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 Deliberations

Although the law increasing the federal debt limit includes a $1.047 trillion discretionary spending limit cap on FY 2013 appropriations, House Republicans are considering even lower limits as they craft a new budget resolution.  One would reduce the amount to $950 billion derived by subtracting the amount that would be taken away from FY 2013 discretionary appropriations if the $97 billion in automatic spending sequestrations now scheduled for next January are allowed to take effect.  Another alternative set at $931 billion would be determined by using the previous House budget resolution ($1.028 trillion) and subtracting the $97 billion sequestration amount.  The House Budget Committee is expected to unveil their budget blueprint during the third week in March.

In the Senate, Majority Leader Harry Reid has indicated that he will not bring a budget resolution to the floor.  However, both he and Minority Leader Mitch McConnell have agreed to bring appropriations bills to the Senate floor, perhaps as early as in April, which would conform to the $1.047 spending limit.  With the $1.2 trillion in 10-year’s worth of sequestration scheduled to begin next January, Defense Secretary Leon Panetta said, in Senate Budget Committee hearing, that the Administration wants to work with Congress to avoid the cuts.  A budget deal would have to come in the short span of less than two months in a lame-duck session after the November elections.  House Minority Leader Steny Hoyer has also called for a “grand bargain” to address long-term federal deficit concerns and the Medicare physician payment SGR problem.

Senate Defeats Blunt PPACA Amendment

The Senate voted 51-48 to turn back a PPACA-related amendment offered by Senator Roy Blunt that would overturn the HHS rule requiring religious-based organizations to provide certain women’s contraceptive coverage under their fully-insured and self-insured health plans.  The amendment provides that when a plan sponsor drops such coverage because of moral objections, additional coverage of equivalent actuarial value would have to be substituted.  Senator Susan Collins asked for clarification of the rule from HHS Secretary Kathleen Sebelius.  She responded that the President is “committed to rulemaking to ensure access to these important preventive services in fully insured and self-insured group health plans while further accommodating religious organizations’ beliefs.  We are engaging in a collaborative process with affected stakeholders including religiously affiliated employers, insurers, plan administrators, faith-based organizations and women’s organizations as we develop policies in this area.”  Senator Blunt offered that the HHS rule would, nonetheless, be overturned in federal court in the suit recently brought to contest the rule.

HHS Grilled on PPACA Implementation and Budget

At a House Energy and Commerce Health Subcommittee hearing, Republicans were critical of HHS for missing regulatory deadlines and asked why final regulations have not been issued to give guidance to states and plan sponsors regarding guaranteed issue of coverage, health plan accreditation, the content of essential health benefits and the establishment of state health insurance exchanges.  HHS Secretary Kathleen Sebelius said final or interim final regulations will be issued soon. In addition, House Ways and Means Republicans also asked HHS and Treasury why the OMB increased its estimate of PPACA premium subsidy costs by $111 billion in the President’s FY 2013 budget proposal.  Treasury answered that one-third of change is for “technical” reasons while the remainder is due to the law repealing the PPACA’s provision which would have imposed a 3% withholding of certain payments made to vendors by government entities (P.L.112-56).

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