TRP Health Policy Report
December 15, 2014
In a rare weekend session, the Senate on Saturday night passed a $1.1 trillion government spending bill 56-40, sending it to the President Obama for his signature. The measure (H.R. 83) includes 11 appropriations bills that fund most of the government through September 30 and a continuing resolution (CR) funding the Department of Homeland Security (DHS) through February 27. The package of appropriations bills, dubbed the “CRromnibus,” narrowly passed the House last Thursday night in a 219-206 vote, following tense hours of vote wrangling and closed-door meetings. Earlier in the week, Senators voted 89-11 to pass a $585 billion defense policy bill (H.R. 3979) and passed several other measures by unanimous consent, including a cybersecurity bill (S. 1353). The Senate still needs to confirm a list of President Obama’s nominees and pass a package extending a variety of temporary tax breaks before wrapping up the 113th Congress this week.
In the House, members adjourned on Thursday following passage of the $1.1 trillion spending package. Last Wednesday, the chamber voted 417-7 to pass legislation to extend the terrorism risk insurance program (H.R. 2244) and 325-100 to approve an intelligence authorization bill (H.R. 4681). The Senate passed the intelligence bill by voice vote the night before. Elsewhere, House Democrats blocked fast-track approval of a charitable tax bill (H.R. 5806), which passed 275-149, but fell short of a required two-thirds vote. House members further approved a California drought relief bill (H.R. 5781) in a 230-182 vote last Tuesday. The House also voted unanimously to pass legislation (H.R. 5059) that seeks to improve mental healthcare for veterans. Passed last Tuesday, the bill would revise discharge review requirements for veterans diagnosed with post-traumatic stress disorder or traumatic brain injury.
In other healthcare-related news, HHS released data last week showing that 1.4 million U.S. residents have chosen health plans through the Affordable Care Act's (ACA) federal exchange since the second open enrollment period began on Nov. 15. According to HHS, 48% of the enrollees were new customers, while 52% were consumers renewing coverage.
The Week Ahead
The Senate meets today to begin processing 24 of President Obama’s executive and judicial nominations. With Republicans taking control of the chamber in January, Senate Democrats are working to clear as many nominees as possible before the end of the year. The Senate also hopes to approve a House-passed measure (H.R. 5771) that extends about 50 expired tax benefits and may consider a terrorism risk insurance package (H.R. 2244).
Senate Approves $1.1 Trillion Spending Bill
Capping a week of political drama, the Senate gave final approval to a $1.1-trillion spending bill on Saturday night in a 54-40 vote. Passage came after Senators reached a deal to end an impasse, and then cleared a pair of procedural hurdles that could have killed the bill’s passage. The spending bill (H.R. 83) would fund most of government through next September, but Homeland Security only through February so that Republicans can hold leverage with regard to the President’s recent Executive Order on Immigration. The path to passage of the spending bill was fraught in both chambers, with the narrow victory in the Senate showing the same dynamics that nearly derailed the bill’s 219-206 passage in the House on Thursday. Conservatives were angry that the bill didn’t include provisions to block President Obama’s plan to shield millions of illegal immigrants from deportation. Lawmakers on both sides, mostly Democrats, objected to a provision paring back part of the 2010 Dodd-Frank overhaul, and another increasing the amount that donors may give to political parties.
The spending bill contains measures that target various provisions of the Affordable Care Act. Specifically, the spending bill would prohibit CMS from providing new government funds to health insurers to subsidize potential revenue losses under the ACA's so-called risk corridor provision. However, the provision would continue to allow the federal government to collect payments from insurers whose revenues are higher than expected, which it may then give to companies with losses. Further, another provision would cut the ACA's Independent Payment Advisory Board's (IPAB) budget by $10 million. Budget cuts included in the so-called ‘CRomnibus’ could also impede the IRS's ability to enforce some portions of the ACA. The spending bill would cut IRS's budget by $350 million – limiting its ability to determine whether U.S. residents are eligible for exchange subsidies, as well as administering financial penalties to individuals and employers who do not comply with the law's individual and employer mandates. On the other hand, the bill provides funding for U.S. efforts to combat Ebola and other Administration initiatives. Specifically, the bill includes $5.4 billion of President Obama's $6.2 billion funding request for U.S. Ebola efforts and just under $30.1 billion for NIH, in part for Ebola research and clinical trials.
GOP Leaders Mull Reconciliation Options
Last Friday, incoming House Budget Chairman Tom Price (R-GA) said party leaders are considering how to use a controversial budget maneuver to push its agenda on the Affordable Care Act, taxes and other issues.
The Georgia Congressman said GOP lawmakers won’t decide until early next year their plans for using so-called budget reconciliation. He said they could use it to try to dismantle the ACA, knowing that any legislation is certain to be vetoed, in order to make a political statement. Price said they could also use it to advance legislation in areas where Republicans and the White House might be able to work together. He said those possibilities include tax reform, rewriting the nation’s welfare laws and energy policy. Price said the House GOP Conference hasn’t reached a “strategic decision,” but indicated that would occur at a Republican retreat scheduled for early next year.
Reconciliation can be used to avert filibusters in the Senate, allowing legislation to pass with a simple 51-vote majority. Over the years, lawmakers have used it to move everything from President George W. Bush’s 2001 tax cuts to President Obama’s 2010 healthcare reform law. Price will replace House Budget Committee Chairman Paul Ryan, who is stepping down next year to lead the Ways and Means panel. Price said much of his caucus’s approach will depend on whether the White House wants to work with the new Congressional majority next year. He said there are other considerations as well, including the fact that some 40 incoming GOP freshmen haven’t yet had a chance to vote against the ACA. Price also confirmed that Republicans plan to adopt so-called dynamic scoring, a budgeting methodology that takes into account the broad economic effects of legislation when calculating a bill’s likely impact on the Treasury. Price said he agreed with some Democrats that dynamic scoring should apply to spending programs as well as tax cuts.
With Deadline Looming, Healthcare.gov Traffic Jumps
Last week, HHS reported that about 974,000 people applied for coverage on the HealthCare.gov website between November 29 and December 5, while about 619,000 people chose plans. The figures represent a marked increase from the week before, when about 520,000 applied for coverage and about 303,000 people chose plans. In total, about 1.38 million consumers have picked a health policy on the federal exchanges since they opened on Nov. 15. HHS officials said that 48 percent are new consumers, while 52 percent are current enrollees renewing their coverage. The growth comes in advance of the December 15 deadline for consumers to purchase coverage that becomes active on January 1. Federal health officials said that 3 million users visited the site between November 29 and December 5, with about 98,000 visiting its Spanish-language counterpart, CuidadoDeSalud.gov. HHS is hoping to sign up 9.1 million people for coverage this year.
Gruber Subpoenaed Over Health Law Contracts
Last week, House Oversight Committee Chairman Darrell Issa (R-CA) subpoenaed MIT economist Jonathan Gruber for documents related to his government work on the Affordable Care Act. Issa issued the order on Thursday, asking Gruber for all documents and communications to or from government employees relating to the ACA and contracts with government, as well as any results from the economist’s work. The action followed a tense hearing earlier in the week in which Gruber, infamous for his comment that the "stupidity of the American voter" helped the Affordable Care Act to pass, repeatedly declined to say how much he was paid as a consultant on the law. In testimony before the panel on Tuesday, Gruber, an MIT economics professor, apologized for "glib, thoughtless and sometimes downright insulting comments" about whether Americans understood the ACA.
The federal government paid Gruber nearly $400,000 for his work on the health law. He has advised several states on healthcare issues, including Massachusetts and its program under former Gov. Mitt Romney. Last month, Gruber lost a $450,000 consulting contract with Vermont. Despite Gruber’s insistence during the hearing that he was not the “architect” of the ACA, Issa continued to label him as such. “As one of the architects of Obamacare, Jonathan Gruber is in a unique position to shed light on the ‘lack of transparency’ surrounding the passage of the President’s healthcare law, however he has so far been unwilling to fully comply with the Oversight Committee’s repeated requests,” Issa said in a statement. The California Republican has vowed to follow through with the subpoena and to possibly bring Gruber back to testify. Issa will be replaced as chairman in January by Rep. Jason Chaffetz (R-UT).
Survey Suggests Americans Confused On ACA Coverage Penalty
According to a recent Harris Poll, roughly two-thirds of Americans (66 percent) understand they will be subject to a penalty for failing to have health insurance. However, the study also found that an overwhelming majority incorrectly believe they can purchase coverage by December 31, 2014 in order to avoid the tax. The Affordable Care Act requires most Americans to have had coverage as of January 1, 2014 in order to avoid a penalty, although there is a three-month grace period. While only 13 percent of respondents understood that they needed to have coverage throughout 2014 to avoid a penalty, the survey did find that younger adults aged 19 to 34 were more aware than those over 35 (20 percent vs. 9 percent). The results also show that nearly half of Americans (48 percent) were not aware that they need to indicate their insurance status when they file taxes. Analysts said the study clearly suggests that a large portion of taxpayers do not fully understand the obligations under the ACA, and of particular concern is the number, or percentage, of those surveyed who think that they can purchased coverage by the end of the year to cover the insurance requirement that started at the beginning of the year.
In other healthcare-related news, HHS released data last week showing that 1.4 million U.S. residents have chosen health plans through the Affordable Care Act's (ACA) federal exchange since the second open enrollment period began on Nov. 15. According to HHS, 48% of the enrollees were new customers, while 52% were consumers renewing coverage.
The Week Ahead
The Senate meets today to begin processing 24 of President Obama’s executive and judicial nominations. With Republicans taking control of the chamber in January, Senate Democrats are working to clear as many nominees as possible before the end of the year. The Senate also hopes to approve a House-passed measure (H.R. 5771) that extends about 50 expired tax benefits and may consider a terrorism risk insurance package (H.R. 2244).
Senate Approves $1.1 Trillion Spending Bill
Capping a week of political drama, the Senate gave final approval to a $1.1-trillion spending bill on Saturday night in a 54-40 vote. Passage came after Senators reached a deal to end an impasse, and then cleared a pair of procedural hurdles that could have killed the bill’s passage. The spending bill (H.R. 83) would fund most of government through next September, but Homeland Security only through February so that Republicans can hold leverage with regard to the President’s recent Executive Order on Immigration. The path to passage of the spending bill was fraught in both chambers, with the narrow victory in the Senate showing the same dynamics that nearly derailed the bill’s 219-206 passage in the House on Thursday. Conservatives were angry that the bill didn’t include provisions to block President Obama’s plan to shield millions of illegal immigrants from deportation. Lawmakers on both sides, mostly Democrats, objected to a provision paring back part of the 2010 Dodd-Frank overhaul, and another increasing the amount that donors may give to political parties.
The spending bill contains measures that target various provisions of the Affordable Care Act. Specifically, the spending bill would prohibit CMS from providing new government funds to health insurers to subsidize potential revenue losses under the ACA's so-called risk corridor provision. However, the provision would continue to allow the federal government to collect payments from insurers whose revenues are higher than expected, which it may then give to companies with losses. Further, another provision would cut the ACA's Independent Payment Advisory Board's (IPAB) budget by $10 million. Budget cuts included in the so-called ‘CRomnibus’ could also impede the IRS's ability to enforce some portions of the ACA. The spending bill would cut IRS's budget by $350 million – limiting its ability to determine whether U.S. residents are eligible for exchange subsidies, as well as administering financial penalties to individuals and employers who do not comply with the law's individual and employer mandates. On the other hand, the bill provides funding for U.S. efforts to combat Ebola and other Administration initiatives. Specifically, the bill includes $5.4 billion of President Obama's $6.2 billion funding request for U.S. Ebola efforts and just under $30.1 billion for NIH, in part for Ebola research and clinical trials.
GOP Leaders Mull Reconciliation Options
Last Friday, incoming House Budget Chairman Tom Price (R-GA) said party leaders are considering how to use a controversial budget maneuver to push its agenda on the Affordable Care Act, taxes and other issues.
The Georgia Congressman said GOP lawmakers won’t decide until early next year their plans for using so-called budget reconciliation. He said they could use it to try to dismantle the ACA, knowing that any legislation is certain to be vetoed, in order to make a political statement. Price said they could also use it to advance legislation in areas where Republicans and the White House might be able to work together. He said those possibilities include tax reform, rewriting the nation’s welfare laws and energy policy. Price said the House GOP Conference hasn’t reached a “strategic decision,” but indicated that would occur at a Republican retreat scheduled for early next year.
Reconciliation can be used to avert filibusters in the Senate, allowing legislation to pass with a simple 51-vote majority. Over the years, lawmakers have used it to move everything from President George W. Bush’s 2001 tax cuts to President Obama’s 2010 healthcare reform law. Price will replace House Budget Committee Chairman Paul Ryan, who is stepping down next year to lead the Ways and Means panel. Price said much of his caucus’s approach will depend on whether the White House wants to work with the new Congressional majority next year. He said there are other considerations as well, including the fact that some 40 incoming GOP freshmen haven’t yet had a chance to vote against the ACA. Price also confirmed that Republicans plan to adopt so-called dynamic scoring, a budgeting methodology that takes into account the broad economic effects of legislation when calculating a bill’s likely impact on the Treasury. Price said he agreed with some Democrats that dynamic scoring should apply to spending programs as well as tax cuts.
With Deadline Looming, Healthcare.gov Traffic Jumps
Last week, HHS reported that about 974,000 people applied for coverage on the HealthCare.gov website between November 29 and December 5, while about 619,000 people chose plans. The figures represent a marked increase from the week before, when about 520,000 applied for coverage and about 303,000 people chose plans. In total, about 1.38 million consumers have picked a health policy on the federal exchanges since they opened on Nov. 15. HHS officials said that 48 percent are new consumers, while 52 percent are current enrollees renewing their coverage. The growth comes in advance of the December 15 deadline for consumers to purchase coverage that becomes active on January 1. Federal health officials said that 3 million users visited the site between November 29 and December 5, with about 98,000 visiting its Spanish-language counterpart, CuidadoDeSalud.gov. HHS is hoping to sign up 9.1 million people for coverage this year.
Gruber Subpoenaed Over Health Law Contracts
Last week, House Oversight Committee Chairman Darrell Issa (R-CA) subpoenaed MIT economist Jonathan Gruber for documents related to his government work on the Affordable Care Act. Issa issued the order on Thursday, asking Gruber for all documents and communications to or from government employees relating to the ACA and contracts with government, as well as any results from the economist’s work. The action followed a tense hearing earlier in the week in which Gruber, infamous for his comment that the "stupidity of the American voter" helped the Affordable Care Act to pass, repeatedly declined to say how much he was paid as a consultant on the law. In testimony before the panel on Tuesday, Gruber, an MIT economics professor, apologized for "glib, thoughtless and sometimes downright insulting comments" about whether Americans understood the ACA.
The federal government paid Gruber nearly $400,000 for his work on the health law. He has advised several states on healthcare issues, including Massachusetts and its program under former Gov. Mitt Romney. Last month, Gruber lost a $450,000 consulting contract with Vermont. Despite Gruber’s insistence during the hearing that he was not the “architect” of the ACA, Issa continued to label him as such. “As one of the architects of Obamacare, Jonathan Gruber is in a unique position to shed light on the ‘lack of transparency’ surrounding the passage of the President’s healthcare law, however he has so far been unwilling to fully comply with the Oversight Committee’s repeated requests,” Issa said in a statement. The California Republican has vowed to follow through with the subpoena and to possibly bring Gruber back to testify. Issa will be replaced as chairman in January by Rep. Jason Chaffetz (R-UT).
Survey Suggests Americans Confused On ACA Coverage Penalty
According to a recent Harris Poll, roughly two-thirds of Americans (66 percent) understand they will be subject to a penalty for failing to have health insurance. However, the study also found that an overwhelming majority incorrectly believe they can purchase coverage by December 31, 2014 in order to avoid the tax. The Affordable Care Act requires most Americans to have had coverage as of January 1, 2014 in order to avoid a penalty, although there is a three-month grace period. While only 13 percent of respondents understood that they needed to have coverage throughout 2014 to avoid a penalty, the survey did find that younger adults aged 19 to 34 were more aware than those over 35 (20 percent vs. 9 percent). The results also show that nearly half of Americans (48 percent) were not aware that they need to indicate their insurance status when they file taxes. Analysts said the study clearly suggests that a large portion of taxpayers do not fully understand the obligations under the ACA, and of particular concern is the number, or percentage, of those surveyed who think that they can purchased coverage by the end of the year to cover the insurance requirement that started at the beginning of the year.