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.


Appropriations Process Slides Into Threats of Veto and Government Shutdown

Last week the House passed H.R. 2216, the Military Construction and Veterans Affairs, and Related Agencies Appropriations Act for fiscal year 2014 (including $63.1 billion in discretionary funds for the VA) as well as H.R. 2217, the FY 2014 Department of Homeland Security Appropriations Act. Of note, the Rule adopted by the House, which provided for the consideration of the two bills, includes a provision that will allow House members to enforce the spending caps adopted by the House in its FY 2014 budget resolution (H.Con.Res. 25) until the House and Senate agree to a final spending total. The House budget plan also assumes that the spending constraints included under the sequestration measures of the Budget Control Act (BCA) will continue for the 10-year period FY 2014-2023. However, the House Armed Services Committee took a shot at sequestration in passing H.R. 1960, the FY 2014 defense bill which authorized $638.4 billion in discretionary and mandatory spending, $52 billion above the cap set under sequestration. Reflective of the effort likely to take place in the Senate to curtail the effects of sequestration, during the House Appropriations Committee markup of H.R. 2216, Republicans defeated an amendment by Rep. Rosa DeLauro (D-CT) that would have replaced $150 billion in cuts from sequestration with more than $182 billion in tax increases and other spending reductions. The $967 billion in spending constraints and the shifting of the effects of sequestration from defense to domestic programs under the House appropriations measures led the White House to declare that the President will not sign any FY 2014 spending bills unless Republicans agree to a broad budget deal (in which the Administration and congressional Democrats would like to include revenue increases to offset the effect of sequestration, particularly on non-defense programs). House Speaker John Boehner (R-OH) said the veto threat was reckless and that “the president said give him higher taxes and higher spending or we’ll shut down the government….” Notwithstanding the Speaker’s reaction, several Senate Republicans continue to meet with White House officials and Senate Democrats in an effort to craft a budget deal which would include, at least, some entitlement reform. In contrast to the House’s embrace of sequestration, the Senate Appropriations Chairwoman Barbara Mikulski (D-MD) said her committee will attempt to ameliorate the effect of sequestration and use a higher FY 2014 spending cap of $1.058 trillion. She said her committee will take up the Milcon/VA appropriations bill during the week of June 17th. The House Appropriations Committee is on track to take up the Agriculture/Food and Drug Administration (FDA) appropriations bill after last week’s approval of the legislation by voice vote in subcommittee. The FDA would receive almost $2.5 billion in discretionary funding under the bill, an increase of $24 million above the FY 2013 enacted level, and total funding of $4.3 billion, including user fees. As has been the case in the past, it is expected that the House will delay taking up the Labor-HHS-Education appropriations bill until the end of the appropriations season (if then), particularly given the decrease in FY 2014 discretionary budget authority to $121.8 billion from this year’s $150 billion. In contrast, Senate Labor-HHS-Appropriations Subcommittee Chairman Tom Harkin (D-IA) said he intends to mark up his bill in July.

House Passes FDA Legislation

As scheduled, the House passed H.R. 1919, the “Safeguarding America’s Pharmaceuticals Act of 2013,” legislation designed to help ensure drug safety by establishing a uniform national standard for securing the pharmaceutical distribution supply chain. The House also passed and sent to the President for his signature S. 622, the “Animal Drug and Animal Generic Drug User Fee Reauthorization Act of 2013.”

House Republican PPACA "Repeal and Replace" Plan

Rep. Tom Price (R-GA) announced that House Republicans will soon release legislation that would repeal the PPACA and replace the law without individual and employer mandates. He said the bill would: give tax deductions and tax credits to individuals to buy private health insurance; make employer-sponsored coverage “portable”; provide risk pool mechanisms to allow uninsured high-risk individuals with preexisting conditions to purchase coverage; and provide for medical malpractice reform. Senator Orrin Hatch (R-UT) also took a shot at the health law when he asked the Departments of Health and Human Services (HHS) and Treasury for an explanation of why the President’s budget requested a 107% increase in funding for advance premium tax credits. At a House Committee on Education and the Workforce hearing, HHS Secretary Kathleen Sebelius defended her PPACA outreach efforts to increase coverage and said she did not solicit funds from officials in the health care industry to support implementation of the law.


The Patient-Centered Outcomes Research Institute (PCORI) released a Request for Proposal for applicants to create a Coordinating Center to provide technical and logistical support to the individual components of a new National Patient-Centered Clinical Research Network.

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