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.


White House and Republicans Deny Progress Made on Fiscal Negotiations

Even after several terse negotiating sessions between President Obama and House Speaker John Boehner last week, both parties had no progress to report other than to say that the “lines of communication remain open” in their efforts to reach a last minute deal to avoid the upcoming BCA mandated sequestration and increase in individual income tax rates. Reportedly the Speaker is sticking to his position to raise only $800 billion in revenue over ten years while the President is still demanding an increase in tax rates for those earning over $250,000 and a total increase in revenues of $1.4 trillion.

There is also a gap in their positions on health care spending with the Speaker negotiating down from $1.4 trillion to a $600 billion reduction in such federal spending and the President holding out for only a $400 billion reduction over ten years. The Speaker has been unable to extract from the White House the details on what federal health program changes would yield the desired spending cuts and congressional Democrats have made the job harder by taking various Republican proposals off the table. Both Senator Dick Durbin and House Minority Leader Nancy Pelosi have publicly expressed their opposition to raising the Medicare eligibility age from 65 to 67 years and the White House also said that Medicaid cuts will be non-negotiable. This latter stance was recently taken after it became clear that cuts to Medicaid would serve as a further disincentive for state governors, Republicans in particular, to declare their intent to expand Medicaid as provided for under the Affordable Care Act (ACA).

With only one legislative week left before Christmas it is clear that a compromise will not be acted on by Congress before Christmas. But with members staring at the year-end fiscal cliff, some Republicans would like to have a Plan B legislative solution to at least avoid the 27% cut in 2013 Medicare physician reimbursements due to the flawed Sustainable Growth Rate (SGR) formula and the tax hike resulting from the alternative minimum tax increase. House Ways and Means Committee Chairman Dave Camp has indicated an interest to bring up separate legislation to provide a one-year doc fix. On the other hand, Ranking Democrat Rep. Sander Levin expressed his view that without a major agreement it would be hard to pass such separate legislation and that the House should instead pass the Senate bill extending the Bush tax cuts for those earning up to $200,000. The White House spokesman also made clear that “first and foremost” the middle class should not have their taxes go up on January 1st.

Indicative of the impasse, House Majority Leader Eric Cantor scheduled the House to be in session through this Friday and advised Members that a weekend session is possible, without putting any tax bill or other fiscal fix on the docket. It appears that only a last-minute mini-deal after Christmas will fend off the fiscal cliff at year-end (reportedly Speaker Boehner’s latest offer would allow the Bush-era tax rates to expire for those earning over $1 million). As if the budget negotiations did not present a high enough hurdle for bipartisan cooperation, Senate Majority Leader Harry Reid continues to pursue his quest to place limits on minority filibusters in the Senate beginning next year.

Senate Democrats Name New Health Committee Members

The Senate Democratic Steering Committee announced that the ranks of the Senate HELP Committee will be filled by incoming Senators Tammy Baldwin (WI), Chris Murphy (CT) and Elizabeth Warren (MA). Senators Baldwin, Warren and Joe Donnelly (IN) were also assigned to the Senate Special Committee on Aging. The Senate Finance Committee majority next year will also include Senators Sherrod Brown (OH) and Michael Bennet (CO).

House Acts on Health Legislation

The House failed to raise the two-thirds majority needed under the suspension calendar to pass H.R. 6190, Rep. Michael Burgess’ legislation that would have overturned an FDA ruling preventing the sale of a particular existing stockpile of over-the-counter asthma inhalers that contain CFCs. However, in a unanimous vote the House did pass H.R. 4053, the Improper Payments Elimination and Recovery Improvement Act of 2012 which would help identify and prevent waste fraud and abuse under federal health and other programs. This week the House will take up additional health-related legislation under suspension of the rules: H.R. 1509, the Medicare Identity Theft Prevention Act of 2011; and H.R.1845, the Medicare IVIG Access Act. The conference report on H.R. 4310, the National Defense Authorization Act for Fiscal Year 2013, is also expected to be taken up and passed before the Christmas break.

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