TRP Health Policy Report
February 23, 2015
The House and Senate were out last week for the Presidents Day recess. In Affordable Care Act (ACA) implementation news, the Obama Administration moved up next year’s healthcare enrollment period by three weeks, designating Jan. 31 as the last day to sign up. HHS officials said 2016 enrollment would begin Nov. 1, instead of Nov. 15, and would last three months. The White House announced the enrollment deadline extension last Friday after Senate Democrats called for the move earlier in the week. In an embarrassing setback, HHS officials also said that the Administration had sent 800,000 people incorrect information in January about the subsidies they received in 2014, which would affect their tax refunds. The agency will send out corrected forms in March. The Week Ahead
Lawmakers return to Congress this week with just a few days to avert a partial shutdown of the Department of Homeland Security. The agency’s funding expires Friday, giving leaders little time to break an impasse prompted by Republican-led policy riders that would bar spending to implement President Obama’s immigration policies. After three failed attempts to move the $40 billion House bill (H.R. 240) through the Senate earlier this month, Majority Leader Mitch McConnell (R-KY) has indicated that he will try one last time to break the Democratic filibuster on the bill. But Senate Democrats have shown no interest in yielding. Among the unknown variables is the impact of a federal judge’s ruling last Monday which halted President Obama’s executive actions on immigration. The judge’s ruling could prompt Republican leaders to pass a ‘clean’ funding bill later this week, or pursue a short-term funding extension before Friday’s deadline. Also in line for House floor action is legislation that would reauthorize and revise federal primary and secondary school programs (H.R. 5).
At the committee level, there will be a renewed focus on President Obama’s fiscal 2016 budget request and policy priorities. HHS Secretary Sylvia Matthews Burwell will outline her agency’s budget proposal before the House Appropriations Labor-HHS Subcommittee on Tuesday, and testify before the House Energy and Commerce’s Health panel on Thursday. That same day, the Senate HELP Committee will convene for a hearing on medical and public health preparedness. Elsewhere, the House Oversight Committee Subcommittee on Healthcare Benefits and Administrative Rules will convene to examine the impact of tax season on ACA enrollment.
With Deadline Looming, Congress Eyes SGR Fix
As Congress returns from their Presidents Day work period, members of the House and Senate will soon be forced to make a decision on extending, adjusting or reforming the oft-criticized Medicare physician payment system. Absent Congressional action, Medicare doctors will see their fees reduced by 21 percent when a current payment adjustment expires on March 31. The deadline is one of many lawmakers have faced in recent years. Disagreements over how to pay for a permanent replacement stalled action last year, resulting in Congress clearing its 17th extension since 2003 to temporarily avert scheduled physician fee cuts. While the House Energy and Commerce Health Subcommittee held a two-day hearing on the issue last month, neither Democrats nor Republicans moved much beyond their talking points. Leading Republicans insisted that the legislation must be paid for, while Democrats pledged to oppose any offsets that increase burdens on Medicare beneficiaries.
Earlier this month, Senate Finance Chairman Orrin Hatch (R-UT) expressed doubts that there will be any hearings on replacing the formula before the March 31 deadline, but added lawmakers "may have to." He declined to say whether he thinks there will need to be another patch and said lawmakers are working on the offset issue now. Finding consensus on long-term SGR reform will not be easy. Earlier this month, the CBO increased by $30.5 billion the price tag of a repeal and replacement of the current payment formula. According to the updated estimate, a nine-month patch that freezes current payment rates would cost $12 billion, while a freeze through the end of 2016 would cost $30.4 billion.
White House Touts Health Law Sign-Ups
Last Tuesday, President Obama announced that 11.4 million Americans have signed up for, or re-enrolled in, private health coverage during the Affordable Care Act's second open enrollment period, which ended for most individuals on Feb. 15. White House officials said they expect the total number of sign-ups to grow as individuals finish coverage applications started during a special one-week extended enrollment period for individuals who faced long wait times when calling federal enrollment call centers. More than one million U.S. residents signed up for coverage throughout the last nine days of the regular open enrollment period. HHS Secretary Sylvia Mathews Burwell said, "On the final day, we had more consumers sign up than we've ever had, last year or this year." Overall, HHS expects about 9.1 million individuals to complete the enrollment process and keep their coverage by paying their premiums through 2015.
CMS Announces Special Open Enrollment Period for Federal Exchange
Last Friday, HHS announced it will hold an additional open enrollment period for individuals to sign-up for coverage through the ACA federal exchange that coincides with the federal government's April 15 deadline to file their 2014 taxes. The special open enrollment period will begin on March 15 and end on April 30. The sign-up period will only apply to residents in states that use the federal exchange for enrollment. However, states that have established their own exchanges can choose to offer a similar enrollment period. The extension of the enrollment period allows consumers to avoid tax penalties for going without coverage in 2015. The move to extend this year’s enrollment period comes after months of pressure from Congressional Democrats to give people a chance to obtain coverage at the same time they file their 2014 taxes. Under the ACA, individuals who were uninsured in 2014 face fines of $95 or 1% of their income—whichever is higher—when they file their 2014 taxes. Fines grow to $325 or 2% of income for 2015, although millions of people qualify for exemptions. HealthCare.gov, which serves as the insurance marketplace for 37 states, will allow people to shop on the site beginning March 15 if they attest that they learned about the penalty for not carrying insurance when they started to file their taxes.
Tax Glitch Hits 800,000 Health Exchange Enrollees
In related news, the Obama Administration acknowledged Friday that it sent the wrong tax information to 800,000 people who have enrolled in the Affordable Care Act. The information used to calculate subsidies was incorrect on about 20 percent of tax forms, an error that could delay tax refunds for thousands of people. The tax error highlights the complicated links between the 2010 health reform law and taxes, connections that consumers will experience for the first time this year as some who do not have insurance will be charged a penalty. HHS officials stressed that the 800,000 represent just 1 percent of total tax filers — though they represent about one-fifth of filers who used HealthCare.gov coverage last year and got tax credits. The mistake followed weeks of White House officials touting a successful enrollment season — one that saw far fewer technical glitches than the rocky launch in late 2013.
But the tax glitch quickly provided new ammunition for Republicans, who said the latest round of errors are evidence that the ACA is fatally flawed. The GOP critics included Rep. Marsha Blackburn (R-TN) and Dianne Black (R-TN), who said the new problems offer more proof that the IRS should be kept out of healthcare, and pledged to redouble their efforts to repeal the insurance penalty entirety. Other GOP lawmakers, including Senate Majority Leader Mitch McConnell (R-KY) and House Ways and Means Committee Chairman Paul Ryan (R-WI), have already seized on this year’s tax season to renew opposition of the health law. The ACA tax problems will provide a new line for attack for Republicans as they question HHS Secretary Sylvia Mathews Burwell during a hearing by the House Energy and Commerce Committee this Thursday. Tax issues, combined with the new reporting period, could also create new headaches for the White House as it prepares to defend the ACA before the Supreme Court next month.
Poll: Americans Remain Divided on ACA, Subsidies
In related news, American residents remain divided in their views of the ACA, according to a HealthDay/Harris poll released last Thursday. The survey found that 30 percent of respondents favor repeal of the law, while 28% said it should be changed and 26% said it should be kept intact. Opinions on the ACA also remained mostly split along party lines. The poll found that 54 percent of Republicans favor repeal of the ACA, while only 8 percent like the law as it is and 25 percent would like to see it modified. Conversely, 44 percent of Democrats want the law to remain as it stands, with 28 percent supporting modifications and only 9 percent in favor of repeal.
The survey also found that people are less likely to support repeal when asked about specific provisions of the health law. For example:
Lawmakers return to Congress this week with just a few days to avert a partial shutdown of the Department of Homeland Security. The agency’s funding expires Friday, giving leaders little time to break an impasse prompted by Republican-led policy riders that would bar spending to implement President Obama’s immigration policies. After three failed attempts to move the $40 billion House bill (H.R. 240) through the Senate earlier this month, Majority Leader Mitch McConnell (R-KY) has indicated that he will try one last time to break the Democratic filibuster on the bill. But Senate Democrats have shown no interest in yielding. Among the unknown variables is the impact of a federal judge’s ruling last Monday which halted President Obama’s executive actions on immigration. The judge’s ruling could prompt Republican leaders to pass a ‘clean’ funding bill later this week, or pursue a short-term funding extension before Friday’s deadline. Also in line for House floor action is legislation that would reauthorize and revise federal primary and secondary school programs (H.R. 5).
At the committee level, there will be a renewed focus on President Obama’s fiscal 2016 budget request and policy priorities. HHS Secretary Sylvia Matthews Burwell will outline her agency’s budget proposal before the House Appropriations Labor-HHS Subcommittee on Tuesday, and testify before the House Energy and Commerce’s Health panel on Thursday. That same day, the Senate HELP Committee will convene for a hearing on medical and public health preparedness. Elsewhere, the House Oversight Committee Subcommittee on Healthcare Benefits and Administrative Rules will convene to examine the impact of tax season on ACA enrollment.
With Deadline Looming, Congress Eyes SGR Fix
As Congress returns from their Presidents Day work period, members of the House and Senate will soon be forced to make a decision on extending, adjusting or reforming the oft-criticized Medicare physician payment system. Absent Congressional action, Medicare doctors will see their fees reduced by 21 percent when a current payment adjustment expires on March 31. The deadline is one of many lawmakers have faced in recent years. Disagreements over how to pay for a permanent replacement stalled action last year, resulting in Congress clearing its 17th extension since 2003 to temporarily avert scheduled physician fee cuts. While the House Energy and Commerce Health Subcommittee held a two-day hearing on the issue last month, neither Democrats nor Republicans moved much beyond their talking points. Leading Republicans insisted that the legislation must be paid for, while Democrats pledged to oppose any offsets that increase burdens on Medicare beneficiaries.
Earlier this month, Senate Finance Chairman Orrin Hatch (R-UT) expressed doubts that there will be any hearings on replacing the formula before the March 31 deadline, but added lawmakers "may have to." He declined to say whether he thinks there will need to be another patch and said lawmakers are working on the offset issue now. Finding consensus on long-term SGR reform will not be easy. Earlier this month, the CBO increased by $30.5 billion the price tag of a repeal and replacement of the current payment formula. According to the updated estimate, a nine-month patch that freezes current payment rates would cost $12 billion, while a freeze through the end of 2016 would cost $30.4 billion.
White House Touts Health Law Sign-Ups
Last Tuesday, President Obama announced that 11.4 million Americans have signed up for, or re-enrolled in, private health coverage during the Affordable Care Act's second open enrollment period, which ended for most individuals on Feb. 15. White House officials said they expect the total number of sign-ups to grow as individuals finish coverage applications started during a special one-week extended enrollment period for individuals who faced long wait times when calling federal enrollment call centers. More than one million U.S. residents signed up for coverage throughout the last nine days of the regular open enrollment period. HHS Secretary Sylvia Mathews Burwell said, "On the final day, we had more consumers sign up than we've ever had, last year or this year." Overall, HHS expects about 9.1 million individuals to complete the enrollment process and keep their coverage by paying their premiums through 2015.
CMS Announces Special Open Enrollment Period for Federal Exchange
Last Friday, HHS announced it will hold an additional open enrollment period for individuals to sign-up for coverage through the ACA federal exchange that coincides with the federal government's April 15 deadline to file their 2014 taxes. The special open enrollment period will begin on March 15 and end on April 30. The sign-up period will only apply to residents in states that use the federal exchange for enrollment. However, states that have established their own exchanges can choose to offer a similar enrollment period. The extension of the enrollment period allows consumers to avoid tax penalties for going without coverage in 2015. The move to extend this year’s enrollment period comes after months of pressure from Congressional Democrats to give people a chance to obtain coverage at the same time they file their 2014 taxes. Under the ACA, individuals who were uninsured in 2014 face fines of $95 or 1% of their income—whichever is higher—when they file their 2014 taxes. Fines grow to $325 or 2% of income for 2015, although millions of people qualify for exemptions. HealthCare.gov, which serves as the insurance marketplace for 37 states, will allow people to shop on the site beginning March 15 if they attest that they learned about the penalty for not carrying insurance when they started to file their taxes.
Tax Glitch Hits 800,000 Health Exchange Enrollees
In related news, the Obama Administration acknowledged Friday that it sent the wrong tax information to 800,000 people who have enrolled in the Affordable Care Act. The information used to calculate subsidies was incorrect on about 20 percent of tax forms, an error that could delay tax refunds for thousands of people. The tax error highlights the complicated links between the 2010 health reform law and taxes, connections that consumers will experience for the first time this year as some who do not have insurance will be charged a penalty. HHS officials stressed that the 800,000 represent just 1 percent of total tax filers — though they represent about one-fifth of filers who used HealthCare.gov coverage last year and got tax credits. The mistake followed weeks of White House officials touting a successful enrollment season — one that saw far fewer technical glitches than the rocky launch in late 2013.
But the tax glitch quickly provided new ammunition for Republicans, who said the latest round of errors are evidence that the ACA is fatally flawed. The GOP critics included Rep. Marsha Blackburn (R-TN) and Dianne Black (R-TN), who said the new problems offer more proof that the IRS should be kept out of healthcare, and pledged to redouble their efforts to repeal the insurance penalty entirety. Other GOP lawmakers, including Senate Majority Leader Mitch McConnell (R-KY) and House Ways and Means Committee Chairman Paul Ryan (R-WI), have already seized on this year’s tax season to renew opposition of the health law. The ACA tax problems will provide a new line for attack for Republicans as they question HHS Secretary Sylvia Mathews Burwell during a hearing by the House Energy and Commerce Committee this Thursday. Tax issues, combined with the new reporting period, could also create new headaches for the White House as it prepares to defend the ACA before the Supreme Court next month.
Poll: Americans Remain Divided on ACA, Subsidies
In related news, American residents remain divided in their views of the ACA, according to a HealthDay/Harris poll released last Thursday. The survey found that 30 percent of respondents favor repeal of the law, while 28% said it should be changed and 26% said it should be kept intact. Opinions on the ACA also remained mostly split along party lines. The poll found that 54 percent of Republicans favor repeal of the ACA, while only 8 percent like the law as it is and 25 percent would like to see it modified. Conversely, 44 percent of Democrats want the law to remain as it stands, with 28 percent supporting modifications and only 9 percent in favor of repeal.
The survey also found that people are less likely to support repeal when asked about specific provisions of the health law. For example:
- 70 percent of respondents favor guaranteed insurance coverage regardless of pre-existing health conditions.
- 62 percent favor parents keeping their children on their insurance plans until age 26.
- 18 percent want to repeal the federal and state health insurance exchanges.
The only provision of the law that remains widely unpopular is the individual mandate, which 52% of respondents want repealed. The poll also revealed that 43% of respondents want the Supreme Court to maintain the availability of federal health coverage subsidies for people in states that did not opt to create their own insurance exchanges. Nineteen percent oppose the subsidies and 38 percent said they aren't sure. The high court has agreed to hear arguments this year in King v. Burwell, a case in which ACA opponents claim that the law as written does not allow the federal government to provide subsidies in states that don’t create their own exchanges. Fifty-nine percent of Democrats favor continuation of the subsidies, while 36% of Republicans oppose and 27% support.