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.


Congress to Vote on Final Tax Reform Bill This Week

The House-Senate Conference Committee on the Tax Cuts and Jobs Act (H.R. 1) signed off on the final language of the conference report on Friday afternoon. House and Senate votes are expected to occur this week. Sens. John McCain (R-Ariz.) and Thad Cochran (R-Miss.) have both been absent from the Senate due to health reasons. Reports on Sunday afternoon indicated that Sen. McCain would not be available for the vote; no word yet on Sen. Cochran. Sen. Bob Corker (R-Tenn.), who voted against the Senate tax bill, has announced that he will support the package, despite sending a letter to Sen. Hatch (R-Utah) over the weekend regarding his concerns with the passthrough provisions in the bill. His decision leaves no other GOP senators publically opposed to the legislation. The final tax bill would end the Affordable Care Act’s (ACA) individual mandate requiring that all individuals purchase insurance or pay a fine. The deal does not, however, include the House-passed provision to repeal the medical expense deduction. Instead, the bill would allow for the deduction of medical bills above 7.5 percent of adjusted gross income for two years before restoring the deduction’s income threshold to 10 percent. Lawmakers will still have to take steps to officially waive the PAYGO rule, which would otherwise trigger cuts to Medicare and other federal programs to offset the impact of the tax bill on the deficit. House Democrats are threatening to allow the automatic spending cuts to take effect next year unless individual mandate repeal is removed from the tax bill. Democratic votes are needed in the Senate to waive the PAYGO law.

House Unveils CR to Fund the Government through January 19

The House of Representatives released its plans for a continuing resolution (CR) to fund the government past December 22, when the current CR is set to expire. The short-term spending bill would fund most parts of the government through January 19, while providing full-year funding for the Defense Department. The CR also includes a five-year extension of the Children’s Health Insurance Program (CHIP) as well as the CHAMPIONING HEALTHY KIDS Act (H.R. 3922), which would also extend funding for federally qualified health centers (FQHCs) for two years in addition to reauthorizing other public health programs. The bill is offset through a reduction in federal Medicare subsidies for high-income seniors, by dis-enrolling lottery jackpot winners from Medicaid, and through cuts to the Affordable Care Act’s (ACA) Prevention and Public Health Fund. The offsets have been previously rejected by Democrats.  Additionally, the CR does not include provisions to stabilize the individual insurance market, though House lawmakers have acknowledged that policies such as funding for reinsurance or cost-sharing reduction (CSR) payments could be added by the Senate. Sen. Susan Collins (R-Maine) has made her vote on the GOP tax bill contingent on passage of such legislation before the end of the year. Lawmakers are also considering the addition of a separate disaster relief measure to the CR to provide increased hurricane response funds for Texas, Florida, and Puerto Rico. The plan is set to be voted on this week. It is unclear whether the proposed House CR has enough support to pass the Senate. While the Senate Democrats have decided not to require a compromise on the Dreamers legislation as part of the end of the year package, Democrats are opposed to a funding increase for the Pentagon without a similar increase in non-defense programs. To complicate matters further, it is also unclear whether the House has enough votes to pass a clean CR should the Senate decide to strip the defense appropriations from the bill. The health committees previously released bipartisan plans to address a variety of expired or soon-to-be expired Medicare extenders which could be addressed before the end of the year.

Ways and Means Members Introduce Legislation to Repeal ACA Taxes

Republicans on the House Ways and Means Committee have introduced several bills to delay a number of Affordable Care Act (ACA) taxes scheduled to take effect in 2018. These targeted introductions provide a potential pathway for their inclusion in an end-of-the-year legislative package. The following bills were introduced last week: H.R. 4616, to provide three years of retroactive relief and one year of prospective relief from the employer mandate, along with a one-year delay of the Cadillac tax; H.R. 4617, to provide relief from the medical device tax for five years; H.R. 4618, to eliminate health savings account (HSA) restrictions on over-the-counter (OTC) purchases for two years; H.R. 4619, to repeal the health insurance tax for all plans in Puerto Rico for two years; and H.R. 4620, to repeal the health insurance tax in 2018 through rebates to consumers and then directly to all plans in 2019. The legislation introduced last week does not include any offsets.

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