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.


Budget Impasse Remains

With significant differences remaining between the budget resolutions passed in the House and Senate, the respective appropriations subcommittees will be faced with major hurdles in arriving at fiscal year (FY) 2014 spending levels when Congress returns May 6th. Unless House Republican and Senate Democrat leaders agree to a new tax and spending compromise, House subcommittees will be forced to attempt to move appropriations bills that cap total spending at $967 billion as reflected under the Budget Control Act (BCA), as modified by the American Taxpayer Relief Act of 2012. In the Senate, the Appropriations Chairwoman Barbara Mikulski (D-MD) is instead attempting to gain both Republican and Democrat support for passing appropriations bills that total $1.058 billion. The passage of appropriations bills in each body may be delayed if appropriators balk at taking votes on the compressed spending allowed under the BCA.

House Republicans Delay Vote on PCIP Extension

After a late move by a number of House Republican conservatives to pull their support from H.R. 1549, the “Helping Sick Americans Now Act,” the Majority Leader canceled a floor vote on the legislation which would have extended funding to sign up more high-medical-risk individuals under the Patient Protection and Affordable Care Act’s (PPACA) Pre-Existing Conditions Insurance Plan (PCIP). The Obama Administration said the President would veto the bill even if the Senate allowed the bill to also pass that chamber (which is unlikely). In general, the White House and congressional Democrats oppose the legislation which would be paid for by diverting $3.7 billion from the PPACA Prevention and Public Health Fund. Subject to a favorable whip call after the one-week recess, the bill could again see potential action in the House.

Republicans and Democrats Express Concern Over PPACA Implementation

Key White House staff lunched with Senate Democrats last week and attempted to allay their concerns over the implementation of the PPACA. It was reported that Senator Jeanne Shaheen (D-NH) said that a lot of small New Hampshire businesses do not know their responsibilities in complying with the complex provisions of the PPACA. Others raised concerns about dental coverage for children and expected health insurance premium increases of up to 25% in 2014 under the Maryland health insurance exchange. The latter concern was reiterated by Rep. Andy Harris (R-MD) at a House Appropriations subcommittee hearing. At a House Energy and Commerce Subcommittee on Oversight and Investigations hearing, full-committee chairman Fred Upton said alarm bells are getting louder every day surrounding the PPACA’s implementation problems. However, the Director of the CMS Center for Consumer Information and Insurance Oversight (CCIIO) testified that state and federally-facilitated health insurance exchanges (FFEs) are on track to begin enrolling eligible participants in October. In this regard, it was reported that about 140 health insurers have told CMS that they intend to offer coverage through the FFEs. Senator Orrin Hatch (R-UT) has also questioned the CCIIO’s waiver for Massachusetts to avoid immediate implementation of the PPACA’s rating requirements and has asked the Department of Health and Human Services (HHS) to provide information on the legal basis for the waiver and whether other state exchanges can also be so accommodated in light of the premium increases insurers say will result from the law’s rate compression. In related news, Senator Maria Cantwell (D-WA) said HHS responded to her request for information on the implementation timeline for the PPACA’s Federal Basic Health Program Option (FBHPO) which allows states to provide coverage to people ineligible for Medicaid but having incomes between 138-200% of the federal poverty level. Proposed regulations will be issued this September followed by the issuance of final regulations in March, 2014 which will allow complying programs to begin enrolling eligible participants in October of 2014 for plan coverage beginning in 2015.

Early Retiree Reinsurance Program Termination Dates Announced

The Centers for Medicare and Medicaid Services (CMS) gave notice to the 5,000+ plan sponsors who have received funding under the PPACA’s temporary Early Retiree Reinsurance Program (ERRP) on their final obligations as the $5 billion program is phased out in 2014. Termination dates for ERRP requirements, such as reporting and submitting information, were provided while CMS said that certain records must be kept for six years after the years in which costs were incurred.

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