Capitol Insights Newsletter

Authors: Luke Schwartz, Matt Reiter, and Caroline Oliver

What happened in Congress this week?

There were no major healthcare developments in Congress this week.

Next Wednesday January 31, CAI looks forward to the Senate HELP Committee’s Hearing on “Authorization for Investigation into High Costs of Prescription Drugs and Related Subpoenas,” as well as the House Energy & Commerce Subcommittee on Health’s Hearing, “Health Care Spending in The United States: Unsustainable for Patients, Employers, And Taxpayers.”

Record Breaking 2024 ACA Enrollment

This week, CMS announced that 21.3 million people signed up for the Affordable Care Act (ACA) Health Insurance Marketplace. This is nearly double the number of enrollees since 2020 when roughly 11 million people were enrolled. Among the 2024 enrollees, 16 million opted to renew their coverage while 5 million are new to the ACA Marketplace.

The spike in enrollments can be attributed to two main factors:

First, during the COVID-19 pandemic, states were prohibited from disenrolling people from Medicaid. However, in the last six months of 2023, it is estimated that 15 million Americans were automatically disenrolled from the Medicaid program. Half of the new ACA Marketplace sign-ups are from Americans who were previously enrolled in Medicaid. The number of people formerly covered by Medicaid who sign up for the ACA Marketplaces is expected to continue to rise. Many states are offering special enrollment periods to these individuals throughout the year.

Second, as a result of the Inflation Reduction Act (IRA), more people are eligible for ACA premium assistance subsidies. When the ACA was first passed, these subsidies were only available to people who earn up to four times the federal poverty level. The IRA removed this income threshold through 2025.  These premiums subsidies allow 80% of federal ACA Marketplace enrollees to pay $10 or less for their monthly premium.

We will be watching to see if ACA Marketplaces will attract the many Americans that have lost Medicaid coverage or if these people will remain uninsured.

The federal 2024 Marketplace Open Enrollment Period was open from November 1, 2023, to January 16, 2024, while state Marketplaces varied. ACA Open Enrollment is still open in four states and Washington DC until the end of January. The number of ACA Marketplace enrollees is expected to increase until the conclusion of the Enrollment Period. This number will also likely increase throughout 2024 due to the special enrollment periods for the large number of newly uninsured Americans.

Top Stories in Healthcare Policy

According to CDC data, hospitalizations from COVID-19 decreased for the first time in two months during the second week of January. The majority of COVID-19 cases continue to be the JN.1 variant. 

Last Thursday, the Senate Committee on Health, Education, Labor and Pensions held a hearing on January 18th Addressing Long COVID. The consensus of the Committee seemed to be that funding should be directed toward more research on long COVID.

Two members of Congress have proposed the Opioid Settlement Accountability Act, which identifies acceptable uses of state and local government funds from opioid settlements. Drug manufacturers and pharmacies are paying $50 billion in settlements over 18 years, but there are currently no oversights in place on how states allocate and spend the funds.

New York City announced this week that it will work with RIP Medical Debt to relieve $2 billion in medical debt for residents. This model was first used in Cook County, Illinois in 2022.

A Commonwealth Fund survey of clinicians found that 80% of providers agreed that their healthcare organization should address its environmental impact. Hospitals account for the majority of healthcare organizations’ 8.5% contribution to greenhouse gas emissions in the U.S.

Biden and Harris focused their campaigning on abortion rights in Virginia this week. Harris also campaigned about abortion in Wisconsin earlier in the week.

Last week, Senate Finance Committee Chair Ron Wyden (D-OR) and House Ways and Means Committee Chair Jason Smith (R-MO) announced they reached an agreement on bipartisan, bicameral legislation to reform certain business taxes and other taxes that help low-income families. It is presently unclear if this bill has enough support to advance through either the House or Senate.

New research shows that many drugs in the U.S. are still far more expensive than they are in other countries.