E&C Hearing - Health Insurance Premiums

Last Friday, the House Energy and Commerce Health Subcommittee held a hearing entitled “Unaffordable: Impact of Obamacare on Americans’ Health Insurance Premiums.” As expected, the Republicans focused on the “broken promise” of health care reform to help lower costs for Americans, noting the potential rate shock due to community rating, guaranteed issue, limit of age rating, and the essential health benefits, especially as it relates to young adults. The Democrats countered that other changes within the Affordable Care Act or ACA (including health insurance subsidies, the catastrophic care plan, and the ability to stay on one’s parents’ plan longer) assist young adults. Further highlighting the difference of opinion in the total effect on the ACA on insurance premiums, the witnesses shared differing opinions. Christopher Carlson, an official with Oliver Wynman, noted that most people will see a decrease in the amount of premiums they pay as a result of the law’s subsidies to purchase insurance, while former Congressional Budget Office director Douglas Holtz-Eakin predicted a rise in premiums.

Sebelius Discusses ACA Implementation With Senate Committee

The Senate Finance Committee held a closed-door hearing with HHS Secretary Kathleen Sebelius last Thursday, which followed a series of one-on-one meetings with committee members last Wednesday.

As part of those discussions, the Secretary fielded questions on a variety of topics, including the complexity of the forms that people will need to fill out to enroll in coverage on insurance exchanges and the need for age rating provisions that will lower premiums for older Americans and raise them for younger ones. Members of the House Ways and Means Health Subcommittee subsequently requested conversations with the Secretary to discuss implementation of the health care law. 

Long Term Care Commission

Last Tuesday, President Obama named his three appointees to a new federal commission on long-term care. The President appointed Henry Claypool, executive vice president of the American Association of People with Disabilities; Julian Harris, director of the Office of Medicaid in Massachusetts; and Carol Raphael, vice chairwoman of the AARP Board of Directors.

The Obama nominees join the twelve other appointees, including 3 nominees selected by House Speaker John A. Boehner -- Judy Brachman of Bexly, Ohio, national co-chairwoman of the Jewish Federations of North America’s Aging and Family Caregiving Committee; Stephen Guillard of Chatham, Mass., a health care executive; and Grace-Marie Turner of Alexandria, Va., president of the Galen Institute – 3 nominees selected by Senate Minority Leader Mitch McConnell -- Bruce D. Greenstein, secretary of the Louisiana Department of Health and Hospitals; Neil Pruitt Jr. of Atlanta, a skilled nursing facility executive; and Mark Washofski, an official in the Treasury Department during the George W. Bush administration, 3 nominees by House Minority Leader Nancy Pelosi -- Bruce Chernof, president and chief executive of the SCAN Foundation; Judith Stein, founder of the Center for Medicare Advocacy; and George Vrandenburg, a philanthropist and former entertainment executive, and 3 nominees by Senate Minority Leader Harry Reid -- Javaid Anwar, a Nevada physician; Laphonza Butler of California, president of the United Long-Term Care Workers Union; and Judy Feder of Virginia, a professor of public policy at the Georgetown Public Policy Institute.

The temporary commission, which was created as part of the fiscal cliff legislation (PL 112-240) to replace the Community Living Assistance Services and Support program, will have six months to send Congress recommendations on how best to provide long-term care to the nation’s elderly and people with disabilities.

Bill Aims To Increase Residency Slots Ahead Of Projected Physician Shortage

House Republican Aaron Schock and Democrat Allyson Y. Schwartz introduced legislation last week that would increase the number of graduate medical training slots for the first time in 15 years, given the increased need for additional physicians to address the health care expansion in the Affordable Care Act, as well as baby boomers entering their senior years. A 1997 balanced-budget law (PL 105-33) capped the federal support for graduate-medical-education training, which hospitals say prevents them from expanding their programs. Schock has noted that in the past 15 years, the country’s population has grown by 50 million people, and that by 2015, there will be a shortage of 62,900 physicians.

Therefore, to address potential looming physician shortages, the “Training Tomorrow’s Doctors Today Act” would increase the number of federally funded positions for residencies, internships and fellowships, while requiring that 50 percent of the positions train residents in primary care. The bill would add 3,000 new graduate-medical-education positions at teaching hospitals every year for five years. The bill would dole out slots based on need, and no hospital would get more than 75 additional slots per year. In addition, the bill would require federal health officials to study the specialty needs of the U.S. healthcare system as they evolve and allocate residencies accordingly. According to Schwartz, the bill would cost an estimated $9 billion to $10 billion over 10 years.

MedPAC March Report Focus of Recent Ways and Means Health Subcommittee Hearing

Members of the House Ways and Means Health Subcommittee questioned Glen M. Hackbarth, chair of the Medicare Payment Advisory Commission (MedPAC), about recommendations for reforming how Medicare pays for healthcare during a hearing on the Commission’s March Report to the Congress. Subcommittee chairman Kevin Brady (R-TX) focused on the importance of a solvent Medicare program but specifically mentioned growing frustration and concern over Medicare physician payment under the flawed Sustainable Growth Rate (SGR) formula. Mr. Hackbarth emphasized the need to move toward value-based purchasing in Medicare through accountable care organizations and bundled payments stating they were the most important steps policy makers could take to improve quality and costs. Other subcommittee members raised concerns about Medicare payments to ambulatory surgery centers (ASCs), specifically, the use of the consumer price index for urban consumers (CPI-U) as a proxy for updating ASC payments each year. The MedPAC chairman agreed that a better mechanism for updating ASCs was needed and pointed to the Commission’s recommendation for ASC cost reporting, which would help Medicare develop a more appropriate proxy. Differential payments to primary care and specialty physicians for Evaluation and Management (E/M) services were also raised by subcommittee members. Mr. Hackbarth responded that MedPAC has already recommended equalization of payments for E&M services and they are in the process of looking in to equalization of other services. MedPAC’s March Report to the Congress is available at www.medpac.gov.

December 31, 1969: | Page 1 Page 2 Page 3 Page 4



 -  2019

 +  2018