Pre-Existing Conditions Fight Takes Center Stage in Midterms

Congress and the White House are facing a number of important issues this fall. But the clock is ticking with the November midterms looming and the end of the year fast approaching. Here’s a look at Washington’s agenda and the key stories The Hill will be watching in the months ahead.

Health care is one of the issues taking center stage in this November’s midterm elections as Democrats press Republicans on preserving protections for pre-existing conditions under ObamaCare. But there is also plenty of unfinished work for Congress and the administration this fall, from passing opioid legislation to tackling drug costs.


The latest Republican lawsuit against ObamaCare is ready for court, with arguments slated for Sept. 5.

Twenty GOP-led states are challenging the law, with the backing of the Trump administration. The lawsuit argues that the health-care law is unconstitutional after the repeal of the individual mandate last year.

That case has given midterm fodder to Democrats who have been hammering Republicans for seeking to invalidate protections for people with pre-existing conditions in court.

In a sign of Republicans’ concern over Democratic attacks, 10 GOP senators last week introduced a bill they said would prevent insurance companies from charging more or denying coverage to people with pre-existing conditions.

Also on the ObamaCare front, open enrollment begins Nov. 1 and ends Dec. 15 and the Department of Health and Human Services (HHS) is facing pressure from Democrats, who have accused them of sabotaging the health-care law.

A report from the nonpartisan Government Accountability Office released last week attributed a 5 percent enrollment drop in large part to a series of changes HHS made to the law last year. Expect Democrats to continue highlighting that this fall.

This year’s open enrollment will also bring more changes. For the second year in a row, HHS will significantly cut funding for outreach groups that help enroll people in ObamaCare plans.

Only $10 million in funding will be awarded to these groups, called navigators, compared to the $62 million they received in the last open enrollment period under the Obama administration.

This will likely also cut down on the number of navigators operating in the U.S., which means those in rural areas could find it more difficult to get in-person enrollment help.

All eyes will also be on the administration’s expansion of non-ObamaCare plans, which experts anticipate could draw healthy people from the market created by the law, further harming it.


Back in Congress, legislation addressing the opioid crisis could move as soon as the week after Labor Day. Senators have been working behind the scenes to combine a range of bills into a package that can get bipartisan agreement.

One holdup so far has simply been the fact that so many senators want to get their provisions included, according to Senate Majority Whip John Cornyn (R-Texas).

“It’s a big bill involving three standing committees and just everybody wants to make sure that they get their piece in it,” Cornyn said, adding that it “takes a lot of diplomacy.”

The House passed its package of opioid bills in June, an accomplishment that could give vulnerable GOP lawmakers something to tout on the stump. Since then, the chamber has been waiting on the Senate.

In the upper chamber, many vulnerable red-state Democrats come from states hit hard by the opioid crisis, and they could be eager to secure a legislative victory as well by pushing through the bills. 

Drug prices

Washington will be on the lookout for more moves on President Trump’s plan to lower prescription drug costs.

Administration officials have been trying to overcome skepticism that their plan will actually significantly lower consumers’ prices.

Rather than one big reveal, officials have been rolling out a series of smaller actions, with more promised to come.

One area being closely watched is a cryptic notice of regulation on the rebates that drug companies pay to the negotiators known as pharmacy benefit managers. The administration has criticized them as being secretive and driving up prices.   

Medicaid work requirements

The administration plans to move forward with Medicaid work requirements this fall even after a federal judge blocked a proposal in Kentucky from taking effect.

HHS Secretary Alex Azar has signaled that he will not back down from the work requirements, which have come to be a defining priority for the administration.

HHS reopened the comment period on a waiver to allow Kentucky to implement its Medicaid work rules in an effort to show a district court that had blocked the proposal that HHS was taking its concerns seriously.

The proposal garnered nearly 12,000 comments, most of which were negative, according to an analysis released Tuesday.

Now the administration has to review the comments and decide how to move forward, though it has not set a timeline.

There are several other work requirement proposals that the administration could approve by the end of the year in Arizona, Maine and Wisconsin. Mississippi, Ohio and Utah also have sent in requests for waivers so they too can implement Medicaid work requirements.


There are several pending regulations at HHS that lobbyists have been eagerly awaiting, and they’re all controversial. In May, HHS announced a proposed regulation that would essentially ban Planned Parenthood from the Title X program.

Title X is the only federally funded program solely dedicated to providing low-income women and men with family planning services.

But Republicans and anti-abortion groups have long criticized it for funding Planned Parenthood, which serves about 40 percent of Title X patients.

The proposal includes several changes, such as banning clinics from funding if they refer women for abortions, removing the requirement that clinics counsel women on abortion as an option and requiring a physical and financial separation between abortion providers and Title X services.

A proposed regulation issued in January would give HHS’s Office for Civil Rights more power to ensure that individuals and entities are not being discriminated against because of their religious beliefs or moral convictions.

The regulation, which was introduced in January, would allow the Office for Civil Rights to initiate compliance reviews, conduct investigations and use enforcement tools to address violations and resolve complaints.

Opponents worry the regulation would result in care being denied to LGBT people or women seeking abortions.

There’s another proposed HHS regulation that advocates worry would negatively affect the LGBT community.

Advocates think HHS will roll back a final rule issued under the Obama administration that prohibited health-care providers and insurers who receive federal funding from denying treatment or coverage to anyone based on sex, gender identity or termination of pregnancy, among others.

The rollback proposal is being reviewed by the White House, one of the final stages before it is released to the public for comment.


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