TRP Health Policy Report

The House adjourned last Wednesday for the annual Republican retreat. Before departing, lawmakers passed legislation to nullify President Obama’s recent immigration order, tying the contentious issue to a bill (H.R. 240) funding the Department of Homeland Security (DHS). The vote was 235-191 for the appropriations bill after the House easily approved amendments to unravel the President’s plan to give safe harbor to up to 4 million illegal immigrants. The underlying $39.7 billion measure would fund DHS from Feb. 27, which its current funding expires, through September. The vote sends the measure to the Senate, where it would need 60 votes to clear procedural hurdles, and where Democrats appear to have the votes to stop it. Even if the legislation reaches the President’s desk, the White House promised to veto it. As a result, it remains unclear how Congress and the White House will agree on a bill funding Homeland Security. According to Republican aides and lawmakers, House GOP leaders intend to wait to see how the Senate responds before making their next move. Lawmakers in both parties have suggested it is unthinkable that DHS funding will be allowed to expire, particularly in light of recent terrorist attacks in Paris.

Elsewhere, the House on Wednesday voted 271-154 for legislation (H.R. 37) to amend the 2010 Dodd-Frank financial overhaul. The measure first hit the House floor on Jan. 7, but it failed under a fast-track procedure typically reserved for noncontroversial bills. The legislation came to the floor last week under a procedure requiring only a simple majority, ensuring its passage. In other activity, the House voted 250-175 for legislation (H.R. 185) to require federal agencies to estimate the economic costs of regulations. In the Senate, members voted 63-32 last Monday to begin debating a bill (S. 1) to approve the Keystone XL oil pipeline, a process that will continue into this week. Eleven members of the Senate Democratic caucus joined with 52 Republicans in voting to proceed to debate. Majority Leader Mitch McConnell (R-KY) is promising an open debate in the Senate that will allow for the consideration of amendments from both sides of the aisle. A similar version of the Keystone bill (H.R. 3) passed the House on Jan. 9. President Obama has threatened to veto the legislation.
The Week Ahead
President Obama delivers his annual State of the Union address this evening before a new Congress led by Republicans determined to block many of his policies. The President is expected to make economic growth a central theme and highlight proposals to make community colleges tuition-free, require companies to pay for sick days and maternity leave, and cut mortgage insurance premiums on loans used primarily by lower-income homebuyers.  Freshman Senator Joni Ernst (R-IA) will deliver the Republican response to the President’s address. In floor activity, the Senate will resume debate on legislation (S. 1) to force approval of the Keystone XL pipeline. Senators will debate a series of amendments to the $8 billion pipeline project, setting up roll call votes later this week. With the Keystone debate dominating floor action in the Senate, the House will focus on legislation restricting some abortions (H.R. 36) and a bill (H.R. 161) to expedite permits for natural gas pipelines. Off the floor, the House Energy and Commerce Health Subcommittee will convene Wednesday and Thursday for a hearing on SGR reform. Members will discuss how to bring SGR reform to the President’s desk before the current patch expires at the end of March 2015. 
CMS Administrator Tavenner Announces Resignation
Last Friday, CMS Administrator Marilyn Tavenner announced that she will be leaving her post in February. A former hospital executive and Virginia health secretary, Tavenner was appointed interim head of CMS in 2011. Two years later, she became the first CMS Administrator to win Senate confirmation since 2006. The vote was 91-7. She announced her departure Friday in an email sent to staff. Tavenner didn’t give a reason for her departure, but listed a series of agency accomplishments under her tenure, including slowing the growth of health-care costs, now at a historically low rate. She also praised the current operation of the Affordable Care Act’s (ACA) online insurance exchanges.
Though one of the most senior officials involved in the bumpy rollout of the website in 2013, Tavenner never drew as much fire as her boss at the time, former HHS Secretary Kathleen Sebelius, who resigned last year. However, Tavenner has received some criticism, including for CMS's role in miscounting the number of U.S. residents who enrolled in health coverage through the health law's exchanges during its first open enrollment period. The second health law enrollment period will close Feb. 15, and HeathCare.Gov is operating without the glitches that hindered the site last time. About 6.8 million people in states covered by the federal site have so far signed up for, or renewed, 2015 coverage 2015, HHS announced last Wednesday.
Tavenner will be succeeded by Andy Slavitt, who is currently the second-highest ranking official at the agency. As a top executive at UnitedHealth Group, Slavitt had worked closely with the agency on’s technical issues and was brought in-house in 2014. Slavitt will ultimately need Senate confirmation if he is to become the agency’s permanent Administrator. With many Republicans in the GOP-controlled Senate pressing for major changes to the 2010 health law, the confirmation process could again be difficult.
Upton, DeGette Outline Goals for 21st Century Cures Bill
Last week, Energy and Commerce Committee Chairman Fred Upton (R-MI) and Rep. Diana DeGette (D-CO) outlined five broad goals of the 21st Century Cures draft bill they plan to introduce later this month. In a opinion piece, Upton and DeGette provided highlights of policies that they intend to drive cures and treatments for the more than 7,000 diseases for which only 500 have cures and treatments. The goals include:
  • Modernize clinical trials to streamline the approval of drugs and devices;
  • Integrate the patient perspective into the regulatory process;
  • Promote better access to and sharing of information such as genomic and other clinical data to foster more collaboration among researchers;
  • Invest in the future of science to support and encourage young, emerging scientists;
  • Incentivize new drugs and devices for unmet medical needs.
Last year, Upton and DeGette embarked on the 21st Century Cures initiative with the goal of getting new cures and treatments to patients more quickly. Over the course of the year, the E&C committee issued four white papers and hosted a series of hearings and roundtables around the country to gather stakeholder input. In January, 21st Century Cures will release a discussion draft based on their review of input from patients and advocates, healthcare workers and researchers, and government and the private sector. Upton hopes to have final language for the bill in March, and vote on the legislation by Memorial Day with the goal of having the measure on President's Obama’s desk by the end of the year.
States on Hold Ahead of ACA Ruling
The Supreme Court is set to hear oral arguments in March over a legal challenge that contends the Affordable Care Act only allows individuals to get tax credits for coverage bought through a state-run exchange. At issue are subsidies for millions of consumers under the health law that make health plans cheaper. In 37 mostly Republican-controlled states, the federal government has a hand in running the exchanges where consumers buy insurance. About 4.7 million people in those states got billions of dollars of tax credits to offset the cost of insurance premiums for 2014, and more are expected to get them this year. A decision on the legal challenge is expected this summer.
When the high court appeared poised to take the case last year, several states – including Illinois and Arkansas – weighed whether their federally run exchanges could quickly be transformed into state-run marketplaces, thereby protecting the tax credits. Now, many of those states are backing away from making such changes. If the court were to strike down the credits, people who currently receive them could see their monthly premiums rise hundreds of dollars within a few weeks, creating turmoil and calls for fixes by consumers, insurers, hospitals and other stakeholders in affected states. With most of those states unlikely to take action on their exchanges, decisions over the health law’s future would likely involve negotiations between President Obama and Congress, which is controlled by Republicans opposed to the law.
Congressional Republicans are already sending a clear message that they would try to use a court ruling as a chance to significantly revamp the law, rather than voting through a fix to its wording that could restore the tax credits. “If the Supreme Court rules against the Administration, the President is going to have to work with Congress to deal with the problem,” said Sen. John Barrasso of Wyoming, who leads the Senate Republican Policy Committee. “Republicans are in the process of developing a plan to transition from the health law.” White House officials, including the President, HHS Secretary Sylvia Mathews Burwell and CMS Administrator Marilyn Tavenner, have all declined to say what they would do if the court struck down the subsidies. But last Thursday, an HHS spokesperson expressed optimism, saying “We are confident that our interpretation – that all Americans are eligible for premium tax credits no matter where they live – will stand.”
Senators Target ACA’s Medical Device Tax
Last Tuesday, a bipartisan group of ten senators reintroduced legislation (S. 149) to repeal the Affordable Care Act’s medical device tax. Sen. Orrin Hatch (R-UT) proposed the Senate measure alongside a bipartisan group of five Democratic Senators and five Republicans. Rep. Erik Paulsen (R-MN) has introduced the repeal measure (H.R. 160) in the House. The five Democratic members in support of the Senate measure bring the chamber close to meeting the 60-vote threshold needed to avoid a filibuster on the bill. With support from members of both parties as well as industry, the bill is one change to the health law that seems likely to pass Congress this year.
The House measure also has bipartisan support, with 258 current co-sponsors, including 29 Democrats. The House passed a device tax repeal bill in 2012 that would have offset the costs by recovering subsidy overpayments from the healthcare reform law. In March 2013, the Senate approved a symbolic resolution calling for repeal of the tax, with more than 30 Democrats joining Republicans in support of the non-binding measure. In the past, President Obama has threatened to veto device tax repeal because it undermines the Affordable Care Act. While the President has not said whether he would veto such legislation in the 114th Congress, device tax repeal was raised as one area of cooperation immediately after the 2014 election.
Poll: Majority Support GOP Change to ACA Mandate
According to poll results released last Tuesday by the Morning Consult, only 20 percent of Americans believe that employees clocking in 30 hours a week qualify as full-time, giving weight to the GOP argument to raise the government's threshold for full-time work under the Affordable Care Act. A majority of Americans say they are in “total support” with the Republican position that employers should only have to provide healthcare for employers working 40 or more hours a week, researchers found. Nearly three-quarters of those polled said they consider a full-time workweek to be 40 hours.
The definition is crucial under the ACA, which requires many employers to offer insurance to full-time employees. On Jan. 8, the House approved a bill (H.R. 30) to define full-time as a 40-hour workweek in a 252-172 vote, which fell largely along party lines. The Morning Consult poll found that the employer mandate itself enjoys wide support, with 60 percent of respondents in favor of the policy. The approval rating is an increase from the 53 percent of people who said they supported it in a poll taken near the midterm elections. The boost in support comes even as GOP lawmakers remain in strong opposition to the mandate, arguing that it is forcing employers to limit the hours of their part-time work force. Nearly the same percentage of people who supported the employer mandate also believe companies should also be required to offer healthcare to part-time employees, the poll found.