Watchwords for 114th Congress: Gridlock, Confrontation or Compromise?

Senator Mitch McConnell (R-KY), who is the presumptive Senate Majority Leader in the next congress, was resolute in stating that under his watch there would be no government shutdown or default on the national debt. However, in assessing the chances for the full repeal of the Patient Protection and Affordable Care Act (PPACA), he stated the obvious that this is not in the cards given the President’s clear words that he would veto such a move and that the Republican votes would be insufficient to override a veto. Nonetheless, House Speaker John Boehner (R-OH) also made clear that he would push for another vote in the House on a repeal measure whether or not a vote could be brought up in the Senate. He said that Republicans should get what they can and that they should move to repeal the PPACA’s individual mandate, medical device tax and the Independent Payment Advisory Board (IPAB). He said the new majority should also pass legislation to increase the law’s definition of full-time employee from 30-hours/week to 40-hours/week to stem the tide underway by employers to reduce employee hours worked as a way to avoid having to offer and pay for health insurance coverage. In his post-election remarks, the President made clear that while he is open to making needed corrections, he would veto any changes that undermine the basic “structure” of the law. Republicans have also countered that, if necessary, they may invoke the budget reconciliation process, which imposes Senate rules for consideration requiring a 50 vote threshold instead of 60, to defund elements of the health care law and regulations that they consider to be unconstitutional or particularly egregious. Republicans will also be challenged, including by the House GOP Doctors Caucus, to pass legislation to repeal and replace the current sustainable growth rate (SGR) framework for setting Medicare physician reimbursement rates. However, finding the means to offset the cost of the legislation will remain the major hurdle for the bi-partisan/bi-cameral majority pushing for passage of the reform in anticipation of the March 31, 2015 expiration of the current temporary fix. As to the extension of funding in the lame-duck session for the Children’s Health Insurance Program (CHIP) being pushed by retiring Senator Rockefeller (D-WV), House Energy and Commerce Committee Republicans appear resigned to pushing the decision and hearings on the matter into later next year, closer to when the program is set to expire. The same committee’s bipartisan hearings, on the 21st Century Cures initiative, are also expected to result in the release of draft legislation in January which Health Subcommittee Joe Pitts (R-PA) said the committee would like to pass this summer. The goal of the legislation is to reform the Food and Drug Administration (FDA) process to speed up new treatments, drugs and new technologies. U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell also indicated that one of her priorities is to assist states in expanding Medicaid.

Administration Tightens Net under Health Reform Law

Even as congressional Republicans plot their upcoming legislative agenda to curtail the PPACA, the Administration is taking steps to constrain employer actions under the law. The Departments of Labor, HHS and Treasury issued guidance to employers instructing them that the following actions will be considered a violation of the market reforms under the law: if an employer reimburses an employee’s expense for purchasing health insurance on an exchange; if an employer offers a high-claims-risk employee a cash subsidy to purchase health insurance outside the employer’s own health plan; and if an employer eliminates group health insurance coverage and then reimburses employees for the purchase of individual coverage obtained elsewhere. In addition, the DoL issued a technical release clarifying that states can regulate the health insurance policies issued to group health plan sponsors regulated under the Employee Retirement Income Security Act (ERISA). The agency said that this authority also includes the ability of states to regulate so-called stop-loss insurance sold in connection with such group health plans. State insurance commissioners have criticized small employers for using stop-loss insurance to limit a plan’s exposure to high-cost claims. The clarification amounts to an exception to ERISA’s preemption of state insurance law in connection with self-insured group health plans and will allow states to regulate the limits of stop-loss coverage, particularly in connection with small employer plans. Another clarification issued by the Internal Revenue Service (IRS) will assist employers and health insurers in that the agency said that sponsors of self-insured group health plans and health insurance issuers can treat contributions under the PPACA’s transitional reinsurance program as ordinary and necessary business expenses for tax purposes.

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



 -  2019

 +  2018