Additional Health Legislation Advances

The Senate passed without dissent the House-passed bill H.R. 2019 that House Majority Leader Eric Cantor (R-VA) promoted to enhance by $126 million (over ten years) National Institutes of Health (NIH) funded research to address pediatric cancers, autism, Downs Syndrome and other childhood diseases. The legislation, which the President is expected to sign into law, offsets the cost by transferring federal funding that would otherwise have helped pay for political party conventions. The House also passed the following bills that would exempt certain individuals from the individual mandate under the PPACA: H.R. 1814, the “Equitable Access to Care and Health Act,” that would allow individuals citing religious reasons to remain uninsured without becoming subject to the health law’s penalties; H.R. 3979, the “Protecting Volunteer Firefighters and Emergency Responders Act,” that would exempt volunteer firefighters and other emergency responders from being counted as employees under the health law’s employer mandate; and H.R. 3474, the “Hire More Heroes Act,” that would exempt veterans and reservists who have coverage from the Department of Veterans Affairs or TRICARE from being included as employees for purposes of the employer mandate. The House also passed the following bills which would allow Congress to take aim in court at the Obama Administration’s executive actions to which it objects: H.R. 3973, the “Faithful Execution of the Law Act of 2014” and H.R. 4138, the “ENFORCE the Law Act of 2014.”

HHS FY 2015 Budget Scrutinized

Within the President’s budget recommendations for fiscal year (FY) 2015, the Centers for Medicare and Medicaid Services (CMS) has requested $4.1 billion for program management (an increase of $226.6 million), including PPACA related activities: $544.2 million for operation of HealthCare.gov (which is projected to continue to be operating in the majority of states); and an increase in the Medicaid/Children’s Health Insurance Program (CHIP) budget of $16.2 million, partly to help implement the PPACA Basic Health Program. A total of $1.8 billion is slated for implementation of the PPACA, $1.2 billion of which is estimated to be offset by PPACA-related user fees. In a House Ways and Means Committee hearing, Chairman Dave Camp said the President’s budget “doubles down on this law….With so many unanswered questions, it is hard to understand how or why Congress would approve such a request.” Of note, the U.S. Department of Health and Human Services (HHS) reported that PPACA cost-sharing subsidies will not be included among the programs subject to the automatic cuts mandated under sequestration.

PPACA Individual Mandate Delay?; That is the Question

Last week HHS Secretary Kathleen Sebelius, in testimony before the House Ways and Means Committee, said that the Administration will not extend the individual mandate beyond the March 31st deadline. Republicans questioned how this is fair, given the Administration’s actions to delay the effect of the employer mandate. As explained above, House Republicans answered their own question by including a 5-year delay of the individual mandate under the doc fix legislation. At a House Appropriations HHS/Labor/Education Subcommittee hearing, the HHS Secretary was also criticized by Republicans for the latest CMS move to broaden the so-called “hardship exemption” under which individuals would avoid the PPACA’s penalty for not obtaining health coverage. The new provisions would give hardship exemptions through October 1, 2016 to individuals whose non-PPACA-compliant policies were cancelled and who find that their other options are more expensive (and also allow them to buy catastrophic only coverage); and to individuals who experience “another hardship in obtaining health insurance”, although documentation of that fact would only have to be provided “if possible.” The Administration said the exemptions are justified under the terms of the PPACA and that applicants have to fill out a form and receive approval in order to gain the exemption. Republican critics of the various exemptions and delays the Administration has promulgated under the law also asked the HHS Secretary whether the 4.2 million who were enrolled through February under the law’s exchanges is what you call “success?” She deflected the question and refused to utter her earlier prediction that about 7 million would be enrolled by the March 31st deadline. HHS has also said that it lacks the data on how many individuals have enrolled and actually paid their premiums. In this regard, Republicans on the House Energy and Commerce Committee have written to the health insurers asking plans on HealthCare.gov to give them information on their enrollees’ ages and previous insurance status. In another Republican initiative, Senators Lamar Alexander (R-TN), Orrin Hatch (R-UT) and 23 other Republicans sent a letter to the Office of Management and Budget (OMB) threatening action pursuant to the Congressional Review Act if the Administration does not rescind a CMS ruling that gives union-negotiated multiemployer group health plans what the senators say is an “unwarranted specials carve-out” from the PPACA’s mandate to pay reinsurance fees.

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