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.


Leaders Mull Length of Continuing Resolution (CR)

With the President’s statements urging Congress to spend more to improve jobs numbers and congressional GOP leaders’ retort that the President is mocking policies that would actually increase employment, little agreement can be expected on fiscal year (FY) 2014 appropriations when Congress returns September 9th. It was reported that House Speaker John Boehner (R-OH) will likely seek to pass a CR in September which extends federal funding for a period of two months or less, while Senate Democrats would like the CR to last for at least six months which would move any discussion of a long-term deal on taxes and entitlement spending into the next session of congress. On the other hand, the House may be intent on using the need to increase the federal debt ceiling in December as leverage to make broader spending changes. The idea that the House will insist on provisions to defund Obamacare was debunked by both House Majority Leader Eric Cantor (R-VA) and House Budget Committee Chairman Paul Ryan (R-WI). If the past is prologue, however, the House and Senate are likely to conference and reach agreement this fall on the Defense spending bill for FY 2014.

Congressional Members and Staff Get Relief Under Obamacare

Erasing the possibility that congressional members and their “official office” staff would lose the federal employer contributions to their current health coverage under the Federal Employees Health Benefits Program (FEHBP), the Office of Personnel Management (OPM) released a proposed “Grassley Amendment” rule providing for such contributions to be continued when they are required to purchase coverage next year in the health insurance exchanges established under the PPACA. If members and staff meet the current eligibility requirements for continued employer payments at retirement, the rule states that future employer contributions will be made only if such individuals continue to obtain health coverage from the exchanges. They also would be prohibited from re-enrolling in the FEHBP, although the employer contributions to the chosen exchange plan would be based on the current FEHBP rules.

CMS Guidance on Exchanges

The Centers for Medicare and Medicaid Services (CMS) released a frequently asked questions (FAQs) document which specifies the rules under which state-based health insurance marketplaces would be obligated to verify the income of exchange enrollees in order to determine their eligibility for federal tax credits based on income. In general, exchanges would have to use data from tax filings and Social Security, as well as electronically available wage information in certain circumstances, to verify household income information provided on an application for tax subsidies. However, for 2014 only, if an applicant’s self-reported income is less than 90% of the most recent income data from the Internal Revenue Service (IRS), state exchanges would be relieved from having to further verify household income under certain conditions. Nonetheless, full verification of income would have to be made in the 34 states in which the federal government will operate federally facilitated exchanges (FFEs). In related news, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said the agency will not be spending much time or effort to rebut the actions being taken by FreedomWorks and other organizations to dissuade young adults from enrolling under the health insurance exchanges established under the PPACA, but will be ramping up the educational efforts already underway to encourage enrollment, including the ability to set up personal accounts under the FFE-related website. Significant hurdles still remain before the exchanges begin enrollment procedures on October 1st. According to a recent HHS Office of Inspector General’s report, the data services hub that will be used as a conduit for patient information exchanged between the IRS, Social Security Administration (SSA), other federal agencies and the federal and state exchanges may contain unidentified security risks and a lack of timely testing and correction could delay the release of such data.

Alternatives to Obamacare

Although the prospects for a repeal of the entire Patient Protection and Affordable Care Act (PPACA) are slim to none during the tenure of President Obama, the House Republican Study Committee is said to be intent on releasing an alternative to the PPACA this fall. Also, a report commissioned by American Enterprise Institute (AEI) sets forth another set of criteria that would replace the current law. In general, the proposal would: eliminate insurer mandated community rating; provide for government-financed premium support; eliminate legal and practical barriers to allow health insurance policies to be renewed for periods of more than one year; and raise about $300 billion in revenue by repealing the current tax exemption for employees who purchase employer-provided health coverage. On the Medicaid front, the state of Arkansas has submitted a proposal to CMS asking for a waiver allowing the state to use Medicaid funding to enroll Medicaid eligible individuals in health plans offered under the state PPACA health insurance exchange (a form of “premium assistance”).

Members Object to CMS Proposed Cuts in Dialysis Payments

Over 200 members of the House of Representatives sent a bipartisan letter to CMS which expresses their concern that the $970 million in proposed cuts to Medicare dialysis facility payments could result in the closure of many facilities, thus threatening access to needed patient care. Reps. Diane Black (R-TN), John Lewis (D-GA), John Shimkus (R-IL) and Ben Ray Lujan (D-NM) urged CMS to consider its “full statutory obligations” when finalizing the rule to ensure that the final payment amounts do not fall below the actual costs of providing such care.

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