House Ways and Means Committee Probes Effect of PPACA on MA Plans

At a House Ways and Means Health Subcommittee hearing, a health researcher said his analysis shows that Medicare Advantage (MA) beneficiaries could experience benefit reductions/premium increases of $3,700 or more because of the changes in the PPACA affecting plan payment levels. The researcher said that the CMS pilot program which gives bonuses to plans having rating “stars” of 3-3.5 will end this year and, thus, lead to future plan payment reductions. Republican members contend that the PPACA will ultimately cut about $300 billion from the Medicare Advantage program in the long run. Subcommittee Ranking Democrat Jim McDermott (D-WA) countered that the PPACA has already put Medicare fee-for-service (FFS) and MA on a stronger financial footing, resulting in premium stability. Chairman Brady (R-TX) said that this issue will be part of the discussion among House Republicans in their consideration of PPACA “repeal and replace” efforts.

Courts Give Conflicting Rulings on PPACA Subsidies in Non-Electing States

The U.S. Court of Appeals for the District of Columbia Circuit ruled in Halbig v. Burwell that the IRS overstepped the plain language of the PPACA in the agency’s ruling that individual subsidies are available in states that do not establish their own health insurance exchanges (thus deferring enrollment to HealthCare.gov). However, in King v. Burwell the U.S. Court of Appeals for the Fourth Circuit found that the law is ambiguous on this matter and, thus, the IRS did not exceed its authority to interpret the subsidies as being available to individuals in states not having their own exchange. If the DC Circuit ruling is not reversed in an en banc rehearing being requested by the Department of Justice, the split decision would be ripe for adjudication by the U.S. Supreme Court. The Administration said that the individual subsidies at issue will continue pending a final resolution in the courts.

Court Rules Congressional Staff Eligible for Employer Contributions Under PPACA

In a suit brought by Senator Ron Johnson (R-WI) maintaining that Members of Congress and their staff are not eligible for continued employer contributions to their health plans after the passage of the PPACA, the U.S. District Court for the Eastern District of Wisconsin said the case lacked “concrete injury” and dismissed the challenge.

House E&C 21st Century Cures Hearing

At a House Energy and Commerce Health Subcommittee hearing, following up on the committee’s 21st Century Cures initiative, Chairman Joe Pitts (R-PA) said that barriers to the development and use of medical technology include efforts to limit off-label use among the provider community and limitations on communication included under the provisions of the Health Insurance Portability and Accountability Act (HIPAA) and the Physician Sunshine Act. Witnesses testified that means have to be in place to allow the capture of the large volume of real-time data that contain the secrets to ensuring the next generation of high quality health care; and that there is a need for open access to federally collected health care data and changes to HIPAA allowing the sharing of data among medical researchers. As to evidence of a decline in medical innovation in the United States, a device company executive testified that Congress could help support the Food and Drug Administration (FDA) in its efforts to bring innovative treatments to patients on a more acceptable timetable.

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