Questions Remain about Budget/Appropriations, PPACA and Other Health Legislation contd.

Will congressional Republicans respond to a decision by the high court upholding King v. Burwell with legislation retaining subsidies for individuals obtaining coverage in state-run exchanges and giving other individuals an alternative means for subsidizing coverage for low-income individuals (e.g. revised tax credits; federal grants to states providing state-based subsidies; etc.)?

Will congressional Republicans otherwise repeal and/or replace the individual mandate; the employer mandate; the medical device tax; the Independent Payment Advisory Board (IPAB); the minimum “essential health benefits”; Medicare changes; etc.?

Will congressional Republicans find or include budget offsets for any changes to Obamacare?

Other Pending Health Legislation:
Will Congress repeal the current sustainable growth rate (SGR)-based Medicare physician payment system with an alternative (with or without budget offsets)?

When and how will Congress address the continued authority for spending under the Children’s Health Insurance Program (CHIP) program (and reconcile the program with Obamacare)?

When and how will Congress address the continued payment of Medicaid reimbursements at Medicare levels?
When will the House Energy and Commerce Committee consider, amend and vote on the proposed 21st Century Cures Initiative?

Will the retirement of Senator Tom Coburn (R-OK) move the Senate to vote on a new version of H.R. 5059, the Clay Hunt Suicide Prevention for American Veterans Act which he objected to saying it was duplicative of existing Veterans Administration programs?

When and how will Congress react to the various provider payment recommendations to be reported in March by the Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC)?

Administration Marches Forward with Implementation of PPACA

U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell touted the advances of the operations of Heatlhcare.gov in this year’s open season, reporting that 6.4 million individuals signed up with about 1.9 million of the total being new enrollees. It was also reported that another 1.1 million individuals signed up in eleven of the thirteen state-run exchanges. The Centers for Medicare and Medicaid Services (CMS) announced that five states were awarded $187 million in its last round of PPACA grants for developing state-run exchanges. During a recent hearing held by the House Committee on Oversight and Government Reform, Rep. James Lankford (R-OK) questioned CMS Administrator Marilyn Tavenner about whether permitting grant money to be used after 2014 would be contrary to the authority for the grants under the PPACA. The question remains unanswered. CMS also said that 89 new accountable care organizations (ACOs) will participate in the Medicare Shared Savings Program in January which will increase the total number of ACOs operating next year to 405. The Administration also issued a proposed rule which intends to determine whether allowing employers to offer employees “wrap-around” coverage to non-employment-based health insurance they obtain inside or outside exchanges will result in more employees electing to be insured. The IRS/HHS/DOL rule provides for a three-year pilot program that would consider such wrap-around coverage to be “excepted benefits” under the PPACA and exempt them from various requirements of the law, but require them to meet other conditions such as being non-discriminatory and low-cost. The IRS/HHS/DOL also released a proposed rule affecting group health plans and health insurers that makes changes to the summary plan description (SPD) of benefits/coverage and the uniform glossary they are required to provide employees and consumers under the PPACA. The agencies said that the changes are intended to “help people who are shopping for health insurance coverage better understand their options….” CMS also alerted health insurers subject to the PPACA that the agency will consider their plans “discriminatory” if they exclude all drugs for a certain condition or restrict access by requiring considerable copayments or prior authorization for such a drug, or place such a drug only on the highest-cost tier. Some of the conditions specifically mentioned are: bipolar disorder; diabetes; HIV/AIDS; rheumatoid arthritis and schizophrenia.

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