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 Parliamentarian Makes Reconciliation Ruling

The Senate parliamentarian has ruled that the provisions to repeal the individual and employer mandates in the reconciliation bill do not pass the complex rules for using the fast track budget tool. The Byrd Rule is a five-part test that determines what language can be protected from a filibuster through reconciliation, requiring that the primary purpose of legislative provisions affect spending and revenues. The rule bars “extraneous matter” where budgetary effects are only incidental to policy changes. The parliamentarian found that repeal of the mandates was merely incidental. Overruling the parliamentarian’s decision would require 60 votes, and in this case would be blocked by Senate Democrats. The parliamentarian decided, however, that the bill was “privileged,” which means it can still avoid a filibuster. Republicans have said that they will restore the mandate repeal measures with a substitute amendment from the floor. But the reconciliation bill has hit other stumbling blocks since being passed by the House of Representatives. Several moderate Republicans in the Senate have voiced opposition to the use of reconciliation to defund Planned Parenthood, while more conservative members have argued that the bill does not go far enough to repeal the Affordable Care Act (ACA). With a 54-member majority, Republicans can only afford three defections for the bill to pass on the floor because Democrats are expected to unanimously vote against it. If passed, however, the bill will surely face a presidential veto.

Senate Passes VA, Military Construction Spending Bill

The Senate passed the fiscal year (FY) 2016 spending bill for military construction and veterans’ benefits last week. The bill was agreed to by a vote of 93-0 on the eve of Veteran’s Day. It appropriates $1.1 billion in funding for veterans’ care above the President’s budget request, and includes special protections for doctor and nurse whistleblowers who expose problems with access to and quality of veterans’ health care. The bill will also increase VA research funding on prosthetics. House and Senate lawmakers will continue the process of negotiating an FY 2016 omnibus-spending bill. It remains unclear how many spending bills will be a part of the omnibus package. Appropriators are working to determine how to allocate the extra funding resulting from the two-year budget and debt ceiling deal. The deal raised sequester caps by $50 billion for FY 2016, with half of that total going to defense programs. The remaining $25 billion will be divided up among the 11 other spending bills that collectively fund the rest of the federal government. Republicans strongly desire to pass new spending bills for FY 2016, rather than using continuing resolutions, which would mean a continuation of policies written when Democrats controlled the Senate. Democrats, however, continue to voice opposition to the Republican insertion of contentious policy riders, like the potential defunding of Planned Parenthood, into spending bills. In the House, appropriators plan to hold members-only listening sessions on the six spending bills that did not pass the House earlier this year in order to receive input on the measures. The session on spending for the Department of Agriculture and the Food and Drug Administration (FDA) will be held on November 18, and the session on funding for the U.S. Departments of Labor, Health and Human Services, and Education will be held on November 19. Congress has until December 11 to pass a government-funding bill in order to avoid a shutdown.

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