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 - JUNE 24, 2013


FY 2014 Appropriations Measures Advance


The Senate Appropriations Committee advanced several measures last week that will set up a confrontation with the House over the level of fiscal year (FY) 2014 federal spending. The committee approved so-called 302(b) spending caps for each appropriations subcommittee, including $164.330 billion for Labor/Health and Human Services/Education in contrast to the $121.797 billion allocated to the corresponding subcommittee in the House. Overall the Senate committee capped spending at $1.058 trillion ($552 trillion for defense and $506 for non-defense programs) in contrast to the House total spending cap of $966.924 billion as set under the Budget Control Act (BCA). Of note, the BCA with its sequestration caps would limit defense spending to $498 billion and domestic spending to $469 billion, but the House total spending caps would shift funding to defense, thus leaving domestic programs to make up the shortfall. The Senate Appropriations Committee also voted to pass the FY 2014 Agriculture/Food and Drug Administration (FDA) spending bill which would give the FDA $2.55 billion in discretionary spending, including an increase of $19 million for improvements to medical product safety. The bill also would allow all $4.3 billion in FDA user fees, already authorized, to be spent in FY 2014. The Senate Appropriations Committee also approved the FY 2014 Military-Construction/Veterans Administration (VA) bill which would give the VA $147.9 billion in discretionary funding, including $63.4 billion for VA medical care and $55.6 billion in FY 2015 advance funding for medical care. Senate Democrats continued to press for a conference with the House to forge a compromise on FY 2014 spending. In this regard, Senator Dick Durbin was successful in adding his amendment to the MilCon/VA bill which expresses the sense of the Senate that “Congress should immediately request a conference with the House, appoint conferees and complete work on a final fiscal 2014 budget resolution.”


House and Senate Actions on Vaccines, Veterans Mental Health and HIV Donor Issues


The Senate Judiciary Committee voted to pass S. 162, legislation that would authorize $40 million per year in FY 2015-2019 to provide grants for veterans’ mental health programs, including peer-to-peer counseling and alternatives to incarceration and transitional services. The full-Senate also passed S. 330, legislation that would facilitate research into the potential health risks individuals with HIV face after receiving organs from donors who also have HIV. The bill also contains provisions: instructing HHS to develop and implement safeguards and quality standards for research related to HIV-infected organ transplantation; and that would decriminalize organ donations by individuals with HIV if the research concludes that there are no health risks. The House also passed and sent to the President for his signature H.R. 475, legislation amending the Internal Revenue Code of 1986 to include vaccines against seasonal influenza within the definition of taxable vaccines. The House also passed H.R. 1797, the Pain-Capable Unborn Child Protection Act, which in general, subject to certain exceptions, would prohibit any person from performing or attempting to perform an abortion if the probable post-fertilization age of the unborn child is 20 weeks or greater.


More Threats to Full Implementation of the PPACA


Rep. Jim Matheson (D-UT) announced that H.R. 763, legislation that would repeal the Patient Protection and Affordable Care Act’s (PPACA) tax on health insurers, has 221 cosponsors, enough to pass the House. Senator Orrin Hatch (R-UT) and the other eight Senate Finance Committee Republicans sent a letter to HHS Secretary Kathleen Sebelius which demands details on the so-called “navigator” program to determine the extent to which appropriate safeguards to protect consumer privacy have been adopted (some have expressed concerns that identity theft could increase if the standards for navigators are set too low). Also, the House Oversight and Government Reform Committee issued a subpoena to HHS Secretary Kathleen Sebelius for documents related to reviews and other information about each PPACA CO-OP applicant’s financial viability and ability to repay the loans each has received (a total of about $2 billion). In addition, the GAO issued a report finding that CMS has missed several deadlines in completing key activities necessary to establish federally facilitated health insurance exchanges in the 34 states which have ceded their roles to the federal government under the PPACA. GAO said that the remaining activities cross the core exchange functional areas of eligibility and enrollment, plan management and consumer assistance. In a related report, the GAO said the problems also cross-over to the federal role in establishing Small Business Health Options Program (SHOP) exchanges. Another factor confronting the implementation of the PPACA is the potential cost of the low-income subsidies to individuals who would be made newly eligible under the immigration reform legislation currently pending in the Senate (S. 744). Although CBO estimated that there would be about $200 billion in budget savings in the first 10 years after enactment of the bill, the CBO also estimated there would be 10.4 million more legal immigrants in the United States by 2023 which would result in an additional $82.3 billion more in health care law subsidies over the decade. In an attempt to help make the PPACA law successful, HHS Secretary Kathleen Sebelius is scheduled to visit at least seven states in the next few weeks to garner support for the law and increase enrollment under the exchanges beginning this October. The HHS outreach program includes programs for the following groups: the “Healthy and Young” who might feel medically invulnerable and might not see the value in health coverage; the “Active, Sick and Worried” who want to obtain health insurance but do not know how to choose a plan; and the “Passive and Unengaged” who are uninterested in health coverage and might have some mistrust of the PPACA. HHS also said that the PPACA medical loss ratio (MLR) requirements will reduce premiums by about $500 billion for certain policyholders in 2012.

House and Senate Actions on Vaccines, Veterans Mental Health and HIV Donor Issues The Senate Judiciary Committee voted to pass S. 162, legislation that would authorize $40 million per year in FY 2015-2019 to provide grants for veterans’ mental health programs, including peer-to-peer counseling and alternatives to incarceration and transitional services. The full-Senate also passed S. 330, legislation that would facilitate research into the potential health risks individuals with HIV face after receiving organs from donors who also have HIV. The bill also contains provisions: instructing HHS to develop and implement safeguards and quality standards for research related to HIV-infected organ transplantation; and that would decriminalize organ donations by individuals with HIV if the research concludes that there are no health risks. The House also passed and sent to the President for his signature H.R. 475, legislation amending the Internal Revenue Code of 1986 to include vaccines against seasonal influenza within the definition of taxable vaccines. The House also passed H.R. 1797, the Pain-Capable Unborn Child Protection Act, which in general, subject to certain exceptions, would prohibit any person from performing or attempting to perform an abortion if the probable post-fertilization age of the unborn child is 20 weeks or greater



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