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.


Budget Resolution, Sequestration, Appropriations and Debt Limit Issues Converge

Congress returns this week without agreement on Fiscal Year (FY) 2014 spending levels and whether or not to scale back the defense and non-defense Budget Control Act (BCA) mandated sequestration levels going forward. Absent an agreement between the House and Senate on FY 2014 federal spending levels, House appropriators may have little choice but to proceed with subcommittee markups that reflect the House budget resolution cap of $967 billion while Senate appropriators may attempt to move bills totaling a larger $1.058 trillion spending cap. Because sequestration has already lowered monthly federal spending and the U.S. Department of Treasury has reported higher than anticipated revenues, the showdown over raising the federal debt ceiling may be pushed to later this summer or even into October. House Republicans can be expected to use the debt limit issue as leverage to help obtain a major agreement on “revenue neutral” tax reform and FY 2014-2023 spending levels. Absent a bicameral budget agreement, Republicans and Democrats will continue to wrangle over the extent to which to extend the effects of sequestration on defense and non-defense spending.

PPACA Attacked and Defended

According to House Majority Leader Eric Cantor (R-VA) the House will again take up legislation to fully repeal the Patient Protection and Affordable Care Act (PPACA), although a specific timetable has not been set. Pending a whip vote count, House Republicans may also try to bring to a vote, H.R. 1549, the “Helping Sick Americans Now Act,” which would transfer funds from the Prevention and Public Health Fund to the Pre-existing Condition Insurance Plan (PCIP). Also, there appears to be bipartisan support in both chambers to repeal the PPACA’s Independent Payment Advisory Board (IPAB). Once the 15 members of the IPAB have been nominated and confirmed by the Senate, the Board could make recommendations beginning in 2014 to keep the rising costs of Medicare within targeted growth rates; however, the President has yet to make the required nominations. In any event the acting CMS Chief Actuary has indicated that his office’s current 5-year projections of Medicare per-capita spending increases of 1.15% do not exceed the 3.03% growth target and are, therefore, insufficient to trigger IPAB cost-cutting recommendations next year. This finding may serve to further defer any congressional action regarding the IPAB. In another knock on the PPACA’s provisions requiring members and staff to obtain their health insurance coverage under the newly established exchanges in 2014, House Ways and Means Committee Chairman Dave Camp (R-MI) and other Republicans introduced H.R. 1780, legislation that would require all federal employees, including the President and Vice President, to obtain coverage through PPACA health insurance exchanges. At a press conference, President Obama also weighed-in to fend off criticism of the law’s implementation, most recently from Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, who said at a recent hearing that he feared a “huge train wreck” as the 2014 effective date approaches. The President said “Even if we do everything perfectly, there will still be glitches and bumps, and there will be stories that can be written that say, oh look, this thing is not working the way it’s supposed to, and this happened and that happened. And that’s pretty much true of every government program that’s ever been set up.”

CMS Issues Short Form for Online Health Coverage

The Centers for Medicare and Medicaid Services (CMS) released revised shortened application forms, for singles and families, that consumers can access online to enroll under health insurance exchanges, Medicaid and CHIP. Open enrollment begins on October 1 for calendar year (CY) 2014 plan years. In related news, CMS awarded a Virginia health information technology company to operate a call center in at least 34 states to respond to questions on federally-facilitated and partnership exchanges as well as Medicare and Medicare Advantage programs.

Small Businesses Seek Court Relief from PPACA Penalties

A group of small businesses operating in several states deciding to forego state-run health insurance exchanges (i.e. Kansas, Missouri, Texas, Tennessee, Virginia, and West Virginia) have filed suit in the U.S. District Court for the District of Columbia seeking to nullify certain employer provisions under the PPACA. Their complaint says that the IRS regulations giving premium subsidies to individuals in the 33 states abdicating their role to operate health insurance exchanges violates the plain language of the PPACA. The plaintiffs believe the court should enjoin the IRS from assessing the $2,000 penalty for each of their employees who do not participate in their own health plan and instead obtain coverage under the default federally-facilitated-exchanges. In related news, the Treasury/Internal Revenue Service (IRS) released proposed rules defining the circumstances under which individuals will not be eligible to receive premium tax credits under all exchange types. Such individuals would be ineligible if they are eligible for coverage under an employer-sponsored plan that meets “minimum value” requirements. Each plan must determine total plan costs using a standard population and would meet the minimum value rule if the employer pays at least 60% of such costs.

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