Executive Order Signed to Reduce Regulatory Burden

President Trump signed an executive order last week that would require any new proposed regulation to be accompanied by a repeal of two existing regulations. For FY 2017, it mandates that costs of new regulations be completely offset by repealing existing regulations, and that regulations in future fiscal years be subject to an agency specific cap to be determined by the director of the Office of Management and Budget. However, it appears that the executive order will allow the director of the Office of Management and Budget (OMB) to exempt certain regulations from these requirements. The executive order could cause complications for agencies with health care jurisdiction, because these agencies issue many regulations that are required by law. OMB has issued interim guidance implementing the executive order for FY 2017, but notes that such guidance may be subject to revision and that additional guidance will be forthcoming for future fiscal years.

ACA Rhetoric May Be Shifting

Some Republicans are changing their rhetoric in regard to the future of the Affordable Care Act (ACA). While the GOP’s original goal was to repeal and replace the law, several Republican members of Congress have begun using words like “repair” to speak about their intentions for the 2010 health care law. House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) have both made recent statements indicating that some provisions of the ACA will be kept and modified if necessary. Sen. Bill Cassidy (R-La.), for example, introduced a health replacement plan that would maintain the ACA’s taxes while providing states flexibility to offer coverage to their citizens using the Obamacare structure or craft an alternative.. There are still many, however, who remain strongly in favor of complete ACA repeal and replace, including the House Freedom Caucus, House Ways and Means Committee Chairman Kevin Brady (R-Texas) and Senate Finance Committee Chairman Orrin Hatch (R-Utah). Chairman Hatch has definitively called for all of the law’s taxes to be repealed as quickly as possible. Eve Chairman Walden, however, has acknowledged that a compromise would have to be reached on the issue of Medicaid expansion in order to successfully pass ACA repeal, given the number of Republican members with constituents who have benefited from expansion of the program in their state.

IPAB Repeal Bills Introduced

Legislation that would repeal the Independent Payment Advisory Board (IPAB) was introduced in both the House and the Senate last week. IPAB was created by the Affordable Care Act (ACA). It is responsible for making recommendations to reduce Medicare costs should spending exceed a certain target. The law allowed for a one-time process to discontinue IPAB if a joint resolution is introduced no later than February 1. Members met the statutory deadline required to discontinue the process by introducing 3 identical joint resolutions fulfilling this statutory requirement. In addition, three bills to repeal the Board in full were introduced. Sen. Ron Wyden (D-Ore.) introduced both a resolution (S.J.Res. 16) and a bill (S. 251) that would prevent the IPAB process from moving forward. Sen. Wyden’s bill has three cosponsors: Sen. Martin Heinrich (D-N.M.), Sen. Debbie Stabenow (D-Mich.), and Sen. Brian Schatz (D-Hawaii). John Cornyn (R-Texas) also introduced both a joint resolution (S.J.Res. 17) and repeal bill (S. 260), which currently has 25 Republican cosponsors. In the House, Rep. David Roe (R-Tenn.) and Rep. Raul Ruiz (D-Calif.) introduced H.J. Res. 51 and H.R. 849. The latter currently has 12 Republican cosponsors.

Hearings Held on the Future of the ACA and Entitlement Programs

Seven congressional hearings were held across five committees last week to serve as guidance for the GOP as they work to repeal and repair the Affordable Care Act (ACA) and reform the Medicare and Medicaid programs. The Energy and Commerce Health Subcommittee held a hearing titled “Patient Relief from Collapsing Health Markets” to consider legislation that would change the age rating for health insurers and shorten the grace period for people who fail to pay their premiums. The Committee also considered a bill from Chairman Greg Walden (R-Ore.) that would bar insurers from denying coverage to those with preexisting conditions, but does not prescribe a limit on what insurers could charge patients who do not retain continuous coverage. Republicans argued that their goal is to lower the price of premiums and expand access to health insurance. Chairman Walden’s proposal was criticized by Ranking Member Frank Pallone (D-N.J.) for undermining consumer protections and discriminating against those with preexisting conditions. The Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing on the individual health insurance market. The witnesses, who included insurance regulators and executives, stressed the importance of stability in the individual market. Several House hearings were held about potential changes to the Medicaid program. The Energy and Commerce Health Subcommittee evaluated three pieces of draft legislation focused on keeping the wealthy out of Medicaid and ensuring the program is only serving those who are citizens or legal immigrants. During the hearing, Republicans focused on the need to restrain the Medicaid program’s cost growth, and make sure it is serving the program’s intended population. Democrats expressed concerns that their colleagues were trying to scale back the program, which they stressed serves not only the low-income, but elderly Americans in need of long-term care as well. During a Senate Budget Committee hearing on the Congressional Budget Office’s (CBO) Budget and Economic Outlook, members debated the need to curb federal entitlement programs. During his testimony, CBO Director Keith Hall explained the risks and consequences of allowing the national debt to continue to increase. Chairman Michael Enzi (R-Wyo.) said that he was open to leaving every option on the table, including an overhaul of Social Security and Medicare. Ranking Member Bernie Sanders (I-Vt.) encouraged his colleagues to allow President Trump to keep his campaign promise to not cut these programs.

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