Earlier this year, congressional Republicans and the Trump Administration laid out a three-part approach to health reform, and this week House Republicans took steps to begin advancing legislation to address their “third bucket.” The first of the buckets was to fast-track a reconciliation bill, the American Health Care Act (AHCA), to repeal budget-relevant portions of the ACA; the second was to use administrative flexibility to ease regulatory guidance and undo earlier rules by the Obama Administration; and the final bucket was to pass standalone patchwork pieces of legislation under regular order that would be able to attract the requisite bipartisan support to pass the Senate and be signed into law.

On Tuesday, the House passed the first of these third-bucket bills, H.R. 2581, by a largely party-line vote of 238-184. That bill would require individuals to verify their income eligibility and citizenship status prior to being able to access advanced premium tax credits (APTCs) to purchase health coverage. Congressional Republicans argue that millions of dollars in subsidies have gone towards coverage for individuals not eligible, including illegal immigrants. While the Treasury Department currently has a process in place to determine eligibility, this bill would require the Treasury to receive confirmation from the Social Security Administration of the applicant’s immigration status prior to granting subsidies. The provision would also apply for subsidized coverage under the AHCA, should that become law.

The consideration of legislation was temporarily suspended on Wednesday following the shooting of Republican members of Congress earlier in the day. On Thursday, The House voted to pass H.R. 2372 by a voice vote to allow veterans to access APTCs if they are not enrolled in coverage under the Veterans Administration. They also voted 267-144 to pass H.R. 2579 to allow federal healthcare tax credits to be applied towards the cost of unsubsidized COBRA continuation health coverage. This bill would not apply to the ACA’s APTCs, but would rather only become effective by the enactment of the AHCA with an effective date of January 2020. Each of these third-bucket bills now head to the Senate for consideration, where the White House has already indicated they will sign them into law should they be passed.

Meanwhile, on Wednesday, Senators Tom Carper (D-DE) and Tim Kaine (D-VA) introduced S. 1354, the Individual Health Insurance Marketplace Improvement Act. This legislation would create a permanent reinsurance program for the ACA marketplaces, similar to the reinsurance mechanism for Medicare Part D. The ACA’s now-defunct reinsurance program was one of the “three-R” programs, alongside a temporary risk corridor and a permanent risk adjustment program, designed to provide stability during the law’s initial years. Both the reinsurance and risk corridor programs expired at the end of last year.