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 Conferees Leave Town and Appropriators in a Lurch

The House has recessed until December 2, the date that appropriators had hoped to have a decision from budget conferees on the level of top-line spending for FY 2014 to allow their subcommittees to make final spending allocations for the remainder of the fiscal year. The Senate does not get back until December 9th. Given that it is increasingly unlikely that the conferees will reach a final agreement on the level of federal spending before the December 13th deadline, House Speaker John Boehner (R-OH) announced that he would direct House appropriators to develop a new continuing resolution (at the $967 billion sequester level) to allow budget negotiations to continue. Senate Minority Leader Mitch McConnell (R-KY) is said to also support the $967 billion ceiling set under the Budget Control Act (BCA). The Speaker’s announcement may presage a move to allow budget negotiations to continue until at least January 15, 2014 when the current continuing resolution (CR) expires. Members continue to seek avenues by which the adverse effects of sequestration can be ameliorated (e.g. for sequestered medical device fees that would otherwise be available for Food and Drug Administration (FDA) device approvals). The lack of a legislative vehicle this year on which to attach a long-term fix for the current Medicare physician payment sustainable growth rate (SGR) formula may force members to take one of two courses of action--that is, to either pass a stand-alone reform bill that includes an offset for the increased spending or to follow past patterns which have led to short-term relief from the Centers for Medicare and Medicaid Services (CMS) determined cuts (i.e. 24.4% for calendar year (CY) 2014). Rep. Michael Burgess (R-TX), the sponsor of the House Energy and Commerce Committee’s bipartisan Medicare physician payment reform legislation (H.R. 2810), said he may oppose another short-term physician payment fix unless a long-term solution is “moving in the right direction” in December. In this regard, the Senate Finance Committee announced that a markup of the joint Finance/Ways-and-Means Medicare physician payment reform proposal (as well as other Medicare extenders) will be held on December 12th. The tax committees’ proposal would freeze payments for five years, unlike the House Energy and Commerce Committee bill which includes a 0.5% per year increase. The Congressional Budget Office (CBO) has yet to provide a cost estimate of the tax committees’ measure which does not currently include an offset for the increased spending under the proposal. However, Senator Jay Rockefeller (D-WV) is promoting his Medicare Part D drug rebate bill, S. 740 which would restore rebates for dual-eligibles, as the preferable means to offset the cost of physician payment reform.

Senate Changes Rules On Executive/Judge Confirmations

Senate Majority Leader Harry Reid (D-NV) decided it was time to overturn the time-honored ability of the minority to filibuster against executive and judicial branch nominees and forced a vote to change the Senate’s rules to allow a 51 majority to give their “advise and consent” to President Obama’s nominees. This tactic to invoke the so-called “nuclear option” was the tipping point for Republicans last week and they reciprocated by refusing to allow the Defense authorization bill to proceed before the Thanksgiving recess. The change to the filibuster rule may also create a more contentious situation when Congress returns to address critical budget/appropriations issues. Republicans are also unlikely to back down on opposing executive/judicial nominations, perhaps by delaying committee votes and extending the time of post-cloture debate on such nominations.

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