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.


Post-Inaugural Schedule Includes Debt Ceiling Push-Back

On Tuesday, January 22nd, the day after the Presidential inauguration, the House will take up H.R. 307, the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPA) of 2013, as well as a bill, Legislation Conditioning an Increase in the Nation’s Debt Limit Upon Congress Passing a Budget, which confronts the Senate Democrat leadership’s past inability or refusal to bring up and pass a budget.  The debt limit legislation will extend the nation’s ability to borrow for only three months and require the Senate to pass a budget resolution by April 15th in accordance with the Congressional Budget Act or face a deferral of pay for all Senators (House Republicans are expected to meet the April 15th deadline).  It remains to be seen whether the House Republican Caucus will stand behind Speaker John Boehner in this move to gain some political leverage over congressional Democrats and the President in the fiscal years 2013-14 and long-term budget debate.  In this regard, the Speaker is attempting to restore the so-called “Hastert Rule” under which legislation would be taken up in the House only when a majority of Republicans support the move (the rule was set aside in the vote taken to avoid the fiscal cliff, 35% of R’s voted aye, as well as in the supplemental appropriations vote to fund Sandy-related restoration, 21% of R’s voted aye).  While Senate Minority Leader Mitch McConnell seemed to support the House’s condition, the office of Senate Majority Leader Harry Reid said the Senate would be looking to the House to pass a “clean debt-ceiling increase to avoid default,” and if that happens, “we will be happy to consider it.”  Even if a debt ceiling extension is enacted, the Congress still faces a March 1 deadline to reach an agreement on how to ameliorate the $85 billion in automatic spending cuts mandated under the Budget Control Act and a March 27 deadline to extend funding for FY 2013 federal operations and avoid a government shut-down.  Senator John Cornyn (R-TX) has suggested that these two dates be used to force the President to negotiate a long-term budget including Medicare and Social Security entitlement reforms.  The Office of Management and Budget (OMB) has directed federal agencies to come up with contingency plans to cut spending if Congress is unable to reach a resolution of the matter and has warned that hundreds of thousands of federal employees may need to be furloughed without a legislative solution.  It is not expected that Congress will consider legislation proposed by Senator Pat Toomey (R-PA) and Rep. Daniel Webster (R-FL-10) which seeks to resolve the debt limit ceiling problem by setting spending priorities, beginning with interest payments on the debt and the payment of Social Security and active/retired military pay.  The spectrum of views on long-term spending is reflected by recent positions of the AARP to reject cutting Medicare benefits or provider payments and of the Business Roundtable to increase the Medicare eligibility age to 70 and adopt a premium support regimen for the program.  The need to reduce federal deficits was also promoted by the Treasury Department in its Financial Report of the United States which concludes that, despite the spending constraints included under the Patient Protection and Affordable Care Act (PPACA) and sequestration, if federal spending policy remains unchanged, the debt-to-gross domestic product ratio will continually increase over the next 75 years and beyond, “which implies current policies are not sustainable and must ultimately change.”

Committee Health Agenda

The new chairman of the House Ways and Means Subcommittee on Health, Rep. Kevin Brady(R-TX-08), said his committee will focus on repealing parts of the PPACA, scrutinizing the law’s implementation, replacing the Medicare sustainable growth rate (SGR) physician payment system with a formula that rewards quality and reducing Medicare overhead by 10% within five years.  The House Energy and Commerce Committee, which has scheduled an organizational meeting this Tuesday, announced a similar agenda to oversee the PPACA and examine the fiscal challenges facing Medicare and Medicaid.  House Budget Committee Chairman Paul Ryan (R-WI-01) also indicated his committee would work on a substitute for the PPACA.  The ranking member of the W&M’s Health Subcommittee, Rep. Jim McDermott (D-WA-07), said he has not given up on seeking a single-payer health care system, but will work with Rep. Brady (R-TX-08) to see that the PPACA is implemented in the best way possible.  Of note, Rep. Schakowsky (D-IL-09) and 44 other House Democrats introduced legislation, H.R. 261, which would add a “public option” under the PPACA.  Another topic likely to be given attention was highlighted in a Congressional Research Services (CRS) report, Physician Supply and the Affordable Care Act, which states that “experts suggest that there are too few physicians overall, too few primary care physicians specifically, and that physicians are inadequately distributed throughout the United States.”  House and Senate committees of jurisdiction will also have to address the reauthorization of a number of health programs, including those involving graduate medical education, HIV-AIDS and the National Health Service Corps.  House Republicans have already introduced a flurry of bills intended to repeal various parts of the PPACA: 

  • H.R. 37, the Business and Government Operations Improvement Act – repeals the individual and employer mandates and the Independent Payment Advisory Board, introduced by Rep John Barrow (D-GA-12)
  • H.R. 45 - repeals the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act, tintroduced by Rep Michele Bachmann (R-MN-06)
  • H.R. 105, Reclaiming Individual Liberty Act – repeals individual mandate, introduced by Rep Scott Garrett (R-NJ-05)
  • H.R. 132, ObamaCare Repeal Act - repeals the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act, introduced by Rep Steve King (R-IA-04)

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