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.


House Labor/HHS Appropriations Subcommittee Approves FY 2013 Spending Bill

On an 8-6 vote the House Labor/HHS/Education Appropriations Subcommittee approved the draft FY 2013 spending bill containing $150 billion in discretionary funding ($6.3 billion less than in FY 2012 and $8.8 billion less than the Administration’s request). Under the bill, HHS would receive $68.3 billion ($1.3 billion less than last year and $1.8 billion less than the Administration’s request). The bill would scale back PPACA funding by $123 billion over five years by eliminating: $1.6 billion for the Medicare and Medicaid Innovation program; $1 billion for the Prevention and Public Health Fund; $3 billion for the Consumer Operated and Oriented Plan program; $300 million for community health centers; and $150 million for the Patient-Centered Outcomes Research Trust Fund; and all funding for the Independent Payment Advisory Board and the Center for Consumer Information and Insurance Oversight. An attempt by Democrats to strike this provision was defeated along party lines. The bill would also eliminate Title X funding for medical services such as for contraception and cancer screenings for low-income women and preclude funding for Planned Parenthood unless the organization affirms it will not perform or provide referrals for abortions. HHS agencies would receive the following: $3.5 billion for CMS (about $409 million less than for FY 2012); $30.6 billion for NIH (about the same as for FY 2012); $16.4 billion for the Administration for Children and Families; $5.75 billion for CDC; and $3.1 billion for the Substance Abuse and Mental Health Services Administration. The bill would also allow insurers and sponsors of group health insurance plans to refuse coverage for any health services “on the basis of religious beliefs or moral convictions.” Also included is about $20 million in grant funding for abstinence-only sex education programs. While the bill may be taken up in full committee this week, it remains to be seen when the bill will be taken up in the House. The $8.8 billion difference with the Senate bill will guarantee that the Labor/ HHS appropriations bills will not see a House/Senate conference.


funding from defense operational accounts to cover the cost of brain injury, vision and eye, spinal cord and Gulf War Illness research. The bill also provides funding for suicide prevention programs and prohibited certain enrollment fees for TriCare. This bill, Labor/ HHS and other unfinished FY 2013 appropriations bills will likely be put on hold until after the election subject to the passage of a short-term continuing resolution. With sequestration looming, the House also passed the Sequestration Transparency Act of 2012 (H.R. 5872), legislation designed to force the Administration within 30 days of enactment to provide specifics as to the budget hit that each federal program will take if the Budget Control Act sequestration is allowed to go forward unchanged next year. The CBO has warned about a new recession unless Congress comes up with a plan that prevents both steep tax hikes and the across-the-board spending cuts. Also, the Chairman of the Federal Reserve told the Senate Banking Committee that Congress needs to act sooner rather than later.

Senators Kelly Ayotte and Carl Levin

suggested that the sequestration could be delayed as part of an upcoming continuing resolution.

Final Reporting Rule for Essential Benefits

HHS issued a final rule under which the three largest small group health insurance plans in each state will be required to report benefit, treatment, drug coverage and enrollment information on covered benefits. The information will enable HHS to determine the minimum “essential health benefits” to be offered under PPACA health insurance exchanges. A rule issued by the IRS states that PPACA low-income subsidies are to be made available to eligible individuals choosing essential benefit health plans in state-run exchanges as well as in the default federally run exchange. However, a paper to be published by authors Jonathan Adler and Michael Cannon maintains that a reading of the PPACA does not allow for the subsidies to be legally provided under the federal exchange operated in states which do not establish their own exchanges

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