POLICY BRIEFINGS


Top Republicans Raise Concerns About Cost of New Medicaid Enrollees


Senate Finance Committee Chairman Orrin Hatch (R-Utah) and House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) have written to the administration raising concerns about the cost of Medicaid beneficiaries who have enrolled under the Affordable Care Act’s (ACA) expansion of the program. Data shows that individuals made eligible for the program under the health care law cost 19 percent more than other enrollees – on average $5,517 per person. The ACA expanded Medicaid coverage for people up to 138 percent of the poverty line, or $33,000 for a family of four. The federal government has paid for the cost of new enrollees during the early years of expansion, and the letter urges the Centers for Medicare and Medicaid Services (CMS) to conduct robust oversight to ensure that states do not set higher payment rates for newly eligible adults and shift the costs to the federal government. “States effectively lack economic incentives to be prudent purchasers for the newly-eligible population, because the federal government pays 100 percent of the cost of care for this population,” the lawmakers write. Over four million people have gained coverage through the 30 states that have expanded their Medicaid programs since 2014.


Congressional Oversight Leaders Ask CMS About Fraud Prevention System Update


Republican oversight leaders in the House and Senate have written to the Centers for Medicare and Medicaid Services (CMS) asking the administration for more details about the agency’s plans to update its Fraud Prevention System (FPS). The system uses predictive analytics and other technology to combat waste, fraud and abuse in the Medicare program. The Government Accountability Office (GAO) estimates that improper payments in the Medicare and Medicaid programs have increased in recent years, totaling $77.4 billion in fiscal year (FY) 2014. “Given the magnitude of these improper payments, in addition to the fraud and abuse identified in both programs, our Committees have followed the progress of the FPS investment at CMS with great interest,” the lawmakers write. “While FPS has successfully used this technology to identify fraud and improper payments, much more needs to be done.” The letter was signed by Senate Finance Committee Chairman Orrin Hatch (R-Utah), Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa), House Ways and Means Chairman Paul Ryan (R-Wis.), Ways and Means Subcommittee on Oversight Chairman Peter Roskam (R-Ill.), Ways and Means Subcommittee on Health Chairman Kevin Brady (R-Texas), House Energy and Commerce Chairman Fred Upton (R-Mich.), Energy and Commerce Subcommittee on Oversight Chairman Tim Murphy (R-Pa.), and Energy and Commerce Subcommittee on Health Chairman Joseph Pitts (R-Pa.).


Upcoming Congressional Meetings and Hearings


House Homeland Security Committee hearing titled “Defending Against Bioterrorism: How Vulnerable is America?” 10:00 a.m., 311 Cannon Bldg.; November 3

House Energy and Commerce Health Subcommittee hearing titled “Examining Legislation to Improve Medicare and Medicaid”; 10:15 a.m., 2322 Rayburn Bldg.; November 3

House Energy and Commerce Health Subcommittee markup to consider mental health, menu labeling, and synthetic drugs legislation; 3:00 p.m., 2322 Rayburn Bldg. Opening statements only; November 3

House Energy and Commerce Health Subcommittee markup to consider mental health, menu labeling, and synthetic drugs legislation; 10:00 a.m., 2123 Rayburn Bldg.; November 4

House Ways and Means Health Subcommittee hearing on the status of the Consumer Operated and Oriented Plan (CO-OP) Program; 2:00 p.m., 1100 Longworth Bldg.; November 5

House Energy and Commerce Oversight and Investigations Subcommittee hearing titled “Examining the Costly Failures of Obamacare’s CO-OP Insurance Loans;” 10:15 a.m., 2322 Rayburn Bldg.; November 5

House Veterans’ Affairs Health Subcommittee: hearing on veterans’ health legislation; 10:00 a.m., 334 Cannon Bldg.; November 17

House Energy and Commerce Health Subcommittee hearing titled “Examining the Regulation of Diagnostic Tests and Laboratory Operations;” 2:00 p.m., 2123 Rayburn Bldg.; November 17

House Veterans Affairs Committee hearing titled “Choice Consolidation: Assessing VA’s Plan to Improve Care in the Community;” 10:30 a.m., 334 Cannon Bldg.; November 18



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