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.


House Appropriations Committee Approves FY 2014 302(b) Subcommittee Allocations

On Tuesday the House Before adjourning for the Memorial Day recess, the House Appropriations Committee approved by voice vote the FY 2014 302(b) spending allocations (i.e., the cap on spending) for each of its subcommittees. The committee also passed the FY 2014 Military Construction/Veterans’ Affairs appropriations bill with a $73 billion cap on FY 2014 spending. The Department of Veterans Affairs (VA) would get $63.1 billion and military construction would get $9.9 billion. VA medical services would receive $43.6 billion. In addition, the full-committee allocated the Labor/Health and Human Services/Education subcommittee $121.797 billion in spending, a $27.8 billion cut below current sequester-level spending. In contrast, the spending cap for defense-related programs was set at $522 billion, an increase over the $498 billion that would otherwise be allowed under sequestration. Committee Democrats were unable to delay the committee’s actions to allow for a possible agreement between the House and Senate on the differing budget resolutions passed in each chamber. The committee also defeated along party lines a Democrat amendment that would raise the overall $967 billion spending cap set under the rules of sequestration (included in the House-passed budget resolution) to $1.058 billion which is the level included under the President’s budget and the level likely to be used by the Senate Appropriations Committee. In other budget news, House Republicans continue to discuss their options in obtaining tax reform, entitlement reform or other spending curtailments from the President and congressional Democrats in trade for their support of any increase in the federal debt limit. House Speaker John Boehner has previously insisted that any increase in the debt limit be accompanied by similar spending reductions.

GOP and Democrats Continue to Attack and Defend the PPACA

Rep. Joe Pitts (R-PA) said he will modify and reintroduce his legislation to fund the high-risk programs which failed to gain enough support among House Republicans to be considered on the House floor. He said the new version would repeal the Patient Protection and Affordable Care Act (PPACA) Prevention and Public Health Fund and reallocate the $8.5 billion in savings to deficit reduction and grants to states to fund their own high-risk pools or start new ones. The bill may have a better chance for approval from House Republicans, given that new members have had an opportunity to vote for a full repeal of the PPACA (H.R. 45) and the bill would prevent further Department of Health and Human Services’ (HHS) efforts to use the money for other PPACA implementation efforts (such as $53 million for the navigator program under which CMS has received 830 letters of intent to participate in the program). Senator Dean Heller (R-NV) has also taken aim at the Internal Revenue Services’ (IRS) enforcement of the PPACA by filing an amendment to S. 954, a farm bill, prohibiting the agency from receiving funds to enforce the law. Senators John Cornyn (R-TX) and Rep. Diane Black (R-TN) have also introduced legislation, S. 983 and H.R. 2022, which would have the same effect. Although the Director of the Centers for Medicare and Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) testified at a House Oversight and Government Reform Committee that there is no connection between the IRS implementation of the PPACA and the IRS’ Tax Exempt/Government Entities Division targeting of conservative and other groups for selective scrutiny, Senator John Thune (R-SD) sent a letter to the Department of Justice with a demand that the IRS refrain from implementing the PPACA until the Department of Justice determines whether there will be action taken on the former IRS Tax Exempt Division head who was recently placed in charge of IRS efforts to implement the health law. At a recent House Energy and Commerce Oversight Subcommittee hearing on the cost of health insurance premiums likely to be charged under the PPACA, Republicans released a study, The Looming Premium Rate Shock, stating that premiums will increase significantly for most Americans. It said that premiums for new individual policies under the PPACA will increase by 96% and that premiums for grandfathered policies will increase by 73%. On the other hand, the full-committee ranking member Rep. Henry Waxman (D-CA) released a study, Analysis of Recent Filings of Proposed Affordable Care Act Insurance Rates in Five States, which he said shows that there will not be widespread rate shock and that rates will actually decrease in PPACA “bronze” plans by 11% in Oregon and by 21% in Washington. He noted that in Maryland the original Blue-Cross/Blue-Shield rate filing requesting a 50% increase in premiums was reduced by one-half. Two subcommittees of the House Committee on Oversight and Government Reform also took aim at the so-called “State Assister Grants” conjured up by HHS when Congress refused to include further funding for the PPACA “Navigator” program in the FY 2013 continuing resolution. The CCIIO director testified that while the state assister program will perform the same functions as the Navigator program, it is only a temporary one-year program to help states who have said they do not have the funds to establish their permanent Navigator programs. Answering a question on the legality of the assister program, the CCIIO director said that the PPACA provides statutory authority for all exchanges to “provide outreach and education and enrollment assistance to people.” Defending HHS Secretary Sebelius’ outreach to insurers to assist in informing the public about enrollment and exchange eligibility rules under the health law, the CCIIO director said this effort was similar to the efforts by AARP and the pharmaceutical industry to educate the public in 2006 about the new Medicare Part D program.

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