House Passes PPACA Repeal Measures

The House passed several measures last week that would negate significant provisions of the PPACA.  On a vote of 238-183, the first bill, H.R. 1213, would repeal mandatory funding provided to States to establish American Health Benefit Exchanges and rescind any unobligated funds that have already been appropriated.  CBO estimated that the repeal would result in both higher premiums and higher costs for employer health plans and increase the number of Americans without health insurance by about 500,000 individuals.  However, the legislation was estimated to reduce federal deficits by about $14 billion over ten years.  Nonetheless, the Robert Wood Johnson Foundation announced it would provide states with technical help and disseminate best practices to ensure states successfully implement exchanges.  On a 235-191 vote, a second bill (H.R. 1214) would eliminate the four-year $200 million in PPACA mandatory funding for the construction of school-based health centers.  The House also passed H.R. 3, legislation that amends the IRC to prevent the use of federal funds in paying for abortions, including PPACA premium assistance tax credits for health plans covering such procedures.  The bill would also exclude such procedures from being covered under medical savings accounts.  The Administration’s Statement of Administration’s Policies (SAPs) threatened a Presidential veto of all three bills.  In related news, legislation was introduced to repeal the PPACA maintenance of effort Medicaid eligibility requirements (S. 868 and H.R. 1683).  House Ways and Means Committee Chairman admitted that the repeal legislation would hit a roadblock in the Senate.

Update on PPACA Constitutional Challenges

The Florida AG and 25 other states provided the 11th Circuit Court of Appeals with their reasoning of why the lower court’s holding should be upheld.  They said the entire law should also be held void by the circuit court because it “pushes even the most expansive conception of the federal government’s constitutional powers past the breaking point” in at least two respects: by imposing a “direct mandate on individuals to obtain health insurance” and by expanding the Medicaid program beyond boundaries imposed on Congress’s spending power.  In another case, the U.S. District Court for the Western District of Oklahoma ruled that uninsured individuals have standing to contest the PPACA’s individual mandate to buy health insurance.  In a related move, the Florida legislature sent a bill to Governor Rick Scott which would prohibit Florida residents from being required to buy health insurance.

IRS/Treasury Seeks Comments on PPACA Employer Mandate

The IRS and Treasury Department have requested comment on the PPACA “shared responsibility” provisions applicable to employers with 50 or more employees who do not offer minimum coverage to their “full time” employees.  The agencies seek comment on several alternative full-time rules and also suggestions on how IRS/Treasury/HHS/DOL should coordinate their rulemaking regarding waiting periods.

Hearing on Medicare MD Payment System

At a House Energy and Commerce Health Subcommittee hearing, full-committee Chairman Fred Upton said “although we cannot afford the current rate of spending on physician services, we also know that, if the pending 29.4% fee cuts are allowed to go into effect, a large number of doctors will be forced out of Medicare and a large number of Medicare beneficiaries will lose access to care….”  He indicated that crafting a solution to the SGR problem is on the committee’s “short list”.

HHS Requests Comments on "Mystery Shopper" Rule

HHS announced an information collection request seeking comment on a proposal that would use “mystery shoppers” to determine the rate at which primary care physicians are accepting new Medicare and Medicaid patients.  Given the demand the PPACA will soon create, HHS apparently decided that it needs to measure the availability of primary providers and to establish a baseline for future incentives.

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