Health Policy Report

January 19, 2016

The Week in Review

With the President delivering his final State of the Union address and Republicans holding a joint retreat to plan their legislative priorities for the year, last week in Washington featured competing political visions for 2016. In his address on Tuesday, the President avoided the policy ‘laundry list’ that typically accompanies the State of the Union, instead opting for a message calling for greater political unity, a defense of his foreign policy priorities, and a challenge to the nation’s scientific community to cure cancer. Later in the week, House and Senate Republicans travelled to Baltimore to plan their legislative agenda. Topics of conversation included reconciling differences on the Toxic Substances Control Act, the Freedom Caucus’ insistence to push through tax reform and a replacement to the Affordable Care Act (ACA), and the viability of a budget resolution in the Senate Appropriations Committee. However, this last point already hit a major challenge when the Appropriations Committee’s ranking Democrat, Sen. Barbara Mikulski (D-MD), said that she doesn’t see the need for a budget resolution because lawmakers have already agreed to a two-year budget deal that sets topline spending numbers.

Before Republicans left for Baltimore on Wednesday, the House considered a pair of bills to impose additional sanctions on North Korea and Iran. The bill (H.R. 757) targeting North Korea passed nearly unanimously, 418-2, but the Iran measure (H.R. 3662) proved more contentious with Democrats fearing that it would undermine the nuclear deal struck with the Islamic Republic last year. A roll call vote on the bill was postponed until after the House returns on January 25.

Floor action in the Senate saw Democrats successfully block a bill (S. 2232) that would require an audit of the Federal Reserve, with the minority party claiming that such a move could politicize the financial institution. Sen. Rand Paul (R-KY) sponsored the measure, but failed to secure the 60 votes necessary to pass cloture, as only two Democratic senators—notably including fellow presidential candidate Sen. Bernie Sanders (D-VT)—voted in favor of advancing the bill.

The Week Ahead

With the House in recess this week, the Senate will first vote on the nomination of Wilhelmina Marie Wright to be U.S. district court judge in Minnesota before moving on to the contentious debate over settling Syrian refugees in the United States. On Wednesday, the upper chamber will hold a cloture vote on whether to proceed to legislation (H.R. 4038) the House passed last year, which would require top U.S. law-enforcement and national security officials to affirm to Congress that each individual Syrian refugee doesn’t pose a security threat. The Obama administration contends the refugee program would grind to a halt, and has threatened to veto the measure. 

Although the House is not in session this week, House Ways and Means Chairman Kevin Brady (R-TX) suggested last week that top tax writers from both chambers plan to start an effort to make significant changes to international corporate tax law. Brady said he was uncertain whether a bill could be completed this year.

President Obama Pledges to Cure Cancer 

During his final State of the Union address last Tuesday, President Obama promised “a new national effort” to find a cure for cancer. Vice President Joe Biden will be leading the effort, and has said he will convene the first of several meetings with administration officials on the issue next month. The Vice President, who launched a high-profile push to end cancer after his oldest son died from a brain tumor last year, spoke after Tuesday’s address highlighting the importance of joint public and private efforts and the need to break down the many “silos” that prevent cancer-fighters from sharing their data and research. And in a roundtable with medical researchers at the University of Pennsylvania on Friday, Biden said that President Obama will soon announce a presidential memorandum allowing the Vice President to form a task force dedicated to speeding up progress on cancer research.

The additional resources from the White House to find a cure for cancer follows a bipartisan agreement in Congress to increase National Institutes of Health (NIH) spending for the first time in more than a decade. While Vice President Biden’s efforts quickly drew praise from many members, including House Energy and Commerce Committee Chairman Fred Upton (R-MI), some Republicans were upset that President Obama failed to mention their efforts to secure a nearly seven percent funding increase for the NIH this year. 

President Obama Proposes Funding Boost for States to Expand Medicaid

In a new effort to encourage states to expand Medicaid, the President’s 2017 budget request includes additional federal dollars for states that choose to broaden their Medicaid programs. For states that chose to expand in 2014, the law stipulates that the federal government will fully fund the expansion for three years, while states newly accepting the expansion would receive payments covering about 90 percent of the costs. However, in his most recent budget proposal, President Obama has suggested funding the entire cost of expansion for three years, no matter when a state decides to accept the expansion. 

Passing the proposal will not be easy, as Republicans in Congress remain deeply opposed to the ACA, but administration officials are hoping that allowing flexibility in the implementation of expansion will help attract skeptical states to the program. The White House has allowed Republican-led states to add conservative-preferred elements to their Medicaid programs, such as requiring enrollees to pay premiums, and retain their federal support. Even with that flexibility, many oppose the program, arguing that it is too costly and expands a government-run health insurance program that covers able-bodied people. The budget proposal is a part of the President’s efforts to solidify and broaden his signature legislative achievement in the final year of his presidency.

CMS To Further Limit Special Marketplace Insurance Signup Periods

The Centers for Medicare and Medicaid Services (CMS) is promising to limit the number of special circumstances that allow individuals to enroll for health coverage on HealthCare.Gov outside of the traditional open enrollment period. Acting CMS Administrator Andy Slavitt said last Monday that the agency plans to drop certain special enrollment criteria—as they did last year when a special enrollment period linked to tax season was shut down—and tighten the language around its provisions for special circumstances. CMS has already established an enforcement unit and has terminated coverage for individuals who were improperly enrolled by certain brokers. In general, the enrollment periods are intended to prevent people from waiting to sign up for coverage until after they are sick.

CMS has faced pressure to improve the federal marketplace for insurers after UnitedHealthcare, one of the industry’s largest insurers, announced in November that it was considering pulling back its marketing efforts for individual plans in 2016 as a response to longstanding concerns that already sick patients were signing up through special enrollment, receiving care, and later dropping coverage. Other steps that the agency is expected to take include providing early feedback on data regarding risk-adjustment calculations, which would help insurers set their rates for coverage. The conversation between CMS and insurers has been ongoing and CMS plans to host a conference on risk-adjustment on March 25.

Senate HELP and Judiciary Committees to Discuss Mental Health Reform this Week 

Mental health reform is gaining momentum in the Senate, as both the Health, Education, Labor, and Pensions (HELP) and Judiciary committees are planning to hold hearings on the subject this week.  The hearings are, in part, a response to a series of recent incidences of mass violence linked to individuals with mental health conditions, which has come under a renewed spotlight after President Obama announced additional executive actions to reduce gun violence earlier this month.

The HELP Committee’s hearing on Wednesday may prove to be a boon for proponents of a bipartisan mental health reform bill (S. 1945) recently introduced in the committee by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT). Among the provisions of the legislation, the bill would: (1) modify the Health Insurance Portability and Accountability Act (HIPAA) to clarify when providers may disclose patients’ information, (2) create a new assistant secretary in the Department of Health and Human Services (HHS) to oversee mental health, (3) give grants to improve integration of physical and mental health services and for early intervention in children, (4) reform Medicare and Medicaid to remove rules preventing patients from using physical and mental health services at the same place on the same day, (5) require federal agencies to issue additional clarifying guidance on the parity law, (6) reauthorize the Primary Care-Behavioral Health Integration (PBHCI) program, and (7) enhance the role of peer support specialists. The bill has been characterized as a companion measure to Rep. Tim Murphy’s (R-PA) ‘Helping Families in Mental Health Crisis Act’ (H.R. 2646), which now has 177 co-sponsors in the House.

Meanwhile, the Senate Judiciary Committee is planning on holding a hearing this Friday on a mental health reform bill (S. 2002) introduced by Sen. John Cornyn (R-TX) that focuses on treatment for mentally ill people facing incarceration, and provides financial incentives for states to send mental health information to the national background check system used for gun buyers. Although the bill is not yet getting a formal markup, Judiciary Committee Chairman Chuck Grassley (R-IA) has called the legislation a “good starting point” for discussion in the committee. The bill has been somewhat controversial, however, as Democrats have warned that it would allow persons who are mentally unstable to get guns by strengthening provisions that require a full judicial hearing before someone can be banned from buying firearms due to mental illness.

Despite a number of obstacles, mental health reform may see legislative action this year, as the issue has been considered one of the few areas Congress can find common ground before the November elections.