POLICY BRIEFINGS


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.


THIS WEEK'S BRIEFING - DECEMBER 2, 2012


Fiscal Cliff Looms As Parties Continue to Spat Publicly


At least publicly, the White House and Republican and Democrat congressional leaders appear to have reached little agreement on the means to avoid the upcoming end to the Bush-era tax cuts and $110 billion in Budget Control Act mandated cuts to FY 2013 federal discretionary spending.  Last week the President sent Treasury Secretary Timothy Geithner to the Hill to give congressional Republicans his opening bid to avoid the fiscal cliff.  The plan had Senate Minority Leader Mitch McConnell chuckling over the non-serious nature of the bid and caused House Speaker John Boehner to call the negotiations “stalled”.  In general, the President’s two-stage plan, which was termed “unbalanced and unreasonable” by Republicans, would avert the fiscal cliff and: raise $1.6 trillion in tax revenue, reduce federal spending (unspecified) and prevent the 27% reduction in Medicare physician payments in 2013 through legislation to be adopted this year; cut $400 billion from Medicare and other mandatory federal health programs by means of legislation to be adopted in 2013; provide additional economic “stimulus” under federal programs. 

Senate Majority Leader Harry Reid and other Democrats saw the Obama offer as an opportunity to goad Republicans into offering more detail on their own proposed cuts to Medicare, Medicaid and other federal entitlement programs.  However, Republicans have previously made clear their goals to reduce entitlement spending; for example, under a 10-year deficit reduction plan proposed by Senator Bob Corker Medicare spending would decline by $641 (including by raising the eligibility age to 67 by 2027, combining the Part A and B programs, limiting DME payments, phasing-out Medigap policies, but also providing a two-year doc fix) and Medicaid spending would decline by $70 billion (including by phasing out provider taxes and streamlining the waiver process). 

In response, Senators Dick Durbin and Debbie Stabenow have rejected raising the Medicare eligibility age as a long-term means to slow Medicare spending; although, Senator Durbin has been more open to other health program changes, such as allowing deeper rebates for Medicaid prescription drugs, increasing the use of generic drugs for Medicaid and Medicare patients and expanding competitive bidding for durable medical equipment.  Senator Durbin also indicated he might be open to discussing "elements we need to reconsider" with respect to provisions under the PPACA.

Despite the harsh rhetoric, Despite the harsh rhetoric, Speaker John Boehner said he is still hopeful that a bipartisan compromise can be reached during the lame-duck session.  As to rounding up a majority of House votes for any such compromise, it might be noted that the complexion of the House in the 113th Congress appears to be set with 234 Republicans and 201 Democrats expected to take their seats in what is expected to be a contentious first session beginning next January 3rd. said he is still hopeful that a bipartisan compromise can be reached during the lame-duck session.  As to rounding up a majority of House votes for any such compromise, it might be noted that the complexion of the House in the 113th Congress appears to be set with 234 Republicans and 201 Democrats expected to take their seats in what is expected to be a contentious first session beginning next January 3rd.

It might also be noted that the continuing resolution for FY 2013 spending ends in March which necessitates another round of appropriations negotiations either this year or early next year.  Appropriation earmarks should not be a major roadblock to agreement given that House Republicans have extended the current ban on earmarking for another two years.  However, House Republicans will continue their efforts to defund various PPACA programs, including the Center for Medicare and Medicaid Innovation and the Independent Payment Advisory Board. 


Health Measures Considered


The House passed H.R. 5997, legislation that would expand the existing authorization of the Homeland Security Department’s Urban Area Security Initiative and State Homeland Security Grant Program to allow local use of such funds for general emergency medical preparedness programs.  Funds could be used for the development and maintenance of an initial pharmaceutical stockpile, medical kits and diagnostics to aid first-responders and the immediate victims of a chemical or biological event.  The Senate also considered the Defense reauthorization bill, S. 3254, and will vote on amendments relating to an extension of military health programs, TRICARE pharmacy benefit program adjustments and autism coverage, planning for military mental health counseling and the expansion of emergency medical service benefits.



December 2, 2012: | Page 1 Page 2

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