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.


Health Targeted in House FY 2013 Budget Cuts

Before recessing for this week, the House Energy and Commerce Committee voted mainly along party lines to pass the Republican FY 2013 spending proposal which includes cuts to the PPACA and Medicaid.  The PPACA spending reductions include: repealing the Prevention and Public Health Fund (see House double-down on this move below); eliminating grants to states for establishing health insurance exchanges; canceling funding for consumer-governed health insurance plans, CO-OPs; and eliminating scheduled bonuses to hospitals that serve low-income patients.  The Medicaid provisions include: repealing the PPACA mandated maintenance-of-effort requirements for Medicaid and SCHIP eligibility; repealing the increase in the Medicaid matching rate for U.S. territories from 55% to 50%; reducing the state provider tax threshold from 6% to 5.5%; and eliminating performance bonus payments to states that increase their enrollment of children in Medicaid.  In addition, both the House Energy and Commerce Committee and the House Judiciary Committee approved restrictions on state medical malpractice cases along the lines of H.R. 5 as passed by the House.  The Energy and Commerce Committee did not adopt the Ryan budget proposal to change Medicare to a so-called premium support system.  However, the committee held hearings on the issue during which several witnesses said the premium support approach is the only bipartisan way to address Medicare insolvency.  The committees’ provisions will be packaged together with the reconciliation instructions approved by other committees, pursuant to the House budget plan (H.Con. Res. 112), and sent to the House floor sometime in May.  In accord with the Republican budget plan, the House Appropriations Committee released their recommendations for the twelve FY 2013 appropriations bills to be acted on by the House this summer.  It is likely the Labor, Health and Human Services and Education bill, which would cap spending at $150 billion ($6.3 billion less than this year), will again be the last bill considered.  The House is expected to spend about $8 billion more on defense than the Senate with offsets coming mainly from Labor, Health and Human Services.  This move is designed to head off the first year of $500 billion in 10-year cuts to defense under the Budget Control Act  mandate.  Of note, Office of Management and Budget told the Government Accountability Office that the Budget Control Act’s automatic sequestration cuts will not apply to Veterans Affairs health programs.  Without agreement with the Senate on the level of Labor, Health and Human Services cuts, as is expected, a continuing resolution could be in the cards in order to fund government until after the November elections.

Student Loan Bill Repeals Prevention and Public Health Fund

As part of a 215-195 vote in the House to pass H.R. 4628, legislation to maintain the Stafford student loan rate at current levels for one year, the cost of the bill was offset by repealing the PPACA Prevention and Public Health Fund.  The PPHF has been targeted by House Republicans in reconciliation (see above) and in a previous measure to extend the payroll tax break this year.  The White House issued a Statement of Administration Policy (SAP) pledging to veto the student loan bill if it includes the PPHF repeal.

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