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 Promotes PPACA Gains in State of the Union Address

In last week’s State of the Union Address (SOTUA), the President overlooked the problems with his signature health care law and touted its benefits, including the coverage of 9 million individuals who “won’t have to lose everything” if they get sick, students’ coverage until age 26 under their parents’ policies, the elimination of pre-existing condition exclusions, gender-neutral premiums and helping keep Medicare premiums “flat”. He also praised Kentucky Governor Steve Beshear (D), who was in the audience, for his efforts to get his state-based health insurance exchange up and running successfully. Of note, the President did not reference the HealthCare.gov website when he urged “every American who knows someone without health insurance to help them get covered by March 31st”. The President also promised to address veterans’ health care issues, particularly mental health problems for returning veterans. Egging Republicans for what the President said is their 40+ votes to repeal the Patient Protection and Affordable Care Act (PPACA), he also challenged them “Now I don’t expect to convince my Republican friends on the merits of this law. But I know that the American people aren’t interested in refighting old battles….So again, if you have specific plans to cut costs, cover more people and increase choice, tell America what you’d do differently. Let’s see if the numbers add up….” Although the President did not mention the need for PPACA “fixes”, the Senate Majority Leader, Harry Reid (D-NV), mentioned that he may be open to allowing some Democrat sponsored “fixes” to be offered for a vote in the senate. A possibility is a measure supported by Senator Jeanne Shaheen (D-NH) that would extend the March 31st enrollment date by several months to help individuals avoid the tax penalty for failure to obtain health coverage by that date.

Republicans Respond to SOTUA

Responding to the President, House Republican Conference Chair Cathy McMorris Rodgers (R-WA) criticized the PPACA for increasing premiums and said “whether you’re a boy with Down Syndrome or a woman with breast cancer” you should be able to find coverage and a doctor who will treat you.” She said “No, we shouldn’t go back to the way things were, but this law is not working….” The Tea Party also chimed in with Senator Mike Lee (R-UT) saying “When it comes to health care, we know the best way to repeal Obamacare is to deliver better solutions. We can’t just return to the old system. Health care policy used to give too much power to insurance companies; Obamacare now gives far too much power to government. We know that real reform will put health care dollars and decisions where they belong: in the hands of patients and families and their doctors and nurses….” On the eve of the President’s speech, Senators Hatch (R-UT), Burr (R-NC) and Coburn (R-OK) announced they are asking the health care community to work with them to fashion an alternative to Obamacare, legislation they dubbed “The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act”. They said the Patient CARE Act would be a legislative roadmap to fully repeal Obamacare and replace the law with common-sense measures that would: “Establish sustainable, patient-centered reforms” by:

  • Adopting common-sense consumer protections (e.g. one-time open enrollment and 5:1 age bands);

  • Creating a new protection to help Americans with pre-existing conditions (e.g. COBRA-like continuous-coverage/preexisting-continuous rules);

  • Empowering small business and individuals with purchasing power (e.g. tax credits for individuals and businesses with 100 or fewer employees);

  • Empowering states with more tools to help provide coverage while reducing costs (e.g. auto-enrollment with individual opt out);

  • Expanding and strengthen consumer directed health care;

  • “Modernize Medicaid to provide better coverage and care to patients” by transitioning to capped allotments to provide states with predictable funding and flexibility (e.g. allowing tax credits to pay for private coverage for Medicaid-eligible individuals);

  • Reauthorizing Health Opportunity Accounts to empower Medicaid patients;

  • “Reduce unnecessary defensive medicine practices and rein in frivolous lawsuits” through Medical Malpractice reforms;

  • “Increase health care price transparency to empower consumers and patients” by requiring basic health care transparency to inform and empower patients; and

  • “Reduce distortions in the tax code that drive up health care costs” by capping the exclusion of an employee’s employer-provided health coverage [to help pay for the new tax credits].

Although the Patient CARE Act would repeal the PPACA’s individual and employer mandates and the taxes on insurers and medical devices, it would apparently not repeal the provisions allowing student’s to continue coverage under their parents plans, the expansion of Part D drug coverage and Medicare preventive care benefits. After the Hatch/Burr/Coburn initiative was announced, Senate Minority Leader Mitch McConnell (R-KY) revealed that a request was made to the Republican Governors Association for their ideas on how to replace the health law. The House Majority Leader, Eric Cantor (R-VA), also wound up the House Republican Legislative Retreat by saying the House will attempt to advance a vote on legislation that would repeal and replace the PPACA. While not endorsing any legislation already introduced, the discussion revolved around “guiding principles” involving high-risk pools, portability of health coverage across state lines, medical liability reform and expanded health savings accounts.

February 3, 2014: | Page 1 Page 2 Page 3 Page 4



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