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.


Immigration Reform Passes Senate

Before Congress recessed for the July 4th recess, the Senate voted 68-32 to pass S. 744, immigration reform legislation that would authorize billions in new funding to strengthen border security and provide a new legal roadmap for illegal immigrants to earn citizenship. Three new categories of immigration status would be created: registered provisional immigrants (RPIs); “blue card” farm workers; and “non-immigrant” V-visa status for individuals whose family members have filed immigrant visa petitions on their behalf. However, individuals obtaining such status would not be eligible immediately for federal health benefit entitlements under Medicaid, the Children’s Health Insurance Program (CHIP), and the Patient Protection and Affordable Care Act (PPACA). In general, RPIs would have to wait for a minimum of 10-15 years to obtain lawful permanent resident status or full citizenship to be eligible for federal subsidized health coverage under such programs. Nonetheless, RPIs would be able to obtain non-subsidized coverage in PPACA health insurance exchanges. House Speaker John Boehner (R-OH) said the bill was “dead on arrival” in the House which he said will proceed to mark up several incremental reform bills instead. The divide in the House and Senate over immigration reform is also present with respect to the outstanding appropriations spending bills. The House is poised to take up H.R. 2410, the Agriculture/Food and Drug Administration (FDA) fiscal year (FY) 2014 appropriations bill, when it returns during the week of July 8th.

Veterans' Legislation Advances

The House Veterans’ Affairs Subcommittee on Oversight and Investigations unanimously passed several health-related bills last week: H.R. 1792, legislation that would require the Veterans Administration (VA) to disclose all cases of certain infectious diseases diagnosed at VA health facilities in accordance with state law and allow state fines to apply for such failures; and H.R. 1490, legislation that direct to VA to develop regulations, with several exceptions for MRIs and ultrasound procedures, ensuring that VA patients cannot be subject to “visual recording” during their treatment without their informed consent or under specific circumstances such as a court order.

Republicans Continue Attacks on PPACA as Businesses Ask for Law's Delay

At a hearing last week on the PPACA held by the House Energy and Commerce Oversight and Investigations Subcommittee, representatives of the U.S. Chamber of Commerce, the National Retail Federation and the National Federation of Independent Businesses testified that Congress should take action to delay the implementation of the PPACA, particularly as its provisions relate to employer-sponsored group health plans (such as the broad definition of minimum “essential health benefits”). In general, many business organizations are urging Congress to change the definition of “full-time employee” from 30 hours to 40 hours in order to head off what they say could be a move by businesses to reduce employee work hours below 30 to avoid the employer health coverage mandate. Of note, former Centers for Medicare and Medicaid Services (CMS) Administrator Mark McClellan discussed a report, “Health Care Solutions from America’s Business Community: The Path Forward for U.S. Health Reform,” which includes recommendations for more flexibility for group health plans under the PPACA to achieve greater value in health care, more affordable coverage options and greater access to higher quality, prevention-oriented care. In addition, Republicans on the House Ways and Means Committee sent a letter to Department of Health and Human Services (HHS) Secretary Kathleen Sebelius asking for a response by July 12th as to how the agency will ensure that an individual’s personal and health information will be protected in the Federal Data Services Hub that will be established to implement PPACA health insurance exchanges/marketplaces expected to begin operations in October.

HHS Says Exchanges Will be Open for Enrollment on Time

CMS announced that the HealthCare.gov website has been updated to contain new consumer information and features and that a 24-hour toll-free marketplace call center will be available to provide consumers with educational information until October 1st when the call center will begin assisting them with plan selection and the completion of applications. HHS will soon provide community health centers with $150 million in grants to help with PPACA outreach and enrollment. In August, $54 million in grants will be awarded to “navigators” who will assist people in enrolling under the federal backup exchange. HHS also announced that over 120 health insurers have indicated their interest in participating in the federally operated online marketplaces opening for enrollment on October 1st. Although HHS does not have the authority to reject proposed insurer rates, plans proposing “outlier” rates will be referred to state insurance departments for any actions that they may seek to take under state law.

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