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 Issues

On Monday, OMB will release President Obama’s FY 2013 budget recommendations which are expected to only trim the FY 2012 projected federal deficit of $1.33 trillion to about $.9 to $1.2 trillion.  The Administration is not expected to recommend major changes to Medicare, Medicaid and Social Security, although the President has previously suggested he would accept higher premiums for high-income Medicare beneficiaries.  The President’s FY 2013 budget is likely to be DOA as was his FY 2012 budget recommendations.  Senate Majority Leader Harry Reid is unlikely to want to bring the new budget to a vote in the Senate, given the Senate’s rejection of the President’s recommendations for FY 2012.  Instead, Senator Reid declared that he will not advance a FY 2013 budget resolution during this election year.  Last week the House passed two budget-related bills: H.R. 3521, the Expedited Legislative Line-Item Veto and Rescissions Act of 2011, was passed on a vote of 254-173; and H.R. 3581, the Budget and Accounting Transparency Act of 2011, was passed on a vote of 245-180.  The line-item veto concept may find some receptivity in the Senate among some Democrats when Senators John McCain and Tom Carper attempt to push the concept in the context of other legislation.

Doc-Fix and Payroll Extender Talks Flounder

House Republican conferees on H.R. 3630 offered up spending cuts that would fund about one-half the cost of extending current Medicare physician payment levels, payroll tax reductions and unemployment insurance extensions to the end of this year.  The proposal, rejected by Democrats, would raise Medicare Part B and D premiums for higher-income beneficiaries ($31 billion over ten years), require inaccurate PPACA exchange subsidies to be repaid ($13.4 billion over ten years) and extend the current freeze pay for federal employees.  In rejecting calls for the use of “war savings” to finance the legislation, House Speaker John Boehner suggested that Democrats get “serious” about negotiations.  Further discussions on potential payfors are likely to be held this week behind closed doors.  Senate Majority Leader Harry Reid said his office has begun to draft a Democrat alternative (which he could move separately as a threat to Republicans to reach a compromise on the legislation in conference).

PPACA Health Reform Update Administration Backtracks on PPACA Contraceptive Coverage Mandate

Reacting to the backlash over interim final HHS regulations requiring all health plans, except certain church and related institutions, to cover women’s contraceptives, the White House announced a new policy that would instead allow religious organizations, such as universities and hospitals, to avoid the mandatory coverage requirement but place the burden on health insurers to offer covered individuals the option of such coverage for no cost.  The revised policy is unlikely to have cut this Gordian knot, given the contention by self-insured parochial entities that the revision would still require them to offer and pay for such coverage in violation of their religious tenets.  House Speaker John Boehner has pledged to advance legislation if the new rule is found to be deficient in protecting “religious freedom.”  Senators Joe Manchin and Marco Rubio introduced legislation, S. 2092, which would exempt individuals or entities with a religious or “moral conviction” objection from offering health insurance coverage for contraception or sterilization services and from having to engage in “government-mandated speech” with respect to such services.  This latest dustup of a PPACA mandate could also find its way into the various suits challenging the constitutionality of the PPACA’s individual mandate.

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