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.


Senate Set to Tackle FY 2014 Labor/HHS/Education Appropriations

On Tuesday the Senate Appropriations Labor/Health and Human Services (HHS)/Education Subcommittee will take up Chairman Tom Harkin’s (D-IA) mark and on Thursday the full Appropriations Committee will follow suit. As Congress returns from the July 4th recess, Senate Democrats continue to press the House to go to conference on the two houses’ competing versions of their fiscal year (FY) 2014 budget resolutions. The Senate Budget Committee Chair, Sen. Patty Murray (D-WA), told Senate Democrats that ““When we return in July, we will have a narrow window of opportunity to work toward a bipartisan budget deal, replace sequestration in a balanced way for this year, next year, and beyond, and prevent another round of uncertainty and brinkmanship in September….” However, the task remains uncertain given Senate Democrat’s insistence for an amelioration of the Budget Committee Act’s (BCA) sequestration and the House’s strengthening of support for the cuts, except for defense spending which was set at $54 billion over the sequestration level. A continued impasse could result in defense and Military Construction/Veterans Administration bills being considered separately followed by a FY 2014 “minibus” continuing resolution for other programs for which a resolution cannot be negotiated.

PPACA Employer Mandate Delayed until 2015

In an unusual maneuver, the Administration used a blog by the U.S. Department of Treasury’s Assistant Secretary for Tax Policy to announce that the administering agencies of “Obamacare” will soon issue transitional relief under the law by not enforcing the Patient Protection and Affordable Care Act’s (PPACA) employer minimum health coverage mandate, shared responsibility payments/penalties and employer/insurer reporting requirements until 2015. The announcement said that individual premium tax credits available in 2014 will not be affected by the delay. The Administration, nonetheless, encouraged employers to make coverage available to their workers as would otherwise have been required under the law. Although several business organizations expressed their approval of the relief, Republicans were quick to respond to the surprise blog on other terms. The House Ways and Means Health Subcommittee announced that it will hold a hearing on the delay this Wednesday. Senator Orrin Hatch (R-UT) stated “That the Obama Administration is putting off this job-killing requirement on employers, but not individuals and families, shows how deeply flawed the President’s signature domestic policy achievement is. While a delay of this mandate is welcome news since it shows the challenges the employers are facing complying with it, a delay—conveniently past the 2014 election—only adds to the uncertainty these job creators face because of ObamaCare.” In addition, House Energy and Commerce Committee Chairman Fred Upton (D-MI) and other key House Republicans sent a letter to the Departments of Treasury and Health and Human Services (HHS) requesting that they provide them with documents and information by July 17th “to better understand the process being used by this administration to determine which provisions of the law to implement, on what time-table, and the feedback upon which such decisions are being made.” Rep. Upton said that “Despite delays and missed deadlines, administration officials had repeatedly testified before Congress that they were still on schedule to implement the law…. they [now have] admitted that wasn’t the case, and it’s clear we have no idea [of] the full scope of delays and disarray that may be coming.” Rep. Phil Roe (R-TN) has also asked the Congressional Research Service (CRS) to provide him by this Wednesday with an analysis of the Administration’s delay and legal authority for its action. About a $10 billion reduction in 2014 federal revenues is expected as a result of the delay in employer penalties; and the cost of federal tax credits to individuals who do not take or are not offered employer health coverage is also likely to increase significantly as employers delay establishing coverage and complying with new benefit mandates, thus encouraging employees to seek coverage under the new health insurance exchanges.

Small Businesses Express Other Concerns About the PPACA

Republican leaders on the House Oversight and Government Reform Committee sent a letter to HHS Secretary Kathleen Sebelius to affirm the agency’s assurance that small employers do not need to obtain health insurance coverage only in the new PPACA exchanges which will begin enrollment this October. Their concern is that the Vermont and District of Columbia insurance officials have indicated that small business coverage can only be obtained under their state-run exchanges.

Efforts to Increase Enrollment and Final Rules for Exchanges

Against the backdrop of a Gallup poll finding that 43% of uninsured U.S. residents do not know that they will be required to purchase health coverage or pay a penalty under the PPACA, the Centers for Medicare and Medicaid Services (CMS) announced a new partnership with the Institute of Museum and Library Services to utilize 123,000 libraries nationwide to assist in distributing information about the PPACA and locating navigators who can help individuals enroll under the state and federal health insurance exchanges beginning this fall. In addition, HHS announced it has made $32 million in “Connecting Kids to Coverage Outreach and Enrollment Grants” to 41 state agencies, community health centers, school-based organizations, and other nonprofit groups to identify and enroll children eligible for Medicaid and the Children’s Health Insurance Program (CHIP) programs. The Government Accountability Office (GAO) also reported that, to date, HHS has awarded $3.7 billion to states to help them establish health insurance exchanges and has awarded about $159 million to help states establish insurance rate review processes. CMS also issued a final rule setting out the guidelines (including appeals and electronic notices) for how state Medicaid programs are expected to coordinate with health insurance exchanges to implement the PPACA’s eligibility requirements for Medicaid and CHIP.

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