TRP Health Policy Report
February 9, 2015
Last Monday, President Obama sent his fiscal 2016 budget request to Congress, and Cabinet officials spent the week explaining the details to House and Senate committees. HHS Secretary Sylvia Mathews Burwell appeared before the Senate Finance Committee last Wednesday to take questions about the Administration’s funding proposal and the implementation of the Affordable Care Act (ACA). In legislative activity, Senate Democrats blocked action on a bill (H.R. 240) to fund the Department of Homeland Security to protest Republican language on immigration. The 52-47 vote last Thursday, with 60 required to advance the bill, repeated similar votes held Tuesday and Wednesday. Passed last month by the House, the measure funds the agency through the remainder of the budget year while rolling back President Obama's executive actions to shield some immigrants from deportation. Separately, the Senate voted 99-0 for a bill (H.R. 203) to provide additional mental health and suicide prevention services for veterans. The bill now moves to the White House for the President's signature.
In the House, members voted 239-186 to repeal the Affordable Care Act (ACA), the latest effort by the Republican-controlled chamber to scrap the law. Passed last Tuesday, the measure (H.R. 596) also would direct House committees to develop a replacement for the healthcare reform law. The House-approved bill likely will be defeated in the Senate – where the GOP has a smaller majority- and faces a certain White House veto. Several committee chairmen quickly responded with a framework for a replacement plan. Senate Finance Chairman Orrin Hatch (R-UT) and House Energy and Commerce Chairman Fred Upton (R-MI) unveiled a blueprint last Thursday for repealing the ACA and replacing it with a proposal the lawmakers said would reduce healthcare costs, improve quality and expand coverage. In other floor activity, House members voted 260-163 for a bill (H.R. 527) requiring federal agencies to measure the costs of regulations on small businesses. Last Thursday's vote was for the second bill on the floor last week to reform the regulatory process. The House passed legislation (H.R. 50) on Wednesday to require federal agencies to report the full economic effects of regulations in a 250-173 vote.
The Week Ahead
This week, partisan jockeying is expected to continue over a Homeland Security funding bill (H.R. 240) that would reverse President Obama’s immigration policies. Senate Democrats say they won't agree to the bill unless all the immigration language is removed. Republicans say such a bill won't pass the House. Leaders in both chambers insist they will not allow DHS to go without funding. Aides say the likeliest scenario may be a short-term funding extension. Congress must pass a new spending bill for DHS by Feb. 27 or the agency will shut down. The Senate may also take up a House-passed bill (H.R. 527) that would repeal the Affordable Care Act and call for a replacement. In the House, members are likely to approve Senate-passed legislation (S. 1) that would force approval of the Keystone XL oil pipeline, setting up a veto confrontation with President Obama. The House easily passed similar legislation in January. But the Senate added a number of amendments, necessitating another House vote. The House also plans to vote on two packages of bills (H.R. 644/H.R.636) to permanently extend sections of the tax code.
Off the floor, the Senate HELP Committee holds a hearing Tuesday on the re-emergence of vaccine-preventable diseases. In the House, the Energy and Commerce Oversight panel meets Wednesday to examine federal mental health services. That same day, E&C’s Health Subcommittee will review the status of ICD-10 implementation, while an Appropriations panel examines international investments to fight Ebola. Finally, stakeholder comments on the discussion draft of House Energy and Commerce Committee Chairman Fred Upton’s 21st Century Cures legislation are due tomorrow, Tuesday, February 10.
President Obama's Fiscal 2016 Budget Proposal To Fully Fund ACA
Last Monday, President Obama unveiled a $4 trillion budget request for fiscal year 2016 that includes a number of health care initiatives, including full funding for the Affordable Care Act. The President’s proposal calls for HHS to receive about $1.09 trillion for fiscal 2016, up from $1.04 trillion in fiscal 2015. Of that, $83.8 billion is discretionary funding for the agency, an increase of $4.8 billion from fiscal 2015. Citing concerns with the rapidly growing prices of specialty and brand name drugs, the President’s budget proposes to give the HHS secretary for the first time the authority to negotiate drug prices for biologics and high-cost drugs in the Medicare Part D. The budget also focuses on fighting Medicare fraud and abuse by proposing a series of policies that Administration says will save almost $3 billion over the next 10 years. The plan would also end the Sequester's 2 percent cut in Medicare payments to providers and repeal the flawed SGR formula that otherwise will result in sharply lower payments for physicians.
In addition, the budget proposes a four-year extension of funding of the Children’s Health Insurance Program (CHIP), to be paid for by an increase in tobacco taxes. The program currently serves more than 8 million children of working parents who are ineligible for Medicaid. The NIH budget would total $31.31 billion, up from $30.31 billion in 2015. President Obama has asked for $200 million for additional funding to the NIH and its National Cancer Institute for an ambitious genomic-research project. It would include mapping the genetic makeup of more than one million volunteer Americans. The NIH also is asking for an increase in spending for the Brain Initiative, an effort to map areas of the brain and determine their function. The NIH is seeking $70 million this year, up from $65 million in 2015. The FDA budget request is $4.9 billion, up 9% from the 2015 amount. The agency is also seeking one-time funding for Ebola, of $25 million. The budget calls for $399 billion in savings over 10 years from Medicare, Medicaid and other HHS programs. Notable cuts include $116 billion over 10 years through reduced Medicare payments to drugmakers and reducing payments by $16 billion over 10 years for graduate medical education.
Affordable Care Act Enrollment Nears 10 Million
Last Wednesday, federal officials said that nearly 10 million people have signed up for health insurance in state and federal marketplaces under the Affordable Care Act or were re-enrolled in coverage for 2015. Appearing at a Senate Finance Committee hearing, HHS Secretary Sylvia Mathews Burwell said that nearly 7.5 million people have selected a plan or were automatically re-enrolled on the federal exchange. At least 2.4 million people have come in through state-run exchanges, she added. The enrollment figures indicate the second year of ACA sign-ups, which runs through Feb. 15, is on track to meet the White House’s goal of having 9.1 million to 9.9 million people with paid-up coverage through the insurance exchanges by the end of 2015. The CBO had previously estimated that 13 million people would enroll in private health plans in 2015. Insurance enrollment under the ACA has gone much smoother than last year, when technology problems with the HealthCare.gov website frustrated consumers who in some cases faced long waits or gave up on enrolling. Thirty-seven states use the federal website for exchange enrollment.
The latest sign-up numbers came while the health law remained under attack in Congress. Last Tuesday, House Republicans voted again to repeal the law, though such a measure won’t get past the White House. Also, the King v. Burwell case before the Supreme Court tests the legality of billions of dollars in subsidies provided to more than six million people through the federal exchange. Republicans opposed to the law see that case as an opportunity to make substantial changes to the law or repeal it entirely. Secretary Burwell declined to say Wednesday during the Senate Finance Committee hearing whether the Administration had a contingency plan for corrective legislation if subsidies are struck down, or whether HHS has the authority to implement an administrative fix. Her responses angered some GOP lawmakers, who said her lack of answers showed contempt of the panel’s oversight responsibility.
FDA Commissioner Hamburg To Step Down in March
Last Thursday, FDA Commissioner Margaret Hamburg announced plans to step down at the end of next month. She oversaw drug approvals, food safety, tobacco control and other health initiatives during a tenure that made her one of the longest-serving FDA chiefs in modern history. Stephen Ostroff, the agency's chief scientist, will temporarily fill the position, when Hamburg departs at the end of March. Hamburg’s tenure at the FDA was marked by new public health challenges, including rising obesity, an increase in prescription drug abuse, heightened risk from antibiotic resistant bacteria and the Ebola epidemic in West Africa. Hamburg largely avoided political fights with GOP lawmakers that plagued leaders like former HHS Secretary Kathleen Sebelius. Still, her tenure did not come without its challenges including a deadly outbreak of meningitis tied to compounded drugs and a slew of food safety scares. Hamburg's decision came three weeks after another top Obama Administration health official, CMS chief Marilyn Tavenner, announced she was stepping down.
GOP Unveils New Health Law Alternative
Last Thursday, three top Republicans released an updated Affordable Care Act replacement bill, as GOP leaders on Capitol Hill take steps to show they are preparing a contingency plan should the Supreme Court strike down a provision in the law later this year. Sens. Orrin Hatch (R-UT), Richard Burr (R-NC) and Rep. Fred Upton (R-MI) outlined the plan that would retain a handful of familiar parts of the law and would also include a tax credit tied to the consumer-price index for some lower-income people to buy insurance. The portions of the ACA that would be retained include requirements that insurers sell uncapped coverage to everyone regardless of their medical history and allow parents to cover their children up to the age of 26 in states that chose to allow it. The plan would drop many key pieces of the 2010 health law, including the individual and employer mandates and the medical device tax. Low-income individuals would receive tax credits to help buy health insurance – but only those who earn up to 300 percent of the poverty level, not the 400 percent now mandated. The proposal would also repeal the option for states to expand Medicaid and eliminate the health insurance marketplaces set up under the ACA, and insurers would not be required to cover a specific set of benefits. Insurers would also be able to charge older people five times as much as younger people, rather than the ratio of three to one in the health law.
The proposal is a revised version of a bill first floated by Sens. Burr and Hatch, along with former Sen. Tom Coburn (R-OK), last year. There are a number of new provisions to the measure, including the ability for people to purchase insurance plans across state lines, and caps on noneconomic damages and attorneys’ fees in medical malpractice suits. Released the same week that the House cast its first vote of the year to repeal the ACA, the Hatch-Burr-Upton plan will compete with several other replacement options as the GOP tries to coalesce around an alternative to the health law. While multiple groups of Republicans have worked on replacement options since the enactment of the ACA, none has evolved into a consensus bill, drawing attacks from Congressional Democrats and the White House. Senior aides said the next steps for the plan include outreach to Senate and House colleagues and to the nation’s governors.
Senate HELP to Review Drug, Device Development
Last week, the two leading members on the Senate HELP Committee announced plans to review how drugs and medical devices are approved, with the goal improving access to medical innovation for patients. Chairman Lamar Alexander (R-TN) and ranking member Patty Murray (D-WA) said the bipartisan initiative would involve staff working groups and a series of hearings in March. “We want to modernize the way drugs and medical devices are discovered, developed, and approved,” Alexander said in a statement. The effort will focus specifically on the NIH and the FDA, and it points to a continued level of bipartisan collaboration on the HELP panel despite the power change in the upper chamber, lawmakers said. The plan appears to compliment the 21st Century Cures initiative in the House Energy and Commerce Committee, which produced legislation designed to speed up clinical trials and encourage drugmakers to focus on complex diseases.
The Week Ahead
This week, partisan jockeying is expected to continue over a Homeland Security funding bill (H.R. 240) that would reverse President Obama’s immigration policies. Senate Democrats say they won't agree to the bill unless all the immigration language is removed. Republicans say such a bill won't pass the House. Leaders in both chambers insist they will not allow DHS to go without funding. Aides say the likeliest scenario may be a short-term funding extension. Congress must pass a new spending bill for DHS by Feb. 27 or the agency will shut down. The Senate may also take up a House-passed bill (H.R. 527) that would repeal the Affordable Care Act and call for a replacement. In the House, members are likely to approve Senate-passed legislation (S. 1) that would force approval of the Keystone XL oil pipeline, setting up a veto confrontation with President Obama. The House easily passed similar legislation in January. But the Senate added a number of amendments, necessitating another House vote. The House also plans to vote on two packages of bills (H.R. 644/H.R.636) to permanently extend sections of the tax code.
Off the floor, the Senate HELP Committee holds a hearing Tuesday on the re-emergence of vaccine-preventable diseases. In the House, the Energy and Commerce Oversight panel meets Wednesday to examine federal mental health services. That same day, E&C’s Health Subcommittee will review the status of ICD-10 implementation, while an Appropriations panel examines international investments to fight Ebola. Finally, stakeholder comments on the discussion draft of House Energy and Commerce Committee Chairman Fred Upton’s 21st Century Cures legislation are due tomorrow, Tuesday, February 10.
President Obama's Fiscal 2016 Budget Proposal To Fully Fund ACA
Last Monday, President Obama unveiled a $4 trillion budget request for fiscal year 2016 that includes a number of health care initiatives, including full funding for the Affordable Care Act. The President’s proposal calls for HHS to receive about $1.09 trillion for fiscal 2016, up from $1.04 trillion in fiscal 2015. Of that, $83.8 billion is discretionary funding for the agency, an increase of $4.8 billion from fiscal 2015. Citing concerns with the rapidly growing prices of specialty and brand name drugs, the President’s budget proposes to give the HHS secretary for the first time the authority to negotiate drug prices for biologics and high-cost drugs in the Medicare Part D. The budget also focuses on fighting Medicare fraud and abuse by proposing a series of policies that Administration says will save almost $3 billion over the next 10 years. The plan would also end the Sequester's 2 percent cut in Medicare payments to providers and repeal the flawed SGR formula that otherwise will result in sharply lower payments for physicians.
In addition, the budget proposes a four-year extension of funding of the Children’s Health Insurance Program (CHIP), to be paid for by an increase in tobacco taxes. The program currently serves more than 8 million children of working parents who are ineligible for Medicaid. The NIH budget would total $31.31 billion, up from $30.31 billion in 2015. President Obama has asked for $200 million for additional funding to the NIH and its National Cancer Institute for an ambitious genomic-research project. It would include mapping the genetic makeup of more than one million volunteer Americans. The NIH also is asking for an increase in spending for the Brain Initiative, an effort to map areas of the brain and determine their function. The NIH is seeking $70 million this year, up from $65 million in 2015. The FDA budget request is $4.9 billion, up 9% from the 2015 amount. The agency is also seeking one-time funding for Ebola, of $25 million. The budget calls for $399 billion in savings over 10 years from Medicare, Medicaid and other HHS programs. Notable cuts include $116 billion over 10 years through reduced Medicare payments to drugmakers and reducing payments by $16 billion over 10 years for graduate medical education.
Affordable Care Act Enrollment Nears 10 Million
Last Wednesday, federal officials said that nearly 10 million people have signed up for health insurance in state and federal marketplaces under the Affordable Care Act or were re-enrolled in coverage for 2015. Appearing at a Senate Finance Committee hearing, HHS Secretary Sylvia Mathews Burwell said that nearly 7.5 million people have selected a plan or were automatically re-enrolled on the federal exchange. At least 2.4 million people have come in through state-run exchanges, she added. The enrollment figures indicate the second year of ACA sign-ups, which runs through Feb. 15, is on track to meet the White House’s goal of having 9.1 million to 9.9 million people with paid-up coverage through the insurance exchanges by the end of 2015. The CBO had previously estimated that 13 million people would enroll in private health plans in 2015. Insurance enrollment under the ACA has gone much smoother than last year, when technology problems with the HealthCare.gov website frustrated consumers who in some cases faced long waits or gave up on enrolling. Thirty-seven states use the federal website for exchange enrollment.
The latest sign-up numbers came while the health law remained under attack in Congress. Last Tuesday, House Republicans voted again to repeal the law, though such a measure won’t get past the White House. Also, the King v. Burwell case before the Supreme Court tests the legality of billions of dollars in subsidies provided to more than six million people through the federal exchange. Republicans opposed to the law see that case as an opportunity to make substantial changes to the law or repeal it entirely. Secretary Burwell declined to say Wednesday during the Senate Finance Committee hearing whether the Administration had a contingency plan for corrective legislation if subsidies are struck down, or whether HHS has the authority to implement an administrative fix. Her responses angered some GOP lawmakers, who said her lack of answers showed contempt of the panel’s oversight responsibility.
FDA Commissioner Hamburg To Step Down in March
Last Thursday, FDA Commissioner Margaret Hamburg announced plans to step down at the end of next month. She oversaw drug approvals, food safety, tobacco control and other health initiatives during a tenure that made her one of the longest-serving FDA chiefs in modern history. Stephen Ostroff, the agency's chief scientist, will temporarily fill the position, when Hamburg departs at the end of March. Hamburg’s tenure at the FDA was marked by new public health challenges, including rising obesity, an increase in prescription drug abuse, heightened risk from antibiotic resistant bacteria and the Ebola epidemic in West Africa. Hamburg largely avoided political fights with GOP lawmakers that plagued leaders like former HHS Secretary Kathleen Sebelius. Still, her tenure did not come without its challenges including a deadly outbreak of meningitis tied to compounded drugs and a slew of food safety scares. Hamburg's decision came three weeks after another top Obama Administration health official, CMS chief Marilyn Tavenner, announced she was stepping down.
GOP Unveils New Health Law Alternative
Last Thursday, three top Republicans released an updated Affordable Care Act replacement bill, as GOP leaders on Capitol Hill take steps to show they are preparing a contingency plan should the Supreme Court strike down a provision in the law later this year. Sens. Orrin Hatch (R-UT), Richard Burr (R-NC) and Rep. Fred Upton (R-MI) outlined the plan that would retain a handful of familiar parts of the law and would also include a tax credit tied to the consumer-price index for some lower-income people to buy insurance. The portions of the ACA that would be retained include requirements that insurers sell uncapped coverage to everyone regardless of their medical history and allow parents to cover their children up to the age of 26 in states that chose to allow it. The plan would drop many key pieces of the 2010 health law, including the individual and employer mandates and the medical device tax. Low-income individuals would receive tax credits to help buy health insurance – but only those who earn up to 300 percent of the poverty level, not the 400 percent now mandated. The proposal would also repeal the option for states to expand Medicaid and eliminate the health insurance marketplaces set up under the ACA, and insurers would not be required to cover a specific set of benefits. Insurers would also be able to charge older people five times as much as younger people, rather than the ratio of three to one in the health law.
The proposal is a revised version of a bill first floated by Sens. Burr and Hatch, along with former Sen. Tom Coburn (R-OK), last year. There are a number of new provisions to the measure, including the ability for people to purchase insurance plans across state lines, and caps on noneconomic damages and attorneys’ fees in medical malpractice suits. Released the same week that the House cast its first vote of the year to repeal the ACA, the Hatch-Burr-Upton plan will compete with several other replacement options as the GOP tries to coalesce around an alternative to the health law. While multiple groups of Republicans have worked on replacement options since the enactment of the ACA, none has evolved into a consensus bill, drawing attacks from Congressional Democrats and the White House. Senior aides said the next steps for the plan include outreach to Senate and House colleagues and to the nation’s governors.
Senate HELP to Review Drug, Device Development
Last week, the two leading members on the Senate HELP Committee announced plans to review how drugs and medical devices are approved, with the goal improving access to medical innovation for patients. Chairman Lamar Alexander (R-TN) and ranking member Patty Murray (D-WA) said the bipartisan initiative would involve staff working groups and a series of hearings in March. “We want to modernize the way drugs and medical devices are discovered, developed, and approved,” Alexander said in a statement. The effort will focus specifically on the NIH and the FDA, and it points to a continued level of bipartisan collaboration on the HELP panel despite the power change in the upper chamber, lawmakers said. The plan appears to compliment the 21st Century Cures initiative in the House Energy and Commerce Committee, which produced legislation designed to speed up clinical trials and encourage drugmakers to focus on complex diseases.