TRP Health Policy Report

September 15, 2014

Last week saw both chambers of Congress return to legislative work following their summer recess. On Thursday, Senate Republicans blocked a Democratic proposal (S.J. Res. 19) to amend the U.S. Constitution to place limits on campaign financing. Democrats needed 60 votes to end debate on the measure, but fell short in a 54-42 party-line vote. Republicans said the vote was a political stunt by Democrats ahead of the midterm elections. Last Wednesday, the Senate voted 73-25 to end debate on the motion to proceed to the Paycheck Fairness Act (S. 2199), which aims to ensure pay equity for women. In other activity, the Senate approved two executive branch nominations and legislation (S. 2154) to extend health service programs for children. The Senate also passed a bill (S. 2323) to gives fathers of veterans with disabilities preference for federal employment purposes. Both measures were approved by unanimous consent.

In the House, members voted 247-157 to approve the Employee Health Care Protection Act of 2013 (H.R. 3552), a bill that would allow individuals to grandfather their insurance plans under the Affordable Care Act (ACA). The White House issued a veto threat against the legislation, which is not expected to advance in the Democratic-led Senate. Last Tuesday, the House voted 262-152 for legislation (H.R. 5078) that would prevent the EPA from implementing a proposed water rule. Elsewhere, the House passed a series of suspension bills, including legislation (H.R. 4067) to delay enforcement of supervision requirements for outpatient therapeutic services in certain hospitals. Passed by voice vote, the bill would prevent CMS from requiring Critical Access Hospitals and small rural hospitals from needing a physician to oversee certain therapeutic services.
Off the floor, officials from the IRS Commissioner John Koskinen and CMS Principal Deputy Administrator Andy Slavitt testified before the House Ways and Means Health Subcommittee, addressing lawmakers' concerns related to the Affordable Care Act. In noteworthy implementation news, HHS announced plans last Friday to award $300 million to health centers to expand primary care services. Officials said that 1,300 facilities will receive the grants, allowing them to hire approximately 4,700 primary care doctors. Separately, HHS and the Office of Minority Health awarded $3.2 in grants to help 13 organizations enroll racial and ethnic minorities in the Affordable Care Act.
The Week Ahead
With time running short, the House and Senate reconvene today to take up “must-pass” legislation to keep the government running (H.J. Res. 124), fund military training for Syrian rebels and extend authorization for the Export-Import Bank. The continuing resolution (CR) would keep government operations running from the beginning of the fiscal year on Oct. 1 through Dec. 11. It includes funds to address the Ebola outbreak and would extend to Dec. 11 a moratorium on taxing Internet access that's set to expire on Nov. 1. The House had planned to pass the CR last week but delayed its vote to review President Obama's request on training rebel forces in Syria.
House members will also vote on consolidated packages of “jobs” bills, including a repeal of the ACA's mandate requiring employers with 50 or more workers to provide health insurance. House leaders also plan to vote on legislation (H.R. 523) to repeal the medical device excise tax. House Majority Leader Kevin McCarthy (R-CA) announced earlier this month that he would bring the measure to the floor as part of the “jobs” package. The House will also vote on a package of 14 bills it has already approved, aimed at boosting domestic energy. Those measures include allowing construction of the Keystone XL oil pipeline, expediting natural gas exports and studying the impact of thermal insulation in federal buildings. House Republicans will be passing the bills for a second time to put pressure on Senate Democrats to hold a vote on the measures.
In the Senate, members are scheduled to hold a cloture vote on equal-pay legislation (S. 2199) and a series of executive branch nominations. Senators have a week to pass a short-term continuing resolution (CR) to keep the government funded after Sept. 30 and reauthorize the Export-Import Bank before they recess for the midterm elections. Following the Nov. 4 election, Congress is expected to return for two weeks before breaking for the Thanksgiving holiday. Congress should next be in session through December, when work will continue on extending dozens of expired tax provisions and curbing corporate inversions.
In notable committee activity, Senate Finance will hold a hearing on CHIP reauthorization tomorrow, while Senate Aging will convene a roundtable to discuss the potential and challenges posed by telehealth. On Thursday, the House Energy and Commerce Oversight subcommittee, chaired by Rep. Tim Murphy (R-PA), will host a hearing on suicide prevention and treatment. On Friday, the panel’s Health subcommittee will hold its latest hearing on 21st Century Cures, this time to review the growing threat of antibiotic resistance.
Most Commenters Support Sunshine Act's CME Exclusion
As detailed in a recent Bloomberg BNA article, an overwhelming number of healthcare industry stakeholders want CMS to maintain the continuing medical education (CME) reporting exemption under the Open Payments database mandated under the Physician Payment Sunshine Act, a provision of the Affordable Care Act. The Sunshine Act requires companies to inform CMS about payments to physicians in an effort to boost transparency and discourage conflicts of interest. The Open Payments system is designed to let physicians review and dispute what drug and device makers say they have given them before the information enters the public domain. According to the CME Coalition, more than 900 comments were submitted to CMS encouraging the expansion of the reporting exemption for accredited continuing medical education. Just 21 comments were submitted by those opposing the Open Payments reporting exemption. The article goes on to note that “other organizations including the American Medical Association, the Medical Group Management Association and other industry groups said CMS shouldn't go through with [its July 3rd] proposal to remove section 403.904(g) of the final rule implementing the Open Payments program.”
The stakeholder push came as CMS announced another cut-off date extension for physicians to initiate Sunshine Act data disputes. The agency’s action marked the latest postponement due to website technical problems, system outages and accuracy questions. The original deadline for doctors and teaching hospitals to verify and dispute data about payments they received from drug and device manufacturers was Aug. 27 but was ultimately extended to last Thursday. CMS officials said the federal Open Payments database remains on track to go public on September 30. Federal health officials say the initial site will contain 5 months' worth of payment information, spanning August 2013 through December 2013.
House to Vote on Repeal of Medical Device Tax
House Republican leaders have scheduled a vote this week on legislation (H.R. 523), to repeal the 2.3 percent excise tax on medical devices levied under the Affordable Care Act. The bill’s sponsor, Rep. Erik Paulsen (R-MN) said his Protect Medical Innovation Act will be included as part of a package of “jobs” bills that include several other tax-related provisions. Introduced in February 2013, Paulsen’s bill has 275 co-sponsors, including support from 46 Democrats. Repealing the medical device tax has received broad, bipartisan support in both chambers of Congress. In the Senate, however, momentum for repeal still appears sluggish as Majority Leader Harry Reid (D-NV) has thus far denied device tax repeal votes.
Last March, the Senate voted 79-20 to approve a bill to repeal the tax in a non-binding budget resolution. Last year, 37 House Democrats joined their Republican colleagues to repeal the tax in a bill (H.R. 436) that passed 270-146. The White House and its allies say that device manufacturers can afford the tax since more people with insurance will mean more paying customers for medical devices and services. Device industry advocates have aggressively sought repeal of the med-tech tax, disagreeing with the notion of an industry windfall and saying that it has caused significant job loss and hurt American innovation. Paulsen and other Congressional advocates have expressed optimism that a device tax repeal provision can be included in a broader tax “extenders” package taken up by lawmakers later this year.
House Approves “Keep Your Plan” Bill
Last Thursday, the House voted 247-167 to pass legislation (H.R. 3522) that would allow insurers to continue to sell employer-based health plans that do not comply with the Affordable Care Act's minimum coverage standards through 2018. In November 2013, President Obama issued an administrative fix allowing individuals to keep health plans that did not meet the ACA's requirements, following reports that millions of Americans were notified by insurers that their existing health policies would be canceled. Earlier this year, the White House extended the administrative fix, which now allows people to renew such plans until 2016, with coverage lasting in some cases until September 2017.
The House-passed bill would go beyond the President's fix by allowing small businesses that did not previously have plans that do not comply with the ACA's coverage requirements to purchase such coverage. Insurers would only be able to sell such plans if they were offered prior to 2013.
The White House issued a veto threat against the House bill, saying it would “roll back the progress made because of the [ACA] and would allow insurers to deploy practices such as charging businesses more when a worker has a pre‑existing condition or when it has more workers who are women than men.” The Senate is not expected to consider the legislation.
Rockefeller Plans Hearing on CHIP Reauthorization
This Tuesday, Senate Finance Health Subcommittee Chair Jay Rockefeller (D-WV) will convene a hearing on the Children's Health Insurance Program (CHIP), which is set to lose funding in September 2015 if Congress does not act. CHIP offers health coverage for low-income children and pregnant women. It is similar to the Medicaid program and is financed by both the federal government and the states. CHIP advocates have pressed Congress to start the reauthorization process as soon as possible, but senior Capitol Hill aides expect most of the debate on the issue will happen next year.
Sen. Rockefeller has introduced legislation (S. 2461) that would fund CHIP through 2019. Reps. Frank Pallone (D-NJ) and Henry Waxman (D-CA) have sponsored a similar bill (H.R.5364) in the House. In July, the leaders of the Senate Finance and House Energy and Commerce committees wrote to the governors of all 50 states asking for details on how they administer the CHIP program and what the impact might be if the program were to end. The ACA reauthorized CHIP until 2019, but only funded it through fiscal year 2015. Congress at the time envisioned that after 2015 states would transition CHIP-eligible children into qualified health plans with special certification, or include them in Medicaid. But children's advocates and other stakeholders worry that QHPs offer children less comprehensive coverage than CHIP, and that other program polices could result in fewer children covered.
KFF: Premiums to Rise 3 Percent this Year
According to a new study, premiums for employer-based family health coverage will rise 3 percent this year, one of the lowest rates of increase on record. In its annual report, the Kaiser Family Foundation said the cost to insure the average family through work will be $16,834 in 2015, saying the increase reflects the overall slowdown in health spending in the slower economy. KFF researchers found that eighty percent of workers receiving employer-based coverage will pay a deductible this year before most medical services are covered by their plan. Additionally, they found that the average deductible has risen 47 percent to $1,217 as employers look to save on healthcare costs since 2009. The data sheds light on the current state of the employer-based health insurance market in the year before part of the ACA's employer mandate takes effect. Starting next year, employers with at least 100 full-time workers could face fines if they do not offer health coverage. The study found that nearly all employers with 100 or more workers — 94 percent — already offer some medical benefits. 
In a separate KFF survey released last Tuesday, the percentage of voters who have an unfavorable view of the ACA has declined, from 53% to 47%, while the percentage of voters who support the law has dropped from 38% to 35%. The percentage of respondents who approve of the law has declined from 50% after the law was signed in 2010. Meanwhile, 60% of voters said they have not directly been affected by the ACA. Despite opposition to the law, the poll found that more voters would rather improve the law than repeal it. While 33% favor repealing the ACA, 63% say it should be improved. However, 41% of voters said they would support a candidate who favored repealing the law, compared with 30% who said they would be less likely to support a candidate who wanted to repeal it.