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 to Amend House-Passed FY 2013 CR

Last week the House voted 267-151 to pass H.R. 933, an appropriations continuing resolution (CR), including full appropriations measures for the Department of Defense, $32.7 billion for health programs, and for Military-Construction/VA programs, which provides $984 billion to fund federal agencies through September 30th while preserving the $85.3 billion spending cuts under the sequestration mandated by the Budget Control Act (BCA), including the 2% reduction in Medicare reimbursements. House Democrats were critical of the measure which cuts $10 million in funding for the Patient Protection and Affordable Care Act’s (PPACA) Independent Payment Advisory Board and for state Medicaid performance bonuses while ignoring the Administration’s request for $949 million in additional funding to implement PPACA health insurance exchanges and for $567 million to reduce health care fraud and to administer Social Security Income (SSI) and disability benefits.

Senate Appropriations Committee Chair Barbara Mikulski (D-MD) and the ranking member, Senator Richard Shelby (R-AL), were said to be attempting to craft an alternative to be released on Monday which would give all federal agencies under sequestration enhanced transfer and reprogramming authority to allow them flexibility to better prioritize the sequester cuts. House Speaker John Boehner (R-OH) admonished the Senate to be cautious in making any changes to the House bill that are extraneous, partisan or that would constitute a budget gimmick. However, the Senate bill is also expected to include full appropriations measures already reported by one or more Senate appropriations subcommittees, possibly including the Commerce/Justice/Science bill, but not the Labor/Health and Human Services/Education bill. There is rumbling among some Republican senators that they will oppose the CR if they do not get a vote to delay funding for the PPACA. 

If the House and Senate arrive at a compromise before the spring recess, passage of the CR would serve to avoid a shutdown of the federal government when the current CR expires on March 27th. It is possible that increased program flexibility given agencies under the final CR could alter the effects of sequestration on various health programs as outlined by the Office of Management and Budget (OMB) last week. The Centers for Medicare and Medicaid Services (CMS) also released the payment adjustment changes that would apply to low-volume hospitals and Medicare-dependent hospitals.federal health care spending from continuing to grow faster than the economy over the next 75 years. 

Next Budget Debate: FY 2014-2023 Appropriations Levels

Last week the President met with House Budget Committee Chairman Paul Ryan (R-WI) and ranking member Chris Van Hollen (D-MD), in an attempt to open up a new dialogue with congressional Republicans over FY 2014-2023 federal spending and long-term entitlement reform. While Rep. Ryan said afterward that everyone should be part of an “open debate about how best to balance the budget and expand opportunity”, it remains to be seen how the President will respond to the budget resolution Rep. Ryan is expected to release this week. Shades of prior budget blueprints, the House Republican proposal is expected to balance the budget in ten years by including a so-called Medicare premium support program under which beneficiaries would receive a subsidy to purchase either a private health care plan or a traditional Medicare plan, by block-granting Medicaid and by making cuts to food stamp and social service programs, among other cuts to federal program spending. If last year is a guide, the Republican resolution may also include a full repeal of the PPACA. Noticeably bypassing both House Speaker John Boehner (R-OH) and Senate Minority Leader Mitch McConnell (R-KY) in his talks, the President also dined with a dozen Senate Republicans in an attempt to persuade a critical number of them to join forces with Senate Democrats to resurrect a “grand bargain” to trim future deficits by reducing the cost of health programs and raising revenues by closing tax “loopholes”. The timeframe for reaching such a deal is unlikely to extend much beyond the August recess given that the 2014 election season will make negotiations even more difficult. The President has yet to tip his hand on a budget framework and OMB indicates the Administration’s budget recommendations, likely to be shaped along with Senate Democrats, will likely slide into the second week of April. Another hurdle is looming before May 18 when the current $14+ trillion ceiling on the public debt expires.

Pandemic Bill Sent to President

The House and Senate resolved differences on H.R. 307, the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, and sent the bill to the President for his signature. The legislation will facilitate the development of chemical, biological, radioactive and nuclear (CBRN) medical countermeasures and enhance the response to public health emergencies and disasters, including those caused by CBRN attack; and amends the Public Health Service Act (PHSA) to authorize funding for various Department of Health and Human Services (HHS) agencies to support the readiness of the public health system for such emergencies.

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