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 Rejects ACA Repeal Efforts

In the early hours of July 28, Senate Republicans’ attempt to repeal and replace the Affordable Care Act (ACA) fell apart. Majority Leader Mitch McConnell (R-Ky.) had offered amendment #667, the Health Care Freedom Act, referred to as the “skinny bill,” in hopes of passing something in the Senate that could
engage the House of Representatives in conference negotiations to build consensus toward a final repeal and replace package. The final vote was 49-51 with Sens. John McCain (R-Ariz.), Lisa Murkowski (R-Alaska), and Susan Collins (R-Maine) joining Senate Democrats to oppose the amendment.

At the conclusion of the vote, Majority Leader McConnell returned the bill to the calendar. He thanked members for their work in trying to achieve consensus, but expressed disappointment that they could not come to an agreement. He asked for ideas on how to address the current problems with Obamacare. Minority Leader Chuck Schumer (D-N.Y.) stated that those who voted against the amendment are not celebrating, but are relieved at the outcome of the vote. He acknowledged that Obamacare can be improved, and that both parties should work together to do so. With the health care debate behind them
for now, the Senate adjourned until July 31st, when they will return to consider judicial nominations.

The Health Care Freedom Act – “skinny” repeal – would have repealed the individual and employer mandates, extended through 2020 the moratorium on the medical device tax, increased the maximum health savings account (HSA) contribution limit to the amount of deductible and out-of-pocket limitations
through 2020, provided funding for community health centers (CHCs), eliminated funding for Prevention and Public Health Fund beginning in FY 2019, eliminates funding for Planned Parenthood for one year,
and provided flexibility for state innovation (i.e., 1332 waivers) – which could have allowed states to alter
essential health benefits (EHBs).

Other amendments that failed to pass during the debate Thursday evening until early Friday morning included motions to recommit the bill to relevant health committees for further consideration, providing premium assistance for low-income individuals, and establishing a single payer health care system. An amendment to permanently repeal the ‘Cadillac’ tax on health benefit packages passed by a vote of 52-48.

Going into the evening, several Republican senators demanded assurance from the House that Senate passage of the skinny bill would result in conference negotiations. Speaker of the House Paul Ryan (R-Wis.) provided this assurance, which resulted in several senators voting for the package. Speaker Ryan stated “It is now obvious that the only path ahead is for the Senate to pass the narrow legislation that it is currently considering. This package includes important reforms like eliminating the job-killing employer mandate and the requirement that forces people to purchase coverage they don’t want. Still it is not enough to solve the many failures of Obamacare. Senators have made clear that this is an effort to keep the process alive, not to make law. If moving forward requires a conference committee, that is something the House is willing to do.”

The American Medical Association (AMA) stated that the group was relieved by the outcome of the vote, but added that the status quo is not acceptable and that Congress must work to stabilize the individual marketplace to ensure access to affordable and quality health insurance coverage.

The House adjourned for August recess on Friday. The Senate previously made the decision to delay its recess for two weeks. At this point, the Senate is poised only to complete work on nominatons, but it may also take up the bipartisan Food and Drug Administration Reauthorization Act (FDARA), which previously passed the House by voice vote. Timely passage of FDARA is necessary to ensure that FDA review and approval of pharmaceuticals and medical devices is not disrupted as the user fees authorized by the bill provide more than half of the agency’s funding.

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