The Trump administration may be considering restructuring the U.S. Department of Health and Human Services, potentially adding certain welfare programs under the agency's already vast umbrella.
The White House may seek permission from Congress to move the Supplemental Nutrition Assistance Program, or SNAP — commonly known as food stamps — to HHS, along with other programs, such as school meal programs and nutrition education, alleviating the U.S. Department of Agriculture of that responsibility, according to a June 6 report in Politico.
The White House press office directed all inquiries about the report to the Office of Management and Budget, which did not respond to S&P Global Market Intelligence's questions. The HHS also declined to comment and directed inquiries to the OMB.
According to Politico, the OMB is expected to unveil a plan in the coming weeks outlining the changes to HHS, which employees about 80,000 people and oversees a broad array of agencies, including the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and the Centers for Medicare and Medicaid Services, or CMS.
Given that the Medicaid insurance program for the poor already resides inside the HHS at CMS, some have argued that the agency would be a better fit for SNAP than the USDA.
The White House is also mulling over renaming HHS, possibly adding "welfare" to its moniker. Before 1979, HHS was known as the Department of Health, Education and Welfare before being split up.
Democrats want to fill August with healthcare
Meanwhile, with the Senate now expected to stay in Washington and skip most of its August recess, Democrats want those extra three weeks devoted to solving healthcare issues, specifically, lowering costs, including for prescription drugs.
Senate Majority Leader Mitch McConnell, R-Ky., told senators on June 5 they could have the first week of August off, but he said the remainder of the month must be spent on Capitol Hill working on the fiscal 2019 appropriations and nomination considerations — canceling the traditional monthlong recess.
But Senate Minority Leader Chuck Schumer, D-N.Y., said that newly opened three-week period should focus on legislation to make healthcare affordable.
In a June 6 letter to McConnell, Schumer said President Donald Trump had failed in his promises to make healthcare "far less expensive and far better."
"Unfortunately, today the situation is far worse," Schumer said, adding that premiums, deductibles and the cost of care remain too high and that 1 in 4 Americans still cannot afford their prescription drugs.
He noted that biopharmaceutical stocks rose May 11 immediately after Trump unveiled his strategic plan to lower drug prices — signaling that Wall Street was not too worried those companies would be hit negatively.
Schumer suggested that the Senate take up healthcare bills sponsored by Democrats, including legislation to allow Medicare to negotiate the best possible prices of prescription medicines directly with manufacturers, implement transparency requirements for drug companies that raise prices and ensure that lower-cost generics are brought to market more fairly.
The New York Democrat also called for healthcare tax credits to be enhanced and the so-called cost-sharing reduction, or CSR, payments to be restored to help reduce what Americans pay for their insurance in the individual markets.
The subsidies help low-income Americans with plans provided under the Affordable Care Act cover their out-of-pocket costs for prescription drugs and doctor visits.
Trump terminated the CSR payments to insurers in October 2017, calling them unconstitutional because Congress had not appropriated the specific funds under the ACA.
On the Senate floor June 6, Schumer said Trump "deliberately sowed uncertainty in the healthcare marketplace as a way to make a political point" against the ACA.
"Health insurers from coast to coast cite the repeal of the coverage requirement as one of the major reasons they're increasing rates next year," Schumer said.
No plan soon to avert 'silver-loading'
Insurers, which remain responsible for covering the CSRs despite the lack of the government reimbursement, have cited the uncertainty around legislative moves in recent months to try to get those payments restored as a leading contributor to the increases in premiums.
Some insurers have been engaging in a practice known as "silver-loading," meaning they have shifted all of their premium increases to silver plans — the most popular of the ACA's four plan categories and the one tied to the CSR payments.
That leaves consumers buying plans in the other three metal-themed categories — bronze, gold and platinum — without increases, or with much smaller ones.
Since the subsidies are based on the benchmark plan — the second-least-expensive silver plan — if the premiums rise, so do the subsidies.
CMS Administrator Seema Verma had hinted in April that her agency may take steps to try to block silver-loading, but HHS Secretary Alex Azar told lawmakers at a June 6 hearing that there is currently no plan to do so.
"That would actually require regulations, which simply couldn't be done in time for the 2019 plan period," Azar told members of the House Committee on Education and the Workforce.
"It's not an easy question whether one should attempt to force or even encourage the movement of that loading onto the bronze and golds because that impacts individuals who are in those plans also," the HHS chief said. "I don't think it's actually a facile question how one addresses that."
