Health Policy Update 1-30-17


What’s Ahead: This Week 

Medicare Advantage

The CY2018 Medicare Advantage (MA) Advance Rate Notice and Draft Call Letter is expected to be released this week.

Executive Sessions/Hearings

  • Tuesday, January 31
    • Senate Finance Committee, “Open Executive Session to Consider the Nomination of Thomas Price to be Secretary of Health and Human Services.”
    • House Energy & Commerce Committee, Oversight and Investigations Subcommittee, “Medicaid Oversight: Existing Problems and Ways to Strengthen the Program.”
    • House Oversight & Government Reform Committee, Health Care, Benefits & Administrative Rules Subcommittee, “Fraud, Waste and Abuse Under the Affordable Care Act.”
  • Wednesday, February 1
    • Senate HELP Committee, “Obamacare Emergency: Stabilizing the Individual Health Insurance Market.”
    • House Energy & Commerce Committee, Health Subcommittee, “Strengthening Medicaid and Prioritizing the Most Vulnerable.” Legislation to be discussed includes: the Verify Eligibility Coverage Act (H.R. 705), which would expand verification requirements for immigrants applying for Medicaid benefits; the Close Annuity Loopholes in Medicaid Act, which would count portions of income from annuities of a community spouse as income available to institutionalized spouses for Medicaid eligibility; and the Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, which would include lottery winnings and other lump sum income when determining eligibility for Medicaid.
    • House Education and the Workforce Committee, “Rescuing Americans from the Failed Health Care Law and Advancing Patient-Centered Solutions.”
  • Thursday, February 2
    • House Energy & Commerce Committee, Health Subcommittee, “Patient Relief from Collapsing Health Markets.” Legislation to be discussed includes: the Plan Verification and Fairness Act of 2017 (H.R. 706), which would require verification of eligibility for Marketplace special enrollment periods; the State Age Rating Flexibility Act of 2017 (H.R. 708), which would change the permissible age variation in health insurance premium rates; the Health Coverage State Flexibility Act of 2017 (H.R. 710), which would minimize the grace period allowed before disenrollment for nonpayment of premiums; and the Preexisting Conditions Protection and Continuous Coverage Incentive Act of 2017, which would prohibit preexisting condition exclusions and would require guaranteed issue for consumers maintaining continuous coverage.

Notable Policy Events

  • Monday, January 30 – Tuesday, January 31
    • Academy Health, “2017 National Health Policy Conference.” Additional information: http://bit.ly/2j6jFAO
  • Tuesday, January 31
    • Committee for a Responsible Federal Budget and Kaiser Family Foundation, “Major Considerations for Repealing and Replacing the Accordable Care Act.” Additional information: http://kaiserf.am/2j6ddd5
  • Wednesday, February 1
    • CMS, “Getting Started with QPP: An Overview of MIPS for Small, Rural, and Underserved Practices.” Additional information: http://bit.ly/2j67jZn
  • Friday, February 3
    • Bipartisan Policy Center, “Future of Health Care: Federal Budget and State Choices.” Additional information: http://bit.ly/2k8UwCZ

Weekly Wrap Up: Notable Health Care Developments From Last Week

Budget

On January 24, Congressional Budget Office (CBO) released the 2017-2027 Budget and Economic Outlook Report, estimating that 10 and 13 million people will be enrolled in the Marketplaces in 2017 and 2026, respectively. This is a decrease from CBO’s March 2016 estimate of 15 million enrollees in 2017 and 18 million enrollees by 2026. Report: http://bit.ly/2jsmpng

ACA Repeal/Replace Legislative Activity

  • On January 23, Sens. Cassidy (R-LA), Collins (R-ME), Capito (R-WV), and Isakson (R-GA) introduced the Patient Freedom Act of 2017 (S. 191), which would repeal Title I of the ACA, while retaining several consumer protection provisions, and allow states to choose among three replacement options: reinstitute the ACA, establish an alternative system that will automatically enroll eligible individuals in a high-deductible health plan linked to a health savings account (HSA), and design an alternative solution without federal assistance. Press release: http://bit.ly/2jqx6Xr One pager: http://bit.ly/2jqilnG Section-by-section: http://bit.ly/2jqrBYL Bill text: http://bit.ly/2jqmd8i
  • On January 24, Sen. Paul (R-KY) introduced the Obamacare Replacement Act (S. 222), which would repeal the ACA’s individual and employer mandates and market rules, and would expand the use of HSAs, create Independent Health Pools and Association Health Plans, and would allow for the sale of insurance across state lines. Press release: http://bit.ly/2kf66yN Section-by-section: http://bit.ly/2jVnWnP
  • Also on January 24, Rep. Harper (R-MS) introduced the Patient Fairness and Relief Act of 217 (H.R. 633), which would amend the Public Health Service act to allow health insurance issuers to continue to offer health insurance coverage offered in the individual market prior to the ACA. Press release: http://bit.ly/2jqmOqq
  • Also on January 24, Rep. Allen (R-GA) introduced the Transparency and Accountability of Failed Exchanges Act (H.R. 640), which would amend the ACA to require that states that were awarded exchange establishment grants and later terminated their exchange must return unused grant funds to the federal government. Press release: http://bit.ly/2jqm0ln
  • On January 25, Rep. Guthrie (R-KY) introduced the Employee Fairness & Relief Act (H.R. 661), which would allow insurance companies to continue offering small group market insurance plans as they existed prior to the ACA. Press release: http://bit.ly/2kgQavQ

Other Legislative Activity

  • On January 23, Sens. Whitehouse (D-RI), Franken (D-MN), and Brown (D-OH), introduced the Consumer Health Options Insurance Competition (CHOICE) Act (S. 194), which would establish a publicly operated health insurance option in the individual marketplaces. Rep. Schakowsky (D-IL) introduced a companion measure in the House (H.R. 635). Press release: http://bit.ly/2jqncVJ
  • Also on January 23, Senate Judiciary Committee, Subcommittee on Antitrust, Competition Policy & Consumer Rights Chair Lee (R-UT) and Ranking Member Klobuchar (D-MN) introduced the Short on Competition Act (S. 183), which would allow the Secretary of HHS to grant expedited drug reviews and inspections, and temporary importation in instances where there are fewer than five competitors producing drugs that have been on the market for at least ten years. Press release: http://bit.ly/2jqbtqp
  • On January 24, the House passed by a vote of 238-183 the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act (H.R. 7), which would prohibit the use of federal funds for abortions or health coverage that includes abortion, except in cases of rape or incest or to protect the mother’s life. The bill now moves to the Senate for consideration. Press release: http://bit.ly/2jqjbAZ
  • Also on January 24, Senate Homeland Security and Governmental Affairs Committee Chairman Johnson (R-WI) and 43 cosponsors introduced the Trickett Wendler Right to Try Act of 2017 (S. 196), which would allow the use of unapproved medical products by patients diagnosed with terminal illnesses. Press release: http://bit.ly/2jqeFSK
  • Also on January 24, Sen. Sasse (R-NE) and 27 cosponsors introduced the Born-Alive Abortion Survivors Protection Act (S. 220), which would require appropriate care and admission to a hospital for newborns that survive abortions. Press release: http://bit.ly/2jqfdYU
  • On January 24, Sen. Klobochar (D-MA) and 8 bipartisan cosponsors introduced the Synthetic Abuse and Labeling of Toxic Substances (SALTS) Act (S. 207), which would amend the Controlled Substances Act to make it easier to prosecute the sale and distribution of synthetic substances that are substantially similar to illegal drugs. Press release: http://bit.ly/2kf5CsB
  • Also on January 24, Reps. DeFazio (D-OR) and Slaughter (D-NY) introduced the Health Insurance Industry Fair Competition Act (HR. 617), which restore the application of the federal antitrust laws to health insurance companies. Press release: http://bit.ly/2jqvRYj
  • Also on January 24, Reps. Thompson (R-PA) and Butterfield (D-NC) introduced the Inpatient Rehabilitation Therapy Act of 2017 (H.R. 626), which would direct CMS to cover physician-prescribed recreational therapy services. Press release: http://bit.ly/2kgMZEC
  • Also on January 24, Reps. Jenkins (R-KS) and Kind (D-WI) introduced the Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 662), which would allow hospital-based nursing programs to retain their current accreditation and continue to receive Medicare funding. Press release: http://bit.ly/2jqiw2l
  • Also on January 24, Rep. Duffy (R-WI) introduced the Women’s Public Health and Safety Act (H.R. 656), which would amend the Social Security Act to provide states with greater flexibility to exclude abortion providers from receiving Medicaid funds. Press release: http://bit.ly/2kgW3Jn
  • Also on January 24, House Judiciary Committee Ranking Member Conyers (D-MI) and 51 cosponsors introduced the Expanded and Improved Medicare for All Act (H.R. 676), which would establish a privately delivered, publicly financed universal health care system. Statement: http://bit.ly/2jkBFHG
  • On January 27, Rep. Blackburn (R-TN) introduced a bill that would amend the Social Security Act to allow seniors to elect to receive a voucher for a health savings account, for premiums for a high-deductible health plan, or both (H.R. 707).

ACA Implementation

  • On January 24, National Governors Association (NGA) wrote a letter to House Majority Leader McCarthy (R-CA), House Ways & Means Committee Chairman Brady (R-TX), House Energy & Commerce Committee Chairman Walden (R-OR), and House Education and the Workforce Committee Chairman Foxx (R-VA) urging Congress not to shift costs to states and to continue its dialogue with governors as it pursues health care reform efforts. Letter: http://bit.ly/2jstwvT
  • Also on January 24, National Association of Insurance Commissioners (NAIC) wrote a letter to House Energy & Commerce Committee Chairman Walden (R-OR) and Ranking Member Pallone (D-NJ) and House Ways & Means Committee Chairman Brady (R-TX) and Ranking Member Neal (D-MA) urging caution in federal actions impacting health insurance markets and opposing legislation that would preempt state authority. Letter: http://bit.ly/2jsmW8T

Marketplaces

On January 27, HHS reinstated an part of an advertising campaign intended to encourage consumers to sign up for coverage on Healthcare.gov by the January 31 enrollment deadline; the day before, HHS had announced its decision to cancel $5 million worth of pre-paid television and radio ads.

Medicare

  • On January 24, Medicare Payment Advisory Commission (MedPAC) and the Medicare and CHIP Payment and Access Commission (MACPAC) released a data book on beneficiaries dually eligible for Medicare and Medicaid. Data book: http://bit.ly/2jsl1RN
  • On January 25, Sen. Crapo (R-ID) led a letter cosigned by 64 bipartisan Senators to CMS Acting Administrator Conway encouraging the Trump Administration to enact policies that would protect and strengthen the Medicare Advantage program. Press release with text of letter: http://bit.ly/2jqzBJq

Medicaid

  • On January 24, Senate Judiciary Chairman Grassley (R-IA) sent a letter to CMS Acting Administrator Conway requesting records on CMS’ classification of the EpiPen for the purposes of the Medicaid Drug Rebate Program. Press release: http://bit.ly/2jshZgk Letter: http://bit.ly/2jskxLo
  • On January 26, HHS Office of the Inspector General released a report reviewing nine Medicaid managed-care organizations (MCOs) in California, which found that the Medicaid program would not have realized savings in 2014 if the state had required its MCOs to achieve a minimum medical loss ratio standard. Report: http://bit.ly/2jts2BC 

Health IT

On January 24, HHS Office of the National Coordinator for Health IT (ONC) released data showing that most hospitals electronically reported public health data in 2015. Data: http://bit.ly/2jskAH1

Misc.

  • On January 23, Government Accountability Office released a report on a 5-year demonstration project that established a Veterans Affairs and Department of Defense Integrated Medical Facility in North Chicago, finding that the demonstration was a success and recommending continued integration. Report: http://bit.ly/2jtqR5f
  • On January 24, HHS released a report finding that 1.5 million adults experiencing serious mental illness misused opioids in the past year. Press release: http://bit.ly/2j65CLv Report: http://bit.ly/2j6inFS
  • On January 26, Senate Veterans Affairs Committee Chair Isakson (R-GA) and House Veterans Affairs Committee Chair Roe (R-TN) sent a letter to President Trump requesting the administration provide the Department of Veterans Affairs with additional guidance related to the federal hiring freeze announced on January 23. Press release: http://bit.ly/2jtunNb Letter: http://bit.ly/2jtm57R
  • On January 27, Department of Veterans Affairs (VA) Acting Secretary Snyder released a memo exempting certain positions within the VA from the federal hiring freeze “because they are necessary to meet…public safety responsibilities.” Memo: http://bit.ly/2jmwaIs
  • Also on January 27, HHS posted updated 2017 poverty guidelines; the poverty level is set at $12,060 for an individual and $24,600 for a family of four. Notice: http://bit.ly/2jtqLe0