Legislative Activity

Lawmakers Anticipate King v. Burwell Decision

With the Supreme Court expected to issue its opinion in the statutory interpretation case of King v. Burwell this month, lawmakers are considering legislative options to address any potential changes to the Affordable Care Act (ACA). The issue in the case of King v. Burwell is whether the ACA provides tax subsidies to individuals who purchase insurance through the federal exchange, in addition to the subsidies for those who buy insurance through state-based exchanges, which is explicitly stated in the law.

On Tuesday, June 2, the Republican Study Committee, a group of conservative House Republicans, is expected to unveil its plan to repeal and replace the ACA. The group would like their proposal to influence the Republican response to the King v. Burwell decision. Chairman of the House Committee on Education and the Workforce John Kline (R-MN), Chairman of the House Committee on Ways and Means Paul Ryan (R-WI), and Chairman of the House Committee on Energy and Commerce Fred Upton (R-MI) are currently leading the effort to compose a House Republican response to the upcoming ruling.

On Thursday, June 4, the Senate Committee on the Judiciary Subcommittee on Oversight, Agency Action, Federal Rights, and Federal Courts will examine the subsidy issue. The Subcommittee is scheduled to hold a hearing titled “Rewriting the Law: Examining the Process that Led to the Obamacare Subsidy Rule.”

House Committee on Ways and Means Marks Up Health Care Legislation

On Tuesday, June 2, the House Committee on Ways and Means will hold a markup to consider several health care bills. On the Committee’s agenda is H.R. 160, the Protect Medical Innovation Act of 2015, which would repeal the excise tax on medical device manufacturers and importers that was put into law by the ACA. The bill, sponsored by Rep. Erik Paulsen (R-MN), has 281 bipartisan cosponsors. The committee will also mark up H.R. 1190, the Protecting Seniors’ Access to Medicare Act of 2015. This bill would repeal the portion of the ACA that establishes the Independent Payment Advisory Board (IPAB), an entity to develop proposals to reduce spending growth in the Medicare program. Several bipartisan Medicare Advantage-related bills are also slated for consideration.

This Week’s Hearings:

• Monday, June 1: The House Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations will hold a hearing titled “Circumvention of Contracts in the Provision of Non-VA Healthcare.”
• Tuesday, June 2: The House Committee on Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing titled “Medicaid Program Integrity: Screening Out Errors, Fraud, and Abuse.”
• Tuesday, June 2: The House Committee on Ways and Means will hold a markup of: H.R. 160, Protect Medical Innovation Act of 2015; H.R. 1190, Protecting Seniors’ Access to Medicare Act of 2015; S. 984, Steve Gleason Act of 2015; S. 971, Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015; H.R. 2580, LTCH Technical Correction Act of 2015; H.R. 2505, Medicare Advantage Coverage Transparency Act of 2015; H.R. 2506, Seniors’ Health Care Plan Protection Act of 2015; H.R. 2507, Increasing Regulatory Fairness Act of 2015; H.R. 2579, Securing Care for Seniors Act of 2015; and H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015.
• Wednesday, June 3: The House Committee on Veterans’ Affairs Subcommittee on Health will hold a hearing titled “Assessing VA’s Ability to Promptly Pay Non-VA Providers.”
• Wednesday, June 3: The Senate Committee on Veterans’ Affairs will hold a hearing to examine pending health care legislation, including: S. 207, to require the Secretary of Veterans Affairs to use existing authorities to furnish health care at non-Department of Veterans Affairs facilities to veterans who live more than 40 miles driving distance from the closest medical facility of the Department that furnishes the care sought by the veteran; S. 297, to revive and expand the Intermediate Care Technician Pilot Program of the Department of Veterans Affairs; S. 425, to amend title 38, United States Code, to provide for a five-year extension to the homeless veterans reintegration programs and to provide clarification regarding eligibility for services under such programs; S. 471, to improve the provision of health care for women veterans by the Department of Veterans Affairs; S. 684, to amend title 38, United States Code, to improve the provision of services for homeless veterans; and other calendar business.
• Wednesday, June 3: The Joint Economic Committee will hold a hearing titled “Examining the Employment Effects of the Affordable Care Act.”
• Thursday, June 4: The House Committee on Energy and Commerce Subcommittee on Health will hold a hearing titled “Examining H.R. 2017, the Common Sense Nutrition Disclosure Act of 2015.”
• Thursday, June 4: The Senate Committee on the Judiciary Subcommittee on Oversight, Agency Action, Federal Rights, and Federal Courts will hold a hearing titled “Rewriting the Law: Examining the Process that Led to the Obamacare Subsidy Rule.”

Regulatory Activity

CMS Proposes Updates to Medicaid and CHIP Managed Care

On Monday, May 25, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule titled “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability.” This 653-page rule proposes the first major updates to the Medicaid managed care regulations since the regulations were published in 2002.

Among the many proposals are provisions which would: align CHIP managed care standards with those of the Marketplace and Medicaid; allow states the flexibility to contract with managed care plans regarding quality-based reimbursement approaches; and, require Medicaid managed care plans to meet a medical loss ratio (MLR) of at least 85 percent.

Insurance companies have spoken out against the proposed MLR for Medicaid managed care plans. This provision would require insurance companies that manage Medicaid plans to spend at least 85 percent of their revenues on medical care. In a statement released by America’s Health Insurance Plans, CEO Dan Durham warned that establishing “arbitrary caps” on insurer’s administrative costs could impact “critical services” that insurance companies provide beyond medical care, including social services and transportation to and from appointments.

The deadline to submit comments is July 27, 2015.

HHS Names New CTO

On Thursday, May 28, the Department of Health and Human Services (HHS) announced that Susannah Fox will join the agency as its new Chief Technology Officer (CTO). Fox will replace Bryan Sivak, who stepped down after serving as CTO for three years.

Fox, a self-proclaimed “health data geek,” has stated that she intends to “support and expand the data liberacion” initiative, which aims to make health data more accessible to entrepreneurs, researchers, and policy makers. Fox was most recently the Entrepreneur in Residence at the Robert Wood Johnson Foundation and previously held a role as an Associate Director at the Pew Research Center’s Internet and American Life Project.