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 Signs Budget Deal Negotiated in Senate

Before recessing until October 28, late Wednesday night (a day before the deadline for raising the federal debt ceiling) the Senate voted 81-18 to pass the Continuing Appropriations Act of 2014 (H.R. 2775) and the House voted 285-144 in agreeing to the budget deal negotiated by Senate Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY). The President supported the proposal and he signed the legislation into law, Public Law 113-046. In addition to the health-related provisions described below, the legislation ends the shutdown of the federal government by providing appropriations at the current $986.3 billion level through January 15, 2014 and also includes provisions allowing the Treasury to avoid violating the federal debt ceiling until February 7, 2014 (excluding House demands that Treasury be prohibited from using “extraordinary” measures to avoid default after establishing the new debt ceiling as of February 8th). The Senate deal was necessitated after the House abandoned efforts earlier in the week to obtain a Republican majority on legislation that would condition further appropriations and the lifting of the debt ceiling with provisions changing the Patient Protection and Affordable Care Act (PPACA). Regardless, the President publicly stated his opposition to any deal that included substantive changes to his signature health law. Of note, none of the changes to the PPACA demanded by Republicans were included in the law (that is, defunding the law; delaying the individual mandate; delaying the reinsurance tax on insurers; eliminating the Independent Payment Advisory Board (IPAB); eliminating federal employer contributions for the President, Vice President, Senators and House members who would have to elect coverage under the law’s health insurance exchanges; delaying the tax on medical devices; etc.). House Speaker John Boehner (R-OH) said “we fought the good fight, but we did not win” regarding the tactic to attack the PPACA by shutting down the government. Senator Mitch McConnell went further by declaring that the tactic would not be allowed again on the continuing resolution needed to fund the federal government after January 15th. He also lauded the “importance” of continuing the sequestration provisions of the Budget Control Act in the deal. The only PPACA-related provision included is one that requires the HHS Secretary to certify to Congress by January 1, 2014 that the PPACA health insurance exchanges are using effective procedures to verify income eligibility before making tax credits or cost-sharing reductions available to covered individuals. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is also required to report to Congress by July 1, 2014 on how effective the procedures are in preventing fraud. Additional spending provisions included in the new law provide: $2.5 billion for the Veterans Benefits Administration to help eliminate the backlog of disability claims; authority for HHS to obligate funds to ensure timely execution of planned advanced research and development contracts and the procurement of health security countermeasures associated with the Biomedical Advanced Research and Development Authority (BARDA); for the reimbursement of a state (or another federal grantee) that used its funds to continue carrying out a federal program during a lapse of appropriations and for the compensation of their furloughed employees; that agencies report to their IG the cost and number of employees attending conferences and prohibits the use of federal grants or contracts to defray the costs of such a conference not directly and programmatically related to the purpose of such a grant or contract; and back-pay for health-related and all other federal employees affected by the government shutdown.

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