Veterans' Reform Legislation Conference

This week the House is scheduled to vote on a motion to go to conference on the bipartisan bill introduced by Senators Bernie Sanders (I-VT) and John McCain (R-AZ), the Veterans’ Access to Care through Choice, Accountability and Transparency Act of 2014 (S. 2450), which passed the Senate on a vote of 93 to 3. The Senate substituted the substance of its VA reform into H.R. 3230, legislation previously passed in the House. The House also passed a similar version of VA reform, H.R. 4810, on a unanimous vote of 426 to zero. A House-Senate conference will seek to reach agreement on the legislation’s $50 billion cost for additional health care and $35 billion in new mandatory spending over ten years. The House may insist that the bill be paid for through a supplemental appropriations bill. The Senate waived a budget point of order requiring a cost offset that left the bill relying in part on emergency appropriations. The Senate version includes provisions: allowing veterans to seek medical care outside of the VA system if they experience above average wait times or live over 40 miles from a VA hospital or clinic; allowing the VA Secretary to fire employees without pay (but giving them expedited treatment under the Merit Systems Protection Board) and expedited authority to hire more doctors, nurses and other medical providers; and that authorize 26 major medical facility leases in 18 states. The House and Senate moved expeditiously on the legislation after the VA released an internal audit of 731 medical facilities showing that 57,436 veterans are waiting for care and that an additional 63,869 veterans have enrolled in VA health care over the past 10 years and have not been seen for an appointment.

Health Legislation Advances in House E&C Committee

The House Energy and Commerce Committee unanimously adopted the following two bills, readying them for consideration in the House: H.R. 4299, the Improving Regulatory Transparency for New Medical Therapies Act, which would require the Drug Enforcement Agency (DEA) to issue an interim final rule on the scheduling of a new drug no later than 45 days after receiving a scheduling recommendation from the FDA; and H.R. 4709, the Ensuring Patient Access and Effective Drug Enforcement Act, which would help prevent prescription drug abuse through better collaboration between industry and regulators.

PPACA Health Reform Oversight and Agency Actions

At a hearing held by the House Ways and Means Health and Oversight subcommittees, Republican members declared that of the $1 trillion in health reform act subsidies to be paid over a decade the IRS does not currently have the capability to accurately verify the income eligibility of over one million exchange enrollees. Subcommittee Democrats defended the Patient Protection and Affordable Care Act (PPACA) and stated that about 6.8 million individuals and families will receive tax credits this year averaging about $4,400. Nonetheless, supporters of the Act acknowledged that many individuals will have to repay some or all of the tax subsidies advanced when their actual income exceeds the amount which is declared in their initial application. In another hearing held by the House Energy and Commerce Health Subcommittee, Chairman Joe Pitts (R-PA) lamented the restrictive nature of the physician and hospital networks made available under PPACA health insurance plans. Witnesses said that the restrictions on provider networks and drug formularies offered under the current plans are likely to become more prevalent under Medicare and other insurer plans. The witness from the National Association of Insurance Commissioners (NAIC) said that states, and not federal law, should have control over the networks offered by insurers. In another effort by Republicans to question the authority of HHS to make payments to health insurers under the PPACA’s risk corridor provisions, Representative Fred Upton (R-MI) and Senator Jeff Sessions (R-AL) sent a letter to the recently confirmed HHS Secretary, Sylvia Mathews Burwell, maintaining that payments without approval through congressional appropriations are illegal and that they should be halted absent such authority. In an administrative action, the Center for Medicare and Medicaid Services (CMS) said the agency is seeking applications by June 30th from eligible entities for up to $60 million in payments to support health-care navigators. HHS also announced that it will allow 18 states to put off until 2016 the PPACA provision allowing workers in a small business to choose their health insurance plans rather than having their employer make the choice under the Small Business Health Options Program (SHOP) program.

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