POLICY BRIEFINGS


New Briefs Filed with U.S. Supreme Court on PPACA


The Supreme Court recently received over 24 friend-of-the-court briefs, including those from Senator Harry Reid and House Minority Leader Nancy Pelosi, which defend the constitutionality of the individual mandate and other aspects of the PPACA.  For example, a brief filed by the American Hospital Association and other hospital associations argues that the Eleventh Circuit decision striking down the mandate does not take into account the mandate will help prevent the cost shifting of uncompensated care to those who already have health insurance coverage.  The self-named “Working Group of State Legislators for Health Reform” consisting of 480 legislators from all states also signed onto a Constitutional Accountability Center brief arguing that the “idea that the federal government does not have the power to address a national problem such as the health care crisis has no basis in the Constitution’s text and history.”  In addition, eleven state AG’s filed a similar brief in support of the individual mandate.  On the other hand, 36 Republican senators filed an amicus brief urging the court to agree with their view that, given the lack of a “severability” clause under the PPACA, there was a “clear expression” of congressional intent that the entire law be held invalid if the court strikes down any element of the law.  On another issue, the Supreme Court granted a motion by the National Federation of Independent Business to add two individuals as plaintiffs in the NFIB’s suit challenging the individual mandate.  An individual plaintiff in the original complaint may have been held to lack standing in the suit after declaring bankruptcy.


CLASS is Out?


The House Ways and Means Committee voted 23-13 last week to repeal the PPACA’s Community Living Assistance Services and Supports program (CLASS Act).  The legislation, H.R. 1173, was approved in November by the House Energy and Commerce Committee.  Only one Democrat voted with Republicans for the repeal.  Rep. Charles Boustany, who introduced the legislation, said he is working on legislation to replace the CLASS Act.


GAO Says HHS Falls Short on PPACA Quality Measurement


GAO issued a report criticizing HHS and its subcontractors who are charged with developing specific plans, goals, benchmarks and standardized health quality measures pursuant to the PPACA mandate.  GAO said they have failed to set priorities and deadlines for quality metrics which can hinder the law’s requirement for timely health quality reporting.


Democrats Call for Medical Device Hearings


With the Medical Device User Fee Amendments of 2007 expiring in September, the FDA is charged and expected to release its recommendations for renewal of the Act this week.  In a related development, Democrats on the House Energy and Commerce Committee have asked the Republican majority to hold additional hearings to examine several implanted medical devices which some say are defective in order to give members additional information to consider in the context of the reauthorization of MDUFA.


CBO Bashes DEMO Cost Efficiency


CBO released a policy brief questioning the results of Medicare demonstration projects focusing on disease management and value-based payments.  CBO said most disease management program demos did not reduce Medicare spending while value-based payment demos produced mixed results.  However, CBO found that one demo which bundled hospital and physician payments for heart bypass surgery actually reduced costs by 10% over the fee-for-service model.  To improve future demos, CBO recommended that they be rigorously evaluated using randomized designs and similar groups of demo participants.



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