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.


President's Inaugural Address

The President's inaugural address last Tuesday gave no specifics as to how he would confront the nation’s rising health and entitlement costs which he acknowledged, but he defended such programs in saying that “The commitments we make to each other, through Medicare and Medicaid and Social Security, these things do not sap our initiative; they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great.”

It would not appear from his remarks that the Administration will be in a rush to compromise on long-term deficit reduction, particularly when it comes to entitlement reform. However, he did give a nod to possible action in stating that “We cannot mistake absolutism for principle or substitute spectacle for politics or treat name-calling as reasoned debate. We must act, knowing that our work will be imperfect….We must act, knowing that today’s victories will be only partial.”

Senator Rob Portman (R-OH) expressed Republican sentiment on the President’s speech in saying that “The President missed an opportunity to point out where we can find common ground….Instead, he chose to talk about it in the abstract, and then his specificity was on things he believes but were not issues where we as a Congress and as an executive branch can make progress, and I’m referring to the debt and the deficit and tax reform.”

Up Next: the Debt Ceiling Vote and SOTU

The Senate will convene this Monday to pass the Super-storm Sandy relief legislation while the House will not return for legislative business until the week of February 4th. According to a statement from Senate Majority Leader Harry Reid (D-NV) the Senate will take up and is expected to pass H.R. 365, the legislation passed by the House which extends the federal debt limit for three months (see below). The bill’s fate may have to wait until the week of January 28th. Also, House Speaker John Boehner (R-OH- 08) has requested President Obama to give his State of the Union (SOTU) Address to a joint session of Congress on Tuesday February 12th. It is not expected that the Administration will release the President’s recommended budget for FY 2014 until early March. Thus, there will be little guidance from the Administration as to future spending before the March 2 deadline when the first year cut of the Budget Control Act (BCA) mandated sequestration is scheduled to take place. The lack of any reported discussions between the White House and Congress on budget issues would indicate that some or all of the automatic spending cuts of $85 billion (for the remainder of FY 2013) may well take place. House Speaker John Boehner indicated he might allow the sequestration to take place unless Congress approves an alternative such as a reduction to $73 billion in cuts through September 30th. Of note, the BCA also mandates a 2% cut in Medicare spending for the period as well. Whether House Republicans will use the March 2nd deadline or the March 27th deadline, when the continuing resolution (CR) for FY 2013 spending expires, as further leverage on the President and the Senate to agree to long-term entitlement reform remains to be seen. Senator Orrin Hatch (R-UT) has already put down the gauntlet regarding proposed changes to Medicare, including raising the entitlement age to 67; putting fee-for-service Medicare into competition with private health plans; combining parts A and B and adding a catastrophic benefit (once rejected under the Reagan Administration).

House Passes Federal Debt Limit Extension/Budget Resolution Incentives

By a vote of 285-144, last week the House approved H.R. 325, legislation which temporarily suspends the current limit on federal borrowing of $16.394 billion from the date of the bill’s enactment until May 19 when the debt ceiling would be raised by the amount of debt issued during the suspension period. Senate Majority Leader Harry Reid said he would take up the bill and attempt to have it passed without amendment. Of note, House Speaker John Boehner also had included a provision (see Appendix) which forces both houses to pass a budget resolution for FY 2014 by the April 15th deadline imposed under the congressional budget act or face a deferral of pay for the members of the house that fails to pass a new budget. The provision was included to help persuade the Senate to pass a budget resolution which it has failed to do since 2009. The provision was also included to help persuade House Republican fiscal hawks to support the bill even though it does not provide spending reductions equal to the borrowing increase. The House is expected to pass a budget resolution and avoid the pay deferral penalty. Senate Majority Leader Harry Reid said he would prefer that the Senate’s budget resolution be developed under “regular order” which would turn over the first steps to the new Budget Committee Chair Patty Murray (D-WA).

Senate Rules Confrontation Avoided

Senate Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY) were able to reach agreement on a narrow revision of the Senate filibuster rules which avoided the threat by Senator Reid to invoke the “nuclear option” under which Senate Democrats would need only 51 votes to eliminate or severely restrict the filibuster of measures the majority brings to the floor in the 113th Congress. The agreement adopted last week by the Senate allows the Majority Leader to start debate on any bill at any time as long as Republicans are given the opportunity to have votes taken on two amendments chosen by the Minority Leader. However, as under the previous rules, a senator will still be able to force a 60-vote supermajority on any bill or nomination that is brought up for a vote in the Senate. Another wrinkle that was adopted will allow an initial vote, on a bill or nomination agreed to by both the Majority and Minority Leaders, to be expedited after a delay of only one day (not two as previously). In addition, the period of preliminary debate would be ended after an initial cloture vote.

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