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ACA replacement could pose threat to drug coverage

With Republicans mostly on board to start the process of repealing the Affordable Care Act come January 2017, lawmakers are beginning to debate how to replace the portions of the Obamacare law that are dismantled and what it will mean for coverage of treatments.

New health insurance legislation could be passed by the end of 2017, a Republican Senate aide told reporters during a Dec. 15 Washington forum hosted by the Alliance for Health Reform, a nonpartisan, nonprofit group. Lawmakers may need to give states three to four years to ease into whatever framework is created for the ACA provisions affecting Medicaid or to decide if they want to stay with the current Obamacare structure, the aide said.

Congress needs to ensure states, which run and help fund the Medicaid health insurance program for low-income and disabled people, are partners in the process and are given flexibility, the aide said at the forum, where congressional aides discussed the situation on background. That greater leeway could result in states reducing benefits and increasing costs for Medicaid recipients, a House Democratic aide said, an issue that is likely to concern those in the biopharmaceutical industry.

For instance, Seema Verma, President-elect Donald Trump's nominee to lead the Centers for Medicare and Medicaid Services, has called for more latitude for states with the government's early and periodic screening, diagnostic and treatment program, which guarantees those services to children, the House Democratic aide said.

But to some, the aide said, that flexibility means allowing Medicaid to drop the treatment part of those services. She said others have advised giving states the option to no longer pay for transportation for patients in the program.

If Republicans go through with their plan to provide Medicaid block grants, states will be less likely to afford the latest innovative medicines, the House Democratic aide said.

And if lawmakers back House Speaker Paul Ryan's plan to privatize Medicare, in which beneficiaries will be required to sign up for individual plans in a marketplace, much the way the ACA works now, coverage decisions will be made by individual plans, she said. That threatens access to the latest medicines and technology, she said.

Democrats will be closely watching to ensure the measure in the ACA that bans insurers from excluding patients with pre-existing conditions remains intact, as Republicans have promised, the aide said. Democrats are concerned that Republicans may still try to weaken the protection that measure provides, she said.

Republicans have said they will make the ACA replacement package better, more affordable and that it will cover more people. But they also have committed to rein in the government's costs while ensuring patients have access to the latest innovations, and not everyone is in agreement on how to do that, a Republican House aide said.

While lawmakers praise the great advances in drug discovery and development, they also complain about the prices of those medicines, the aide said. Deciding what innovations the government will be capable of covering is a debate that needs to be had, he said.