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 - SEPTEMBER 23, 2013


House Sets Up Senate this Week for Vote on Defunding Affordable Care Act


Last Friday the House passed and sent to the Senate H.J. Res. 59, the Continuing Appropriations Resolution (CR) for fiscal year (FY) 2014 on basically a party-line vote of 230-189. The $988 billion CR would fund federal agencies at current levels through December 15th while continuing the sequestration cuts for all federal agencies, including the Department of Defense. Because House Republicans rejected an initial move by their leadership to defund the Patient Protection and Affordable Care Act (PPACA) by means of a two-part CR that would make it easier for Senate Democrats to sever the provision, the Speaker acceded to his conference’s demand and included specific language in the CR that would defund the health reform law. Senate Majority Leader Harry Reid (D-NV) said the “reckless” defunding provision would be “dead” upon arrival and that the Senate Democrat caucus is 100% in support of his expected move this week to allow a vote that would remove the offending provision and send the resolution back to the House. Senate Appropriations Committee chair Barbara Mikulski (D-MD) also said she would possibly convene her committee to report a resolution that would continue current spending without appending other controversial provisions. If this scenario proves correct, the House would then have through this coming weekend to pass the amended measure or risk shutting down federal agency activities at the beginning of fiscal 2014 (October 1st). It is conjectured that Speaker Boehner (R-OH) would still like to avoid a government shutdown by passing a cleaner CR and leapfrog the PPACA defunding fight into next month when the Treasury Secretary says the federal debt limit will have to be increased to avoid a potential default on federal obligations. To presage this scenario, the CR also includes a provision that would prioritize principal and interest on government debt held by the public and by the Social Security trust fund, thus putting all other federal obligations (including Medicare and Medicaid payments) in jeopardy if the debt limit is reached. The Office of Management and Budget (OMB) issued a statement saying that the President would veto the House-passed CR and the President continues to insist that Congress increase the debt limit without further conditions. It might be noted that recent debt limit legislation has led to other restraints, including the passage of the Budget Control Act provisions requiring sequestration cuts in federal spending. The upcoming battle over the debt limit is likely to include Republican policy insistence on spending reductions equal to any increase in the debt limit and concessions on PPACA, including at least a one-year delay in the individual mandate to match the Administration’s delay of the employer mandate until 2015 and a prohibition on federal/employer payments for Congress and all of their staff when obtaining health coverage under PPACA health insurance exchanges. House Republicans may attempt to pass a debt ceiling extension bill as early as this week to get the debate going. Even if the Senate and the House ultimately pass a “clean” CR at the above-described levels, House Speaker Nancy Pelosi (D-CA) and other leading committee Democrats have voiced their concern that the CR would cut $13 billion from the Children’s Health Insurance Program (CHIP) program and lead to diminished health coverage under the program. Of note, the Congressional Budget Office (CBO) has avoided providing a complete cost estimate of the House-passed CR including the defunding provision, indicating only that it would reduce federal spending as well as federal revenues over the next ten years. Rejecting the Republican agenda, President Obama said last week that “the single most important thing we can do to prevent that [economic chaos] is for Congress to pass a budget, without drama, that puts us on a sound path for growth, jobs, better wages, better incomes….”


PPACA Health Insurance Exchanges May Have Rough Start


At a hearing held by two subcommittees on the House Oversight and Government Reform Committee, the South Carolina Attorney General testified that there is a “need to indefinitely suspend implementation of the Affordable Care Act until security risks are mitigated, privacy protections are provided and legally mandated deadlines are properly met.” The witnesses from Kansas and Louisiana expressed concerns over the late technical updates mandated by the government to verify marketplace eligibility and the perceived inadequacy of federal oversight of navigators who are supposed to help consumers choose their health plans. The witness from Florida also testified that the state was concerned enough with the possibility of abuse by navigators that a law was enacted to require navigators to undergo background screenings and disqualify them for engaging in certain illegal activities. The committee’s staff also released a report, Risks of Fraud and Misinformation with ObamaCare Outreach Campaign: How Navigator and Assister Program Mismanagement Endangers Consumers, which said that substantial risks of fraud remain because the Administration decided not to require background checks and fingerprinting of individuals hired by Navigator and Assister organizations. Additional problems also were reported last week in connection with the software used to determine federal subsidies to be provided under the federally facilitated marketplaces (FFMs) operated in states that did not elect to set up their own exchanges.



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