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Michael Petruzzelli

, National Council for Mental Wellbeing

Health Reform Update: Administration Can Change Health Care Without Congress

March 30, 2017 | ACA | Comments
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Advocates rejoiced last Friday when Speaker of the House Paul Ryan pulled the American Health Care Act (AHCA) from consideration. The proposal would have rolled back the Medicaid expansion and limited Americans’ mental health and addiction coverage and care with structural reforms to Medicaid. However, with Congressional action likely on hold, the National Council is monitoring ways in which the Administration could make changes the nation’s health care system, including potentially harmful reforms to the Medicaid program.


Despite the initial reaction last Friday that Congress was “moving on” from health reform legislation, reports out this week indicate that the House could possibly rekindle negotiations and move forward with an ACA repeal and replace package in the coming weeks. Even with maneuvering in the House, any proposal similar to AHCA would face tough prospects in the Senate where a number of key Republican Senators have expressed concerns and opposition to the bill. The National Council is monitoring congressional action closely and will notify its members if any advocacy is needed.


Even if President Trump is unable to usher repeal and replace through Congress, there are a number of potential reforms that can be made to health care and Medicaid through the regulatory and administrative processes at the Department of Health and Human Services.

Potential reforms to Medicaid via regulations or Centers for Medicare & Medicaid Services (CMS) state waivers include:

  • Imposing work requirements for able-bodied adults;
  • Implementing various cost-sharing measures like premium payments and emergency room copayments;
  • Redefining the Essential Health Benefits, including mental health and substance use treatment; or
  • Revising annual open enrollment period for insurance coverage.

It is important to note that regulatory actions cannot restructure Medicaid into a block grant or per capita cap system. Changes of that nature require statutory change in the law, meaning Congress must approve with majority vote in both chambers before such revisions could be implemented.


One little-known provision in the Affordable Care Act allows states to fundamentally alter their methods of offering and regulating public health insurance. Section 1332 “State Innovation Waivers” were included in the ACA to allow states the opportunity to pursue innovative methods of providing access to affordable, high quality health care while still maintaining the key elements of the law. However, there is now a concern over the potential scope of these waivers and their ability to significantly modify public health coverage as listed above. Learn more about Section 1332 waivers with this National Council fact sheet.