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.


Federal Debt Limit Extended until May 18/Budget Resolution Incentives

By a vote of 64-34, with 2 absences, the Senate passed H.R. 325, the federal debt ceiling extension legislation previously passed by the House. The bill passed Senate muster without amendment after several Republican amendments were tabled by Democrats. The failed amendments would have required that any debt limit increase be balanced by equal spending cuts over the next decade; provided for automatic continuing resolutions; required the government to prioritize all obligations on the debt held by the public in the event that the debt limit is reached with Social Security and military pay first in line; and prohibited the government from providing Egypt with certain military equipment. The President indicated he would sign the bill into law.

In addition to suspending the current $14.294 trillion public debt limit through May 18, 2013, the legislation suspends, after April 15, the pay of House and Senate members until the respective body passes a concurrent budget resolution for fiscal year (FY) 2014.

House Budget Committee Chairman Paul Ryan (R-WI) has indicated his committee will take up a budget resolution beginning in early March, even if the President’s budget has not been presented to Congress by that time. He said his proposal will attempt to balance the federal budget in 10 years (likely to be accomplished through major changes to Medicare, Medicaid and other entitlement programs, as well as to various discretionary spending programs).

Senate Majority Leader Harry Reid (D-NV) said he will turn over the responsibility for developing the Senate’s proposal to new Budget Committee Chair Patty Murray (D-WA). In the absence of the Administration’s budget, the Majority Leader may also have to waive the procedure whereby the Congressional Budget Office (CBO) first provides each house with an accounting of the President’s recommendations.

The earliest the President’s budget could be sent to Congress is March 4, given that the Office of Management and Budget (OMB) has just started the so-called “pass back” process of negotiating cuts suggested by the various federal agencies. White House officials have recently indicated that the President’s budget will back away from cuts to Medicaid, an element discussed in previous congressional budget negotiations. It is possible that the tax writing committees in both the House and Senate may attempt to come up with an overhaul of the tax code which could be inserted as a major element in a concurrent budget resolution. The House is likely to develop a tax plan that is budget neutral while Senator Patty Murray has publicly insisted that new revenue be included in any budget deal.

Congress also has a March 1 deadline to produce legislation to reverse or ameliorate the Budget Control Act (BCA) sequestration. House Republican leaders continue to show a certain resolve that the $85 billion in sequestration cuts will go through, although this could be a negotiating tactic. Congress also has until March 27 to come up with an extension of FY 2013 spending – when the current Continuing Resolution expires. In this connection, House Republicans may attempt to trim FY 2013 spending to $974 billion, a $69 billion reduction from the $1.043 trillion cap in the BCA.

President's Immigration Reforms Limit PPACA Coverage

The President unveiled an outline of how he will urge Congress to reform the nation’s immigration laws. Of note, the recommendations would prevent undocumented immigrants with provisional legal status from being eligible for health coverage under the Patient Protection and Affordable Care Act’s (PPACA) health insurance exchanges, including premium subsidies. Medicaid would also not be made available to such individuals. Under current law, the PPACA would make non-citizens eligible for such benefits if they are “aliens who are lawfully present” in the United States.

GOP Threatens Subpoena of Treasury/IRS Premium Subsidy Decision

House Ways and Means Committee Chairman Dave Camp (R-MI) and House Oversight and Government Reform Committee Chairman Darrell Issa (R-CA) renewed their previous threat to subpoena the Treasury Department and IRS if the agencies do not release non-redacted records about how the agencies arrived at their decision to allow premium tax subsidies not only through state-run health insurance exchanges, but through the default federally-run exchange as well. The PPACA reads that such subsidies are to be available to individuals when accessing health coverage only “through an exchange established by the state.” Rep. Scott DesJarlais (R-TN) said his legislation to clarify the law, if passed by the House, might encourage the Supreme Court to take a hard look at the regulation and “the seriousness of the breach of constitutional rule and what the IRS did in circumventing Congress.”

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