Health Policy Report

September 21, 2015

The Week in Review
In a week shortened by the Jewish New Year holiday, Congress attacked the Iran deal and inched closer to a possible continuing resolution to fund the government beyond September 30, the end of the current fiscal year. On the Iran deal, Senate Majority Leader Mitch McConnell (R-KY) lost two cloture votes on the resolution disapproving the Administration’s nuclear agreement with Iran (H.J. Res. 61) as the 42 Democrats who support the deal held firm in denying the measure from advancing. The agreement is set to be implemented as last Thursday marked the deadline for a disapproval of the deal to reach the President’s desk.

The House, meanwhile, focused on passing two anti-abortion bills that were designed to separate that issue—and the federal money that Planned Parenthood gets for non-abortion medical services—from the must-pass stopgap spending bill prior to the end of the fiscal year. One measure (H.R. 3134) would bar for one year federal payments to Planned Parenthood and other organizations that perform abortions. It was considered along with companion legislation (H.R. 3504) that seeks to impose criminal penalties on doctors who fail to provide medical attention to live babies delivered during abortions. The former measure passed by a vote of 241-187, while the latter was initially passed by voice vote, with a roll call vote left as unfinished business on Friday afternoon.
On Wednesday, the Republican nominees for President held their second debate at the Ronald Reagan Presidential Library in Simi Valley, California, with former Hewlett-Packard CEO Carly Fiorina joining the other 10 candidates who participated in the first debate. Fiorina took advantage of the opportunity, performing well in front of CNN’s largest viewing audience in its history, with 23 million Americans tuning in. To many, the debate felt more like an entertainment program, as the current frontrunner, Donald Trump, fended off attacks and dealt some of his trademark one-liners in retaliation. Policy often took a backseat to theatre, with a discussion on the dubious link between vaccines and autism providing some of the biggest headlines of the night.
The Week Ahead
With the clock ticking toward the September 30, lawmakers are in the final stretch as they seek to hatch a strategy to avert a government shutdown.  House Republicans will likely try to make progress this week on a continuing resolution (CR) to keep the government open in the new fiscal year that begins October 1.  “There are a lot of steps to get us closer to our goal,” House Speaker John Boehner (R-OH) said on Thursday after a private meeting with fellow Republicans – but Members leaving the meeting said no firm measures were presented.  Appropriations Committee Chairman Hal Rogers (R-KY) has said he has a “clean” CR ready and that his committee is waiting for direction from Speaker Boehner on details, including the duration of such a measure and whether to attach riders. Such instruction presumably includes direction on whether to strip funds from Planned Parenthood, as many conservatives are demanding. House Minority Leader Nancy Pelosi (D-CA) is hopeful that Democrats will have “leverage” to win concessions from Republicans in the final text of the CR as the Speaker may need to count on Democratic votes to get a CR passed.
The Senate is scheduled to return today, and Majority Leader Mitch McConnell (R-KY) has teed up a cloture vote for tomorrow on a motion to proceed to a bill (H.R. 36) banning abortion at 20 weeks. The House passed the bill on May 13 by a vote of 242-184.  In the lower chamber, House members may vote on another measure President Obama has threatened to veto: legislation to speed up environmental reviews of federally sponsored construction.  This week’s work schedule, shortened by the Yom Kippur holiday, also features a Thursday address by Pope Francis to a joint meeting of Congress. 
House Votes to Defund Planned Parenthood; GOP Leaders Plan CR Strategy
Last Friday, the House voted on a measure (H.R. 3141) to freeze federal funding for the women’s health organization Planned Parenthood for a year, pending a full investigation of its practices following the release of videos allegedly showing organization leaders selling fetal organs for research. Democrats have pushed back on the issue, claiming that Republicans are driving the government towards its second shutdown in as many years over a partisan conflict. Republicans have been quick to deny that claim, arguing that the videos and investigation alone are enough to justify withholding taxpayer dollars. The bill passed along largely partisan lines, 241-187, with two Democrats voting for the measure and three Republicans voting against.
Republican leaders are hoping that the bill will be enough to placate the more conservative members of their party on the issue. However, many conservative lawmakers are determined to include defunding language on a CR, with Rep. Steve King (R-IA) saying last week that Friday’s action was “not a sufficient vote to defund Planned Parenthood.” One option that Republican leadership is considering is for the House to vote initially on a CR that includes language defunding Planned Parenthood, so that conservative members can be on record as attempting to pass such a measure. When that measure inevitably fails in the Senate, the Senate will send back a “clean” CR funding the government through mid-December. It is unclear whether the conservative members will hold firm and deny a CR without defunding language; if they do, Speaker Boehner will need Democratic votes to get the clean measure passed.
New Data Suggests Part B Premium Spike Next Year
On Wednesday, the Bureau of Labor Statistics (BLS) released data that is used to calculate whether Medicare Part B premiums rise next year, with analysts saying that the data has increased the likelihood of a premium spike. In July, Medicare Trustees estimated that monthly Part B premiums would be $159.30 next year for some beneficiaries, a 52 percent increase from the $104.90 premium level that has been steady since 2013. However, the increases will only affect 30 percent of the Medicare population and CMS is hopeful that shielding the majority of beneficiaries from the increase will reduce its overall impact. Furthermore, the full data set is not yet available, which leaves open the possibility that the final release of information on October 15 will force the Social Security Administration (SSA) into making a cost-of-living adjustment that would dampen Part B increases.
A dramatic increase in the Part B premium would be bad news for Democrats ahead of the 2016 general election, as Republicans would point to the higher premiums as evidence that the Affordable Care Act is making health care more expensive. Democrats are reportedly looking at Congressional action that could prevent the spike. For example, some Democrats have suggested that preventing a premium increase may be included in a CR if Speaker Boehner needs Democrat votes to pass the stopgap funding measure.
A spike in premiums would also hurt many state governments as the majority of the 30 percent of Medicare beneficiaries who would see a premium hike are “dual-eligibles,” meaning that states would have to cover the higher bills for the 9 million beneficiaries who depend on the Medicaid program. However, not all stakeholders are vying for holding off on an increase; industry advocates have argued against a delay, saying that providers would be faced with significantly higher costs.
Alexander Calls on CMS to Delay Meaningful Use Stage 3 Until 2017
Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee Lamar Alexander (R-TN) called on the Centers for Medicare and Medicaid Services (CMS) to delay their implementation of the “meaningful use” requirements related to electronic health records until 2017. The Wednesday announcement included a recommendation for the Department of Health and Human Services (HHS) to phase in the last stage of the electronic health program based on how successfully providers have adopted previous stages of the rule – a stance that industry organizations have strongly supported. Alexander also urged CMS to immediately implement proposed changes to the second stage of meaningful use, as providers have criticized the agency for not giving enough time to adopt the changes and demonstrate meaningful use by the end of 2015.
On the legislative side, Alexander suggested that he hopes the HELP Committee will be able to push forward legislation that would tweak the meaningful use program. Many organizations have complained that they are struggling to implement stage two of meaningful use, and that the proposed timeline for stage three is unrealistic. Senator Alexander’s colleague in the House, Rep. Renee Ellmers (R-NC), welcomed Alexander’s announcement and promoted her own legislation (H.R. 3309) that would push back the introduction of stage three.