TRP Health Policy Report
March 2, 2015
Congress narrowly avoided a partial shutdown of the Homeland Security Department last Friday night after the Senate approved a one-week extension (H.R. 240) of the agency’s funding and the House followed suit just hours before a midnight deadline. The House vote was 357-60, sending the bill to President Obama for his expected signature. Support for the one-week patch came together hours after a three-week short-term spending bill was defeated in the House in a blow to the chamber’s GOP leaders. After watching top House Republicans’ plan derail Friday afternoon, Democrats agreed to support the one-week stopgap spending measure to prevent a funding lapse. The one-week spending bill looked unlikely to break the immigration impasse that has tied up national security funding and paralyzed Capitol Hill. But the 11th-hour bid from GOP leaders bought a brief respite to hunt for a better strategy while averting a looming funding lapse.
Republicans have been wrestling for weeks over whether to use Homeland Security funding to block implementation of President Barack Obama’s executive action on immigration. The impasse over the longer-term bills left GOP leaders casting about for a stopgap measure to avoid a funding lapse. The immigration debate will continue into this week. Senate Majority Leader Mitch McConnell (R-KY) set up a vote tonight on holding formal negotiations between the two chambers over continued funding for the Department of Homeland Security through September. Earlier on Friday, the House postponed votes on the GOP’s No Child Left Behind reauthorization bill (H.R. 5) due to opposition from both conservatives and Democrats. Conservatives are upset with the bill because leadership didn't permit amendments that would have allowed states to opt-out and rescind federal testing requirements to get votes. It is unclear when votes on the education rewrite bill will occur. Earlier in the week, the House passed a series of suspension bills and voted 401-20 to expand college savings plans (H.R. 529).
The Week Ahead
This week, the U.S. Supreme Court will hear arguments in the King v. Burwell case, which threatens to cut off Affordable Care Act (ACA) subsidies in the 37 states that have opted to use the federal government’s marketplace instead of creating their own. If the court rules against the ACA, more than 8 million people in those states could lose federal subsidies helping them pay for health coverage. Justices are expected to deliver a ruling on the case in June. White House officials have maintained that there is no legislative fix for an adverse ruling in King v. Burwell. Republicans leaders have begun reviewing ways to create a stopgap legislative fix, to ensure that subsidies would not be immediately eliminated this June.
While this week’s floor schedule is fluid, House lawmakers are expected to debate and vote on a short-term spending bill (H.R. 240) that would fund the Department of Homeland Security through March 19. The House could also finish considering amendments to the No Child Left Behind Act reauthorization (H.R. 5) and vote on final passage. In other activity, Israeli Prime Minister Benjamin Netanyahu is scheduled to address a joint meeting of Congress tomorrow. The Senate also faces a Tuesday deadline to override the President’s veto of a bill to force approval of the Keystone XL pipeline. In the House, lawmakers will debate legislation to authorize Amtrak rail service for four years and cut funding levels for passenger service by 40 percent. In notable committee activity, the House Appropriations Labor-HHS Subcommittee meets tomorrow, with National NIH Director Francis Collins slated to testify on her agency’s 2016 budget request. On Wednesday, the House Appropriations Subcommittee on Agriculture, Rural Development and FDA will convene for a hearing on the President’s fiscal year 2016 budget request, with outgoing FDA Commissioner Margaret Hamburg is scheduled to testify. On Thursday, the House Energy and Commerce Health Subcommittee will examine the functionality of the 340B drug pricing program.
Burwell: No Backup Plan if SCOTUS Strike Down Health Tax Credits
Last week, HHS Secretary Sylvia Matthews Burwell told Congress that there are no administrative actions available to fix the problems that would result if the Supreme Court invalidates federal subsidies for millions of people buying healthcare coverage under the ACA. In a letter released last Tuesday, Burwell repeated her warnings that if the court invalidates the subsidies, there would be “widespread damage” to the nation’s health care system. She says that’s because millions of people won’t be able to afford coverage and costs for everyone else’s insurance would increase. “We know of no administrative actions that could, and therefore we have no plans that would, undo the massive damage to our health care system that would be caused by an adverse decision,” Burwell wrote.
The Supreme Court will hear oral arguments this week in a challenge contending that the language of the 2010 Affordable Care Act restricts the law’s insurance premium subsidies to residents of states that have set up their own insurance exchanges. The federal government is currently operating insurance exchanges on behalf of 37 states, and the tax credits are closely tied to other provisions in the health law that require most Americans to obtain coverage or pay a penalty, as well as requirement that insurers sell coverage to all people regardless of their medical history. A decision is expected in June. In related news, a new study by Avalere Health study estimated that plans purchased through the federal exchange could increase by as much as 774% if the Supreme Court strikes down the ACA subsidies to help U.S. residents purchase coverage through HealthCare.gov. According to the study, premiums in states using the federal exchange would increase by an average of 255% if the subsidies are ruled to be illegal. Meanwhile, nine states would see premium increases of more than 300%, including Florida and North Carolina. Alaska and Mississippi would see the largest increases, at about 449% and 774% respectively.
Hatch to Unveil ACA Contingency Plan
Last Monday, the chairman of the Senate Finance Committee he will release a backup plan for the Affordable Care Act in case the Supreme Court rules against the law this summer. Sen. Orrin Hatch (R-UT) said he has been crafting a “solution for those Americans who may be affected” by the looming King v. Burwell case, which threatens to end healthcare subsidies for people living in 37 states. “That solution will address immediate concerns and set the stage for a more permanent solution,” Hatch said during a speech at the Heritage Foundation. The Utah Senator said he would share details about his plan “in the coming days.” Hatch’s announcement of an ACA “backup plan” comes about two weeks after he and two other top Republicans unveiled what they called an ACA replacement plan. House Republicans are also working on their own contingency plans, as charged by House Majority Leader Kevin McCarthy (R-CA) Rep. Paul Ryan (R-WI), one of three chairmen leading the effort, said last week that it was too early to disclose details. Both parties have acknowledged that a plaintiff victory in the King v. Burwell case could force a rewrite of the entire healthcare reform law. Republicans have hailed the court case as their best chance of undoing the ACA, putting pressure on the party to find a way to shield people from the possible financial fallout of rising insurance costs.
House Budget Chairman Says Short-Term SGR Patch Likely
Last Tuesday, House Budget Committee Chairman Tom Price (R-GA) said that a four- to six-month extension of Medicare's SGR formula is likely by the March 31 expiration of the current patch. Price said he doesn't think there is adequate time for lawmakers to get a full repeal passed by the deadline. Instead, Price said he thinks a full repeal of the physician payment system is likely by the end of the fiscal year on Sept. 30, and that it will be tied to extending funding for the Children's Health Insurance Program (CHIP), which expires at the end of fiscal 2015. Price didn't say how the patch would be paid for or what Medicare policy extenders would be included, but he told a gathering of the American Medical Association last week that it wouldn't be funded at the expense of physicians.
Price noted that many lawmakers support the policies included in the bipartisan, bicameral legislation that passed the House in 2014, the proposed SGR Repeal and Medicare Provider Payment Modernization Act (H.R. 4015/S. 2000). There is still bipartisan agreement that the SGR needs to be repealed, but Price said time is running short for a permanent fix to be enacted by the deadline. Price said a short-term patch is likely, “not because there isn't a unified sense that it needs to be repealed, not because we don't think the policy that was agreed to last year was a step in the right direction, but because of the events that are pushing up against us and the amount of resources that are necessary in order to pay for a repeal of SGR. I don't think it can be done in the 12 or 15 legislative days we have left.”
GOP Releases Plan to Renew CHIP
Last Tuesday, House and Senate Republicans released a plan to overhaul and extend funding for the Children’s Health Insurance Program (CHIP), less than two weeks after Democrats in both chambers introduced their own proposals. The discussion draft says GOP leaders are seeking feedback about how long to extend funding for the program that serves low-income children whose parents can't afford private insurance but aren't poor enough to qualify for Medicaid. Both Democratic bills (H.R .919/S. 522) would renew the funds through fiscal 2019. Under the Affordable Care Act, current funding expires Sept. 30.
But the proposal from House Energy and Commerce Chairman Fred Upton (R-MI), Health Subcommittee Chairman Joe Pitts (R-PA) and Senate Finance Chairman Orrin Hatch (R-UT) would also make a number of changes, including the elimination of an ACA provision that provides a 23 percent boost in CHIP matching rates starting in October. The GOP draft would also cut off the health law’s “maintenance of effort” requirements for eligibility standards in October 2015 rather than 2019 and scrap another provision requiring states to cover some low-income Medicaid children and cut federal funding for families with incomes higher than 250 percent of poverty. Hill insiders say finding bipartisan consensus is unlikely and predict Congress will ultimately choose to extend current CHIP funding before the end of the fiscal year on Sept. 30.
Senate, House Lawmakers to Push Mental Health Reform
Last Tuesday, Sen. Chris Murphy (D-CT) and Rep. Tim Murphy (R-PA) outlined plans to introduce a pair of mental health reform bills next month, amid a push that began in the wake of the mass shooting in Newtown, Conn. News of the bicameral bills coincided with a Capitol Hill briefing highlighting the implications of mental health policies being considered in Congress. Rep. Murphy plans to reintroduce a version of a House bill he pushed in the last Congress. Sen. Murphy said he would introduce a bill that has “some differences” but is “substantially similar” in the Senate around the same time. Rep. Murphy introduced legislation in 2013 called the “Helping Families in Mental Health Crisis Act,” a bill he is now looking to revive. The Pennsylvania Congressman’s bill would streamline federal programs for people with mental illness and create an assistant secretary at the HHS to oversee the programs.
Rep. Murphy’s reform bill would also increase the number of psychiatric beds available and relax health privacy laws to give caregivers more information. One of the more controversial provisions involves the provision of involuntary treatment for some people with mental illness. His reform measure won broad support from Republican leadership in the previous Congress, but stalled after the House Energy and Commerce Committee decided to break it into pieces to improve its chances of passage. Rep. Murphy said that Energy and Commerce Committee Chairman Fred Upton (R-MI) is now ready to move forward on his bill, and leadership is supportive as well. In the upper chamber, Sen. Murphy said that he is working on a bipartisan mental health reform bill with Sen. Bill Cassidy (R-LA), a medical doctor, and he hopes to have draft legislation ready in the coming months.
The Week Ahead
This week, the U.S. Supreme Court will hear arguments in the King v. Burwell case, which threatens to cut off Affordable Care Act (ACA) subsidies in the 37 states that have opted to use the federal government’s marketplace instead of creating their own. If the court rules against the ACA, more than 8 million people in those states could lose federal subsidies helping them pay for health coverage. Justices are expected to deliver a ruling on the case in June. White House officials have maintained that there is no legislative fix for an adverse ruling in King v. Burwell. Republicans leaders have begun reviewing ways to create a stopgap legislative fix, to ensure that subsidies would not be immediately eliminated this June.
While this week’s floor schedule is fluid, House lawmakers are expected to debate and vote on a short-term spending bill (H.R. 240) that would fund the Department of Homeland Security through March 19. The House could also finish considering amendments to the No Child Left Behind Act reauthorization (H.R. 5) and vote on final passage. In other activity, Israeli Prime Minister Benjamin Netanyahu is scheduled to address a joint meeting of Congress tomorrow. The Senate also faces a Tuesday deadline to override the President’s veto of a bill to force approval of the Keystone XL pipeline. In the House, lawmakers will debate legislation to authorize Amtrak rail service for four years and cut funding levels for passenger service by 40 percent. In notable committee activity, the House Appropriations Labor-HHS Subcommittee meets tomorrow, with National NIH Director Francis Collins slated to testify on her agency’s 2016 budget request. On Wednesday, the House Appropriations Subcommittee on Agriculture, Rural Development and FDA will convene for a hearing on the President’s fiscal year 2016 budget request, with outgoing FDA Commissioner Margaret Hamburg is scheduled to testify. On Thursday, the House Energy and Commerce Health Subcommittee will examine the functionality of the 340B drug pricing program.
Burwell: No Backup Plan if SCOTUS Strike Down Health Tax Credits
Last week, HHS Secretary Sylvia Matthews Burwell told Congress that there are no administrative actions available to fix the problems that would result if the Supreme Court invalidates federal subsidies for millions of people buying healthcare coverage under the ACA. In a letter released last Tuesday, Burwell repeated her warnings that if the court invalidates the subsidies, there would be “widespread damage” to the nation’s health care system. She says that’s because millions of people won’t be able to afford coverage and costs for everyone else’s insurance would increase. “We know of no administrative actions that could, and therefore we have no plans that would, undo the massive damage to our health care system that would be caused by an adverse decision,” Burwell wrote.
The Supreme Court will hear oral arguments this week in a challenge contending that the language of the 2010 Affordable Care Act restricts the law’s insurance premium subsidies to residents of states that have set up their own insurance exchanges. The federal government is currently operating insurance exchanges on behalf of 37 states, and the tax credits are closely tied to other provisions in the health law that require most Americans to obtain coverage or pay a penalty, as well as requirement that insurers sell coverage to all people regardless of their medical history. A decision is expected in June. In related news, a new study by Avalere Health study estimated that plans purchased through the federal exchange could increase by as much as 774% if the Supreme Court strikes down the ACA subsidies to help U.S. residents purchase coverage through HealthCare.gov. According to the study, premiums in states using the federal exchange would increase by an average of 255% if the subsidies are ruled to be illegal. Meanwhile, nine states would see premium increases of more than 300%, including Florida and North Carolina. Alaska and Mississippi would see the largest increases, at about 449% and 774% respectively.
Hatch to Unveil ACA Contingency Plan
Last Monday, the chairman of the Senate Finance Committee he will release a backup plan for the Affordable Care Act in case the Supreme Court rules against the law this summer. Sen. Orrin Hatch (R-UT) said he has been crafting a “solution for those Americans who may be affected” by the looming King v. Burwell case, which threatens to end healthcare subsidies for people living in 37 states. “That solution will address immediate concerns and set the stage for a more permanent solution,” Hatch said during a speech at the Heritage Foundation. The Utah Senator said he would share details about his plan “in the coming days.” Hatch’s announcement of an ACA “backup plan” comes about two weeks after he and two other top Republicans unveiled what they called an ACA replacement plan. House Republicans are also working on their own contingency plans, as charged by House Majority Leader Kevin McCarthy (R-CA) Rep. Paul Ryan (R-WI), one of three chairmen leading the effort, said last week that it was too early to disclose details. Both parties have acknowledged that a plaintiff victory in the King v. Burwell case could force a rewrite of the entire healthcare reform law. Republicans have hailed the court case as their best chance of undoing the ACA, putting pressure on the party to find a way to shield people from the possible financial fallout of rising insurance costs.
House Budget Chairman Says Short-Term SGR Patch Likely
Last Tuesday, House Budget Committee Chairman Tom Price (R-GA) said that a four- to six-month extension of Medicare's SGR formula is likely by the March 31 expiration of the current patch. Price said he doesn't think there is adequate time for lawmakers to get a full repeal passed by the deadline. Instead, Price said he thinks a full repeal of the physician payment system is likely by the end of the fiscal year on Sept. 30, and that it will be tied to extending funding for the Children's Health Insurance Program (CHIP), which expires at the end of fiscal 2015. Price didn't say how the patch would be paid for or what Medicare policy extenders would be included, but he told a gathering of the American Medical Association last week that it wouldn't be funded at the expense of physicians.
Price noted that many lawmakers support the policies included in the bipartisan, bicameral legislation that passed the House in 2014, the proposed SGR Repeal and Medicare Provider Payment Modernization Act (H.R. 4015/S. 2000). There is still bipartisan agreement that the SGR needs to be repealed, but Price said time is running short for a permanent fix to be enacted by the deadline. Price said a short-term patch is likely, “not because there isn't a unified sense that it needs to be repealed, not because we don't think the policy that was agreed to last year was a step in the right direction, but because of the events that are pushing up against us and the amount of resources that are necessary in order to pay for a repeal of SGR. I don't think it can be done in the 12 or 15 legislative days we have left.”
GOP Releases Plan to Renew CHIP
Last Tuesday, House and Senate Republicans released a plan to overhaul and extend funding for the Children’s Health Insurance Program (CHIP), less than two weeks after Democrats in both chambers introduced their own proposals. The discussion draft says GOP leaders are seeking feedback about how long to extend funding for the program that serves low-income children whose parents can't afford private insurance but aren't poor enough to qualify for Medicaid. Both Democratic bills (H.R .919/S. 522) would renew the funds through fiscal 2019. Under the Affordable Care Act, current funding expires Sept. 30.
But the proposal from House Energy and Commerce Chairman Fred Upton (R-MI), Health Subcommittee Chairman Joe Pitts (R-PA) and Senate Finance Chairman Orrin Hatch (R-UT) would also make a number of changes, including the elimination of an ACA provision that provides a 23 percent boost in CHIP matching rates starting in October. The GOP draft would also cut off the health law’s “maintenance of effort” requirements for eligibility standards in October 2015 rather than 2019 and scrap another provision requiring states to cover some low-income Medicaid children and cut federal funding for families with incomes higher than 250 percent of poverty. Hill insiders say finding bipartisan consensus is unlikely and predict Congress will ultimately choose to extend current CHIP funding before the end of the fiscal year on Sept. 30.
Senate, House Lawmakers to Push Mental Health Reform
Last Tuesday, Sen. Chris Murphy (D-CT) and Rep. Tim Murphy (R-PA) outlined plans to introduce a pair of mental health reform bills next month, amid a push that began in the wake of the mass shooting in Newtown, Conn. News of the bicameral bills coincided with a Capitol Hill briefing highlighting the implications of mental health policies being considered in Congress. Rep. Murphy plans to reintroduce a version of a House bill he pushed in the last Congress. Sen. Murphy said he would introduce a bill that has “some differences” but is “substantially similar” in the Senate around the same time. Rep. Murphy introduced legislation in 2013 called the “Helping Families in Mental Health Crisis Act,” a bill he is now looking to revive. The Pennsylvania Congressman’s bill would streamline federal programs for people with mental illness and create an assistant secretary at the HHS to oversee the programs.
Rep. Murphy’s reform bill would also increase the number of psychiatric beds available and relax health privacy laws to give caregivers more information. One of the more controversial provisions involves the provision of involuntary treatment for some people with mental illness. His reform measure won broad support from Republican leadership in the previous Congress, but stalled after the House Energy and Commerce Committee decided to break it into pieces to improve its chances of passage. Rep. Murphy said that Energy and Commerce Committee Chairman Fred Upton (R-MI) is now ready to move forward on his bill, and leadership is supportive as well. In the upper chamber, Sen. Murphy said that he is working on a bipartisan mental health reform bill with Sen. Bill Cassidy (R-LA), a medical doctor, and he hopes to have draft legislation ready in the coming months.