also includes funding increases for the worker protection agencies that address wage theft, dangerous working conditions and other critical issues for working people. AFSCME succeeded in securing $12.6 million for Susan Harwood grants to help train workers in safety on the job, including preventing workplace violence.
• Department of Health and Human Services: $99 billion for health and human services programs, $8.5 billion above the amount enacted in 2019. The legislation includes increases in funding for critical public health programs, including programs that address mental health, substance abuse, suicide prevention and other critical concerns. It also includes significant increases in funding for children and family programs, including an additional $1.5 billion for Head Start and an additional $2.4 billion for the Child Care and Development Block Grant program. There is $25 million for a new program to provide loan forgiveness for behavioral health professionals. The bill also proposes discretionary funds of $150 million for Certified Community Behavioral Health Clinics.
• Department of Education: $75.9 billion in discretionary funding for education programs, $4.4 billion above the amount enacted in 2019 and $11.9 billion above the president’s budget request. There are sizable increases for foundational resources to states, including special education (IDEA) and Title I, which have been mostly flat-funded recently. There are increases of $1 billion each for Title I and IDEA, $500 million for Title II, $150 million for Title IV-A, and $100 million for 21^st Century Community Learning (afterschool). The maximum annual Pell grant was increased by $150 to $6,345.

The legislation also included language requested by AFSCME that will prevent the Trump administration from implementing yet another anti-union attack, this time on home care workers. As part of their efforts to prevent workers from banding together in strong unions for higher wages and better working conditions, the Trump administration is attempting to implement a federal rule that would take away the right of home care workers to choose to have dues payments deducted from their paychecks. The legislation passed by the House Appropriations Committee includes language that would prohibit the Trump administration from moving forward with this rule.

What You Need to Know: There are still several steps remaining before this legislation is enacted into law. Now that the House Appropriations Committee has approved the legislation, it needs to be voted on by the full House of Representatives, which could occur in June. The Senate Appropriations Committee has not yet released its version of the Labor-HHS-Education bill, which will need to be considered by the Senate Appropriations Committee and the full Senate. Any differences between the House and Senate versions of the legislation will need to be ironed out before the legislation can be sent to the president and enacted into law.

Furthermore, Congress will not be able to provide adequate funding unless it reaches a deal to increase spending limits (often referred to as “budget caps”) established by previously passed legislation. In 2011, Republicans in Congress threatened to allow the United States to default on its debt to force through legislation that resulted in the establishment of tight spending limits for federal programs through 2021. The spending limits were set at such low levels that Congress has repeatedly agreed to increase the limits. Without a new agreement, FY 2020 spending on Labor-HHS-Education programs will be cut by $55 billion. Many of the programs that would be affected are grant programs provided to state and local governments, putting AFSCME member jobs at risk.

Throughout this process, AFSCME will be working to support an agreement to increase spending limits and to ensure that the critical programs supporting the work of AFSCME members are adequately funded.