POLICY BRIEFINGS


PPACA Repeal Provisions Pass House


The House passed another round of PPACA repeal measures last week, including H.R. 674, which would repeal the imposition of 3% withholding on certain payments made to vendors by federal, state and local governments, and H.R. 2576 which would modify the calculation of modified adjusted gross income to include 100% of Social Security payments for purposes of determining eligibility for premium assistance tax credits under state health insurance exchanges and subsidies under Medicaid.  Although the bills passed on mainly party lines, the Administration expressed support for both bills.  In related action, Rep. Charles Boustany introduced H.R. 1173, legislation which would repeal the PPACA long-term care CLASS Act after the White House said the provision was halted only temporarily.  A House hearing on the long-term care program elicited much criticism from Republicans on statements by HHS that they said exaggerated the cost savings produced by the program while suppressing internal HHS estimates that showed the program would be unsustainable over the long term.  They maintained the program was a budget gimmick from the start in order to reduce CBO’s cost of the PPACA by $70 billion.


Hearing on PPACA Subsidies


The staff of the House Committee on Oversight and Government Reform issued a report, Uncovering the True Impact of the Obamacare Tax Credits: Increases the Deficit, Expands Welfare through the Tax Code, and Implements a New Marriage Tax Penalty, which states that the PPACA creates a “substantial new marriage penalty into the tax code” and will result in removing as many as 8.1 million federal taxpayers from the tax roles by 2020.  Former CBO Director Douglas Holtz-Eakin testified before the committee that the PPACA is likely to increase the federal deficit, despite original CBO and Joint Committee on Taxation estimates that the PPACA will reduce the federal deficit by $143 billion over 10 years.  Cornell Professor Richard Burkhauser testified that the PPACA health insurance subsidies will result in perverse incentives for employers to discontinue offering health coverage, particularly to part-time workers.  Others said the law would also discourage marriage because of the formulation of the subsidies.


PPACA Community Health DEMO


HHS said it will provide about $42 million over three years to 500 community health centers pursuant to the PPACA mandated “Federally Qualified Health Center (FQHC) Advanced Primary Care Practice” demonstration project.  The demo will provide Medicare payments based on the quality of care delivered and reward centers for such things as helping patients manage chronic conditions like diabetes and high blood pressure.  In another CHC White House “jobs” initiative, the Health Resources and Services Administration will ask community health centers to hire at least one veteran over the next three years and give training grant priority to universities that prepare veterans for careers as physician assistants.


Upcoming Decision by U.S. Supreme Court on PPACA Constitutionality


The Court is expected to convene November 10th in a private conference to discuss whether to review the several lawsuits contesting the PPACA.  The Department of Justice has urged the court to review the Eleventh Circuit decision which held the individual mandate invalid.  DOJ also would like the court to review another decision which held that the AIA (Anti-injunction Act) precludes court action until 2014 when the penalty under the tax code is effective.  DOJ also asked the court not to review the constitutionality of the mandated Medicaid provisions which 26 states said should be reviewed.  If the Supreme Court decides to review one or more cases, oral arguments would likely begin next spring with a decision to be issued by the end of June.  Whatever decision is made will likely become fodder for the 2012 elections.  Amicus briefs continue to be filed with the court challenging the PPACA with the latest one filed by 100 House Republicans and the American Center for Law and Justice.  The U.S. Chamber of Commerce also filed a brief arguing that the court should void the entire Act if the individual mandate is held unconstitutional given the lack of a severability provision under the law.



October 31, 2011: | Page 1 Page 2 Page 3

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