Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Senate Sends CR to President to Fund Government until March 27, 2013

Early Saturday morning the Senate voted 62-30 to send H.J. Res. 117 to the President for his signature.  The continuing resolution continues federal agency funding at the $1.047 trillion BCA level through next March 27th.  Other major budget issues, such as what actions to take on the upcoming sequestration, the debt ceiling, tax-cut extensions and further FY 2013 appropriations will be left until Congress returns after the November elections.  Spending under the CR is $19 billion more than specified under the House-passed budget resolution.  Also, the House passed H.R. 6433 which makes technical corrections to the FDA drugs and device user fee provisions.  The FDA said the agency would go ahead with the new user fee assessments on generic drug makers regardless of whether Congress enacts the technical corrections needed under the CR.

Action Taken on Several Health Bills Before the Recess

Several health bills were passed by the House as the chamber rushed to adjourn last week.  Among the bills passed are: H.R. 6118, the Taking Essential Steps for Testing Act of 2012, that would give CMS authority to determine if a one-year CLIA ban on labs that refer work to other labs should be applied and the flexibility to impose intermediate sanctions instead of a two-year ban against lab ownership or operation; H.R. 733, legislation that would require the National Cancer Institute to update its scientific framework to expand research on recalcitrant cancers; H.R. 6163, legislation that would create a National Pediatric Research Network; and H.R. 4124, legislation to encourage veterans to become emergency medical technicians.  The House Energy and Commerce Committee also advanced the following legislation: H.R. 1206, legislation that would remove broker commissions from the medical loss ratio (MLR) that health insurers are required to meet under the PPACA and H.R. 1063, the Strengthening Medicare and Repaying Taxpayers Act of 2011, that would provide beneficiaries the amount due Medicare when a secondary payer claim is paid, require HHS regulations on appeal rights and bar HHS from seeking payment of claims below the cost of recoupment.  The Senate HELP Committee also passed its own versions of the cancer research bill (S. 3556) and the laboratory testing bill (S. 3391).  The committee also passed S. 1440, legislation to reauthorize the preterm labor and infant delivery programs.

PPACA Tax Penalty Estimate, Part D Savings and CER Funding

The CBO released a report on the PPACA which estimates that nearly 6 million persons will fail to abide by the law’s individual mandate and be assessed tax penalties.  The report said about $7 billion in penalties will be collected in 2016 and about $8 billion in each subsequent year to 2022.  HHS also reported that Medicare beneficiaries have saved about $4.5 billion on prescription drugs since January 2011 as a result of the law’s closing of the Part D “donut hole.”  In addition, the Patient-Centered Outcomes Research Institute (PCORI) announced that letters of intent are due by October 15th for the second cycle of PPACA funded comparative effectiveness research.

Hearing on Medicare Advantage Funding Challenges

The House Ways and Means Health Subcommittee held a hearing on the Medicare Advantage program and the funding challenges the program faces under the PPACA and budget sequestration.  MA insurer representatives warned of the negative impact of any funding cuts that may result from the upcoming BCA sequestration (overall Medicare cuts are limited to 2% under the BCA mandate).  Another witness from the Ethics and Public Policy Center testified that the full effect of the PPACA on MA plans has yet to be felt has yet because "through 2013, less than 10% of the scheduled Medicare reductions will have gone into effect, and costs have risen modestly in recent years because of the slow economy."  Chairman Wally Herger said that "a significant number of beneficiaries prefer to receive their Medicare benefits from a private health plan" and that the subcommittee has examined the "impact that changes to Medicare health plans will have on beneficiaries in these plans and the value these plans bring to beneficiaries, Medicare and ultimately to taxpayers."  In related news, CMS reported that average Medicare Advantage premiums will increase by 4.7% in 2013 to $32.59 from $31.12 in 2012.

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