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 Wraps Up Legislation Before August Recess

Before recessing for the month-long “district work period”, the House passed two election year statements regarding taxes: H.R. 6169, The Pathway to Job Creation through a Simpler, Fairer Tax Code Act which would fast-track the consideration of comprehensive tax reform early next year; and H.R. 8, the Job Protection and Recession Prevention Act, which extends all of the 2001 and 2003 tax cuts for another year. In addition, the House passed H.R. 1627, legislation to provide medical benefits to individuals exposed to contaminated water several decades ago at Marine Camp Lejeune. The House will remain in pro-forma session throughout the recess because the adjournment resolution failed on a 150 to 265 vote. In the Senate, the Finance Committee passed the recurring tax extenders legislation after a contentious debate to trim tax “earmarks.” Also, the Senate Appropriations Committee approved the FY 2013 Defense appropriations bill which is unlikely to see floor action, given the agreement by House and Senate leaders to take up in September a continuing resolution (CR) to fund federal agencies through next March. The agreement will reflect the $1.047 trillion FY 2013 spending limit adopted last year in the Budget Control Act (BCA). Of note, House Speaker John Boehner (R-OH-08) said that he will immediately call the House back into session if the Senate takes action to avert the “threat” to the economy posed by the BCA defense sequestration and the potential expiration of the Bush tax cuts. The Administration’s line on the scheduled sequestration of defense program spending was to announce that it would exempt personnel from the defense cuts and that it will send out letters to federal agencies over the next few months delineating how they are to administer the sequester. The latter disclosure will be enforced by the enactment of H.R. 5872, legislation requiring the Administration to detail how agency programs will be affected if the Budget Control Act’s $109 billion sequestration is allowed to be implemented next year.

Republicans Unleash Another Shot at PPACA

At a House Oversight and Government Reform Committee hearing on the IRS role under the Patient Protection and Affordable Care Act (PPACA), Chairman Darrell Issa (R-CA-49) said that the IRS acted illegally in issuing a rule which would provide federal premium subsidies and cost-sharing subsidies for low-income participants under the fall-back federal health insurance exchange. Although the health reform law clearly provides for such subsidies under state-run exchanges, a witness from the CATO Institute testified that the law does not provide for such subsidies under the federal exchange and that the legislative history is consistent under this reading of the statute. However, IRS Commissioner Douglas Shulman testified that the regulation “does not rewrite the law….Our legal experts believe this was a correct reading of the law.” Employers with at least 50 employees who are mandated to offer coverage under the PPACA, but who do not, are penalized for each employee who receives federal subsidies under exchanges. The CATO witness said that such employers would face an “illegal tax” in the event the IRS goes forward and penalizes non- complying employers beginning in 2014. On another front, the Government Accountability Office (GAO) responded to a request from Senator Chuck Grassley (R-IA) on the readiness of states for the expansion of Medicaid in 2014 under the PPACA. The GAO report said that states are looking for more guidance from the Centers for Medicare and Medicaid Services (CMS) and that states “reported operational challenges that could affect their ability to meet Medicaid expansion and system development deadlines, such as lengthy state procurement processes, the complexities of developing new systems, coordination of multiple programs and systems, and resource limitations….”

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