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.


Government Shutdown Looms on Monday

Last week on a 54-44 party-line vote (not voting were Senators Hatch (R-UT) and Flake (R-AZ)) the Senate amended H.J.Res. 59, the House-passed fiscal year (FY) 2013 continuing resolution (CR) to remove the provisions defunding the Patient Protection and Affordable Care Act (PPACA) and prioritizing principal and interest on the government debt in the event the debt limit is not raised in October when the U.S. Treasury exhausts “extraordinary measures” to pay the nation’s outstanding obligations. Before recessing until 2 p.m. Monday, the Senate also changed the short-term date through which spending can continue to November 15th. In turn the House used a weekend session to amend the Senate-passed CR to defund the PPACA for one year with exceptions, repeal the health law’s medical device tax (the 248-174 vote would result in a $29 billion cost over ten years) and again extend federal funding at an annualized rate of $986.3 billion until December 15th. The 231 to 192 final vote on the CR refined the one year delay of the individual mandate and exchanges by allowing the provisions already in place (coverage of children up to age 26, etc.) to move forward and also allowing certain entities to deny abortion coverage based on religious or moral objections. If the Senate and House fail to agree to a CR today (September 30th), the end of this fiscal year, a partial government shutdown would occur resulting in about one-half of all Health and Human Services (HHS) and defense department employees being furloughed. The House also used the weekend session to take up additional legislation, including the passage by voice vote of H.R. 3204, the Drug Quality and Security Act, under suspension of the rules. House Energy and Commerce Committee Chairman Fred Upton (R-MI) said the Drug Quality and Security Act is a bipartisan effort to strengthen and secure the nation’s pharmaceutical distribution supply chain by clarifying the FDA’s authority to regulate and oversee compounding pharmacies and by creating a uniform national standard for drug supply chain security. However, plans by House Republican leaders to bring up a bill to increase the federal debt limit containing offsets in federal spending was delayed and could be brought up this week pending an agreement in the Republican conference. President Obama reiterated his stance to sign only a “clean” CR and debt ceiling increase. He said the Republican vote to defund PPACA in the CR amounted to a vote to shut down the federal government and that he would not give in to such “blackmail”.

PPACA Implementation Continues to Stumble

Even as congressional Republicans seek to delay for one year the effective date of the Patient Protection and Affordable Care Act (PPACA) until 2015, the Administration announced several additional delays of its own. HHS said enrollment under the Small Business Health Option Program (SHOP) for employers with 50 or fewer workers would be delayed until November and that online Spanish language enrollment under exchanges would begin later in October. It was also reported that Medicaid applications will not be able to be electronically transferred to states from the federally facilitated exchanges (FFEs) until November. The Treasury Inspector General (IG) for Tax Administration also reported that the Internal Revenue Service (IRS) failed to account for a portion of the funding that it used between 2010 and 2012 to implement the health law. Despite the delays, HHS said that an average of 53 health plans will be made available in 36 FFEs and that premiums will generally be lower than projected. Republicans also continue to question the IRS/Treasury about the adverse effect they say the PPACA tax on insurers will have in increasing small business and individual health insurance premiums.

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