TRP Health Policy Report
September 29, 2014
The House and Senate are adjourned until after the November 4 elections. Following the midterm elections, members of Congress are expected to return for two weeks before breaking for the Thanksgiving holiday. Lawmakers should next be in session through December, when work will continue on appropriations, expired tax provisions and curbing corporate inversions. Other issues that could be considered during the lame-duck session include defense and intelligence operations reauthorizations, terrorism risk insurance (TRIA) reauthorization as well as bills related to commerce, sanctions and trade.
Tax, Spending Issues Likely to Dominate Lame-Duck Session
When the House and Senate reconvene for this November’s lame duck session, tax and spending legislation are likely to be at the forefront of each chamber’s legislative agenda. On September 18, Majority Leader Harry Reid (D-NV) said that members are likely to tackle both an omnibus appropriations package and a package of expired or expiring tax provisions. Besides working on tax extenders, Senators will push to finish up work on a bill to give states the authority to require online sellers to levy sales taxes on items sold over the Internet, the Marketplace Fairness Act (S. 743). Also on tap will be a full debate on use of the U.S. military to combat the Islamic State, which is likely to occur as part of the debate on the annual Defense authorization bill, senior aides say.
Across Capitol Hill, House Budget Committee Rep. Paul Ryan (R-WI), listed many of the same items as well as a few others House Republicans see on the post-election agenda. Also on September 18, Ryan listed a full-fiscal year funding bill and tax extenders as to-do items, but also included potentially action on terrorism risk insurance and international trade. Less certain is further action on repeal of the Affordable Care Act’s (ACA) medical device tax. House Republicans included a repeal of the 2.3 percent excise tax in the “jobs” package (H.R. 4) the chamber approved on September 19. But despite bipartisan support for device tax repeal, it remains unclear if a lame-duck Senate will move forward on the House-passed jobs bill once it returns from recess.
Despite Criticism, Open Payments Database Set to Launch
Last week, CMS confirmed that the federal “Open Payments” database – which tracks pharmaceutical company contributions to doctors and teaching hospitals – remains on track for its scheduled September 30 launch. The database was created under the Sunshine Act provision of the Affordable Care Act (ACA) and aims to give the public a view of the financial ties between physicians and drug and device manufacturers. But the run-up to the launch has been marked by technical glitches and complaints from industry groups and physicians about the way the agency has handled the database’s release. Last week, three of the biggest industry trade groups complained that they have not had an opportunity to review important background information about relationships with physicians. The Pharmaceutical Research and Manufacturers of America (PhRMA), BIO and AdvaMed expressed concern that CMS has not explained why one-third of the payment information submitted by drug and device makers, as well as group purchasing organizations, was removed from the database.
Two months ago, more than 20 medical societies asked CMS to explain the context that will be provided to help the public understand the justification for payments, such as speaking fees and grants used to fund clinical research. Separately, the AMA and dozens of other medical societies have pressed CMS for additional time to allow doctors to register and review payment data for what they called inaccurate, misleading and false information that may be posted to the database. Earlier this month, 64 health advocacy groups asked CMS to exclude from the database indirect payments they make to doctors. CMS has downplayed critics’ concerns that the problems indicate the database is not ready for public viewing and pledged all data will be posted to the site in June 2015. Shifting deadlines and timelines have afflicted the website for more than a year. In August 2013, CMS said registration for the website would start in the first quarter of 2014. Then, in June 2014, the agency said that the registration period would open sometime in July. Physicians finally were able to register for both portions of the CMS' process starting July 14.
HealthCare.gov Costs Exceed $2 Billion; Administration Reviews 2015 Enrollment Goals
According to a Bloomberg Government analysis released last Wednesday, the total cost of HealthCare.gov is now more than $2 billion – a figure significantly higher than previous estimates. HHS Secretary Sylvia Mathews Burwell recently projected that the cost of HealthCare.gov to be about $1 billion through fiscal year 2015. Meanwhile, the total cost of ACA implementation since 2010 is more than $73 billion, according to the analysis. CMS officials refuted the report, arguing that the 2010 healthcare reform law has been saving money for consumers. An agency spokesperson said that the law is saving $9 billion for exchange enrollees and billions more for reductions in uncompensated care. But ACA opponents were quick to pounce on the news, criticizing the White House over the law’s costs. In a statement, House Oversight Committee Chair Darrell Issa (R-CA) said, “Two billion dollars is an awful lot to pay for a website with lingering security issues that transfers the costs of healthcare from customers to taxpayers.”
In related news, HHS Secretary Sylvia Mathews Burwell confirmed last week that her agency is reassessing how many U.S. residents might sign up for health coverage before it announces its estimate for the second enrollment period beginning November 15. The CBO has estimated that 13 million U.S. residents will have exchange coverage after the end of the second open enrollment period. But last Wednesday, Secretary Burwell said that number might not be correct. She said the agency is working with insurance industry officials and market analysts to gauge the market's performance. Burwell declined to say when a new estimate would be announced. This year, about 7.3 million people paid their premiums for plans sold through the insurance exchanges, surpassing CBO's estimate of six million people. Regardless of a new target, Burwell said the goal is to get coverage to as many of the remaining uninsured people as possible.
Burwell: Insurer Participation in ACA Exchanges to Increase 25%
Last week, HHS Secretary Sylvia Mathews Burwell said that insurer participation in the Affordable Care Act's exchanges will increase by about 25% for the next open enrollment period. According to HHS data, the number of insurance companies offering coverage in the 36 states that rely on the federal health insurance exchange will increase by about 30%, from 191 in the first open enrollment period to 248 in the second period, which begins on November 15. Meanwhile, the number of insurers offering plans in the states and Washington, D.C. that operate their own exchanges will increase by approximately 10%, from 61 to 67. Overall, 13 insurers that offered exchange plans in 2014 have decided not to do so for 2015, while 77 new insurers will be entering the exchanges.
HHS officials said that most states will have at least one more insurer selling health plans under the ACA in the second year of the program's full implementation. Some 33 states out of the 43 where insurers have filed their intentions for the coming enrollment season are set to have a net increase in plans on offer through the law's online exchanges, including two states that only had one insurer for 2014, officials said. The new enrollment season starts November 15 and ends mid-February 2015 for most Americans to shop for coverage and apply for tax credits toward the cost of premiums.
HHS Announces Chronic Disease Initiative
Last Thursday, HHS announced a $200 million initiative to fight chronic diseases. Federal dollars will be awarded to nearly 200 health departments and community health organizations. Chronic conditions like heart disease, obesity, and diabetes account for the overwhelming majority of U.S. healthcare spending, and with the program, HHS hopes to encourage a more proactive approach to patient care. The move is part of the Affordable Care Act’s commitment to improve preventative care and the initiative’s funds come from $12 billion slated to be spent on preventative care through the health reform law over the next ten years.
The awards will be focused on high-risk populations, such as individuals who smoke, eat poorly and do not exercise regularly. About $35 million will support a national program called Racial and Ethnic Approaches to Community Health (REACH). Another $5 million will be devoted to areas where more than 40 percent of adults are obese, including Alabama, Kentucky, Tennessee and Texas. Curbing the rates of chronic disease was a core part of the
When the House and Senate reconvene for this November’s lame duck session, tax and spending legislation are likely to be at the forefront of each chamber’s legislative agenda. On September 18, Majority Leader Harry Reid (D-NV) said that members are likely to tackle both an omnibus appropriations package and a package of expired or expiring tax provisions. Besides working on tax extenders, Senators will push to finish up work on a bill to give states the authority to require online sellers to levy sales taxes on items sold over the Internet, the Marketplace Fairness Act (S. 743). Also on tap will be a full debate on use of the U.S. military to combat the Islamic State, which is likely to occur as part of the debate on the annual Defense authorization bill, senior aides say.
Across Capitol Hill, House Budget Committee Rep. Paul Ryan (R-WI), listed many of the same items as well as a few others House Republicans see on the post-election agenda. Also on September 18, Ryan listed a full-fiscal year funding bill and tax extenders as to-do items, but also included potentially action on terrorism risk insurance and international trade. Less certain is further action on repeal of the Affordable Care Act’s (ACA) medical device tax. House Republicans included a repeal of the 2.3 percent excise tax in the “jobs” package (H.R. 4) the chamber approved on September 19. But despite bipartisan support for device tax repeal, it remains unclear if a lame-duck Senate will move forward on the House-passed jobs bill once it returns from recess.
Despite Criticism, Open Payments Database Set to Launch
Last week, CMS confirmed that the federal “Open Payments” database – which tracks pharmaceutical company contributions to doctors and teaching hospitals – remains on track for its scheduled September 30 launch. The database was created under the Sunshine Act provision of the Affordable Care Act (ACA) and aims to give the public a view of the financial ties between physicians and drug and device manufacturers. But the run-up to the launch has been marked by technical glitches and complaints from industry groups and physicians about the way the agency has handled the database’s release. Last week, three of the biggest industry trade groups complained that they have not had an opportunity to review important background information about relationships with physicians. The Pharmaceutical Research and Manufacturers of America (PhRMA), BIO and AdvaMed expressed concern that CMS has not explained why one-third of the payment information submitted by drug and device makers, as well as group purchasing organizations, was removed from the database.
Two months ago, more than 20 medical societies asked CMS to explain the context that will be provided to help the public understand the justification for payments, such as speaking fees and grants used to fund clinical research. Separately, the AMA and dozens of other medical societies have pressed CMS for additional time to allow doctors to register and review payment data for what they called inaccurate, misleading and false information that may be posted to the database. Earlier this month, 64 health advocacy groups asked CMS to exclude from the database indirect payments they make to doctors. CMS has downplayed critics’ concerns that the problems indicate the database is not ready for public viewing and pledged all data will be posted to the site in June 2015. Shifting deadlines and timelines have afflicted the website for more than a year. In August 2013, CMS said registration for the website would start in the first quarter of 2014. Then, in June 2014, the agency said that the registration period would open sometime in July. Physicians finally were able to register for both portions of the CMS' process starting July 14.
HealthCare.gov Costs Exceed $2 Billion; Administration Reviews 2015 Enrollment Goals
According to a Bloomberg Government analysis released last Wednesday, the total cost of HealthCare.gov is now more than $2 billion – a figure significantly higher than previous estimates. HHS Secretary Sylvia Mathews Burwell recently projected that the cost of HealthCare.gov to be about $1 billion through fiscal year 2015. Meanwhile, the total cost of ACA implementation since 2010 is more than $73 billion, according to the analysis. CMS officials refuted the report, arguing that the 2010 healthcare reform law has been saving money for consumers. An agency spokesperson said that the law is saving $9 billion for exchange enrollees and billions more for reductions in uncompensated care. But ACA opponents were quick to pounce on the news, criticizing the White House over the law’s costs. In a statement, House Oversight Committee Chair Darrell Issa (R-CA) said, “Two billion dollars is an awful lot to pay for a website with lingering security issues that transfers the costs of healthcare from customers to taxpayers.”
In related news, HHS Secretary Sylvia Mathews Burwell confirmed last week that her agency is reassessing how many U.S. residents might sign up for health coverage before it announces its estimate for the second enrollment period beginning November 15. The CBO has estimated that 13 million U.S. residents will have exchange coverage after the end of the second open enrollment period. But last Wednesday, Secretary Burwell said that number might not be correct. She said the agency is working with insurance industry officials and market analysts to gauge the market's performance. Burwell declined to say when a new estimate would be announced. This year, about 7.3 million people paid their premiums for plans sold through the insurance exchanges, surpassing CBO's estimate of six million people. Regardless of a new target, Burwell said the goal is to get coverage to as many of the remaining uninsured people as possible.
Burwell: Insurer Participation in ACA Exchanges to Increase 25%
Last week, HHS Secretary Sylvia Mathews Burwell said that insurer participation in the Affordable Care Act's exchanges will increase by about 25% for the next open enrollment period. According to HHS data, the number of insurance companies offering coverage in the 36 states that rely on the federal health insurance exchange will increase by about 30%, from 191 in the first open enrollment period to 248 in the second period, which begins on November 15. Meanwhile, the number of insurers offering plans in the states and Washington, D.C. that operate their own exchanges will increase by approximately 10%, from 61 to 67. Overall, 13 insurers that offered exchange plans in 2014 have decided not to do so for 2015, while 77 new insurers will be entering the exchanges.
HHS officials said that most states will have at least one more insurer selling health plans under the ACA in the second year of the program's full implementation. Some 33 states out of the 43 where insurers have filed their intentions for the coming enrollment season are set to have a net increase in plans on offer through the law's online exchanges, including two states that only had one insurer for 2014, officials said. The new enrollment season starts November 15 and ends mid-February 2015 for most Americans to shop for coverage and apply for tax credits toward the cost of premiums.
HHS Announces Chronic Disease Initiative
Last Thursday, HHS announced a $200 million initiative to fight chronic diseases. Federal dollars will be awarded to nearly 200 health departments and community health organizations. Chronic conditions like heart disease, obesity, and diabetes account for the overwhelming majority of U.S. healthcare spending, and with the program, HHS hopes to encourage a more proactive approach to patient care. The move is part of the Affordable Care Act’s commitment to improve preventative care and the initiative’s funds come from $12 billion slated to be spent on preventative care through the health reform law over the next ten years.
The awards will be focused on high-risk populations, such as individuals who smoke, eat poorly and do not exercise regularly. About $35 million will support a national program called Racial and Ethnic Approaches to Community Health (REACH). Another $5 million will be devoted to areas where more than 40 percent of adults are obese, including Alabama, Kentucky, Tennessee and Texas. Curbing the rates of chronic disease was a core part of the