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.


President Spurns Republican Attempts to Shut Down Government Over Health Reform Law

The President used a White House press conference to chide Republicans over any attempt they may make to use the fiscal year (FY) 2014 appropriations process to defund the Patient Protection and Affordable Care Act (PPACA). He said “The idea that you would shut down the government unless you prevent 30 million people from getting health care is a bad idea….” Although House Speaker John Boehner (R-OH) has not voiced support for the efforts of 66 House Republicans and Senators Mike Lee (R-UT) and Marco Rubio (R-FL) to include the defunding provision in the continuing resolution (CR) to be taken up when Congress returns in September, several alternative routes may be considered by the Republican conference in the House next month. One would be to include the PPACA defunding provisions in the House FY 2014 CR and leave it to Senate Democrats to send the CR back without the provision, thus forcing a conference on spending levels as well as PPACA defunding. Another approach Republicans might take is to pass a “clean” CR without the PPACA provision and defer to using the upcoming need to increase the federal debt limit as leverage to defer the individual mandate until 2015 (and/or repealing the Independent Payment Advisory Board, medical device tax, etc.). Regardless of the approach, a significant hurdle to reaching a House/Senate agreement over spending will be the extent to which to continue beyond September the lower spending levels mandated under the sequestration elements of the Budget Control Act (BCA).

Concerns Over PPACA Delays

Republicans continued their attacks on the PPACA over the congressional recess, renewing concerns over the “grace period” delay until 2015 of the requirement that “grandfathered” and certain other group health plans/insurers cap out-of-pocket costs ($6,350 for individuals and $12,700 for families) and comply with the employer mandate. House Speaker John Boehner encouraged the Senate to take up the House-passed bill (H.R. 2668) which would also delay the individual mandate and said “This is the bottom line: if the president’s health care law is too complex and costly for big businesses and insurance companies to figure out, American families deserve a break from it as well.” Senator Lamar Alexander (R-TN) said that the “most sensible course is to dismantle and replace this historic mistake and replace it with a step-by-step plan to transform our health care delivery system.” Nonetheless, the Department of Health and Human Services (HHS) said many consumers, including individuals and small businesses, who obtain health insurance under PPACA exchanges will benefit from the cap. Senate Minority Leader Mitch McConnell (R-KY) also sent a letter to the Centers for Medicare and Medicaid Services (CMS) asking the agency to delay the October 1st launch of open enrollment under the PPACA Health Insurance Exchanges over concerns raised by the HHS Office of Inspector General (OIG) that the multi-agency data hub might not be fully functional to secure the personal and financial information shared with the state-run and federally-run exchanges. The Internal Revenue Service (IRS) also released a final rule spelling out how the agency will share taxpayer income and Social Security information with the exchanges. As to the same matter, Senator Orrin Hatch (R-UT) asked the Government Accountability Office (GAO) for a report on the risks the data hub presents in breaching the privacy and identity of exchange participants. Senator Roy Blunt (R-MO) also wrote to HHS Secretary Kathleen Sebelius requesting that the agency release by September the premium rates for health plans to be offered under the federally-run exchanges. Chairman Darrell Issa (R-CA) and Rep. James Lankford (R-OK) of the House Committee on Oversight and Government Reform also threatened Treasury/IRS to comply by August 29 with their request for information on how the agencies arrived at their decision to provide tax credits to individuals under the federally-run exchanges or become subject to a subpoena for the information.

HHS Grants to PPACA Navigators

HHS announced that 105 different navigator groups have been awarded $67 million to help individuals obtain information and enroll under federally-run and state-partnership exchanges/marketplaces.

Request for HHS Written Plan for Stark Self-Referrals

Rep. Jim McDermott (D-WA), the author of the so-called Stark self-referral provisions under the PPACA, sent a letter to CMS asking the agency to submit a detailed plan by October 15th for revising the protocol for the self-disclosure by physicians of actual and potential violations and for reducing the backlog of unresolved disclosures. In a busy week, the congressman also sent a letter to the GAO requesting the agency to investigate recent hospital consolidations which he says may result in less competition and higher costs. The letter is attached and can be found on page 4.

Expanded Medicare Coverage for Certain Pacemakers

CMS released a decision memorandum under which Medicare will allow for the coverage of single chamber or dual chamber pacemakers for treatment of nonreversible symptomatic bradycardia due to sinus node dysfunction and second- and/or third-degree atrioventricular block.

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