Health Reform GPS: Navigating the Implementation Process » Congressional Action

Ways and Means Committee speculates that ACA could cause employers to drop ESI

mmcdowell — Tue, 01 May 2012 20:04:39 +0000

The Ways and Means Committee Republicans released a report today estimating that the Affordable Care Act (ACA) provides large employers with an incentive to stop offering health care benefits to employees. Ways and Means Staff analyzed survey information from 71 of the Fortune 100 companies who reported that they will spend $38.4 billion on health care for active employees in 2014. The report indicates that if these large employers choose to drop health insurance coverage for active employees, they would save a collective $28.6 billion in 2014. They reached this conclusion by subtracting the $9.9 billion in mandate penalty payments that the companies would accrue as a whole if they opted out of the requirement from the $38.4 billion health care expenditure total. They speculated that if these large employers did indeed choose to drop health insurance coverage for active employees, they would save a
collective $28.6 billion in 2014. The report also noted that the Congressional Budget Office (CBO) does not expect such an exodus from the ESI market. CBO argued last year that “if firms could have attracted employees more cheaply by dropping health benefits and adding wages or other benefits that cost less, then they would have done so.”

House passes student loan bill

mmcdowell — Fri, 27 Apr 2012 17:33:18 +0000

The House passed H.R. 4628: Interest Rate Reduction Act 215-195 to hold subsidized student loan interest rates at 3.4 percent for one year. House Republicans attached a Democratically unfavorable rider to the bill. The rider would tap into the Prevention and Public Health Fund, the Affordable Care Act (ACA) provision designated to improve public health efforts such as screening programs. The White House has threatened to veto such a bill, arguing that further slashing the Prevention Fund would cause harm to those in need of preventive services.

The Senate will debate its own student loan interest rate freeze bill on May 7. While the House bill pays for the bill through cuts to the Prevention and Public Health Fund, Senate Democrats will fund the bill through tax increases on certain corporations.

House approves IPAB repeal

mmcdowell — Fri, 23 Mar 2012 16:04:34 +0000

Members of the House approved H.R. 5, the Protecting Access to Healthcare (PATH) act, by a vote of 223-181, with only seven Democrats supporting the bill and ten Republicans opposing. H.R. 5 would repeal the Independent Payment Advisory Board (IPAB), a provision under the Affordable Care Act. IPAB, a 15-member government agency, would have the power to force cuts to providers if Medicare expenditures rose beyond a predetermined cap. The board’s decisions would be immune from the court system, and thus would carry the full force of law. IPAB was tasked with finding Medicare savings and instituting medical tort reform across the country.

For more information on IPAB, click here.

Update: Prevention and Public Health Fund

mmcdowell — Mon, 27 Feb 2012 22:58:37 +0000

The Patient Protection and Affordable Care Act (ACA) of 2010 created the Prevention and Public Health Fund (Prevention Fund) to improve American health through disease prevention efforts. The ACA allotted almost $20 billion over 10 years to the Prevention Fund with the goal of improving wellness and restraining cost growth incurred by the increasing prevalence of chronic disease. This fund is structured as a trust fund, and is not subject to the annual appropriations process.

In combination with other provisions of the ACA, including the National Prevention, Health Promotion, and Public Health Council, the Prevention Fund represents a substantial increase in federal funding for public health activities. Given the large federal budget deficits and the need to offset federal spending, the Prevention Fund has remained a target for conservative and moderate policymakers on both sides of the political aisle. For more information on the Prevention Fund, click here.

On February 22, President Obama signed the Middle Class Tax Relief and Job Creation Act, with the purpose of averting the impending cuts in physicians’ payment under Medicare, extending jobless benefits to the unemployed and extending payroll tax cuts.^[1] In Section 3205 of this act, Congress made several important amendments to the Prevention and Public Health Fund appropriations under Section 4002 of the ACA. Under the Middle Class Tax Relief and Job Creation Act, $1 billion is allotted to the Fund for fiscal years 2012 through 2017, $1.25 billion for fiscal years 2018 and 2019, $1.5 billion for fiscal years 2020 and 2021, and the Fund’s appropriations peaks at $2 billion in 2022.^[2] This differs from the ACA appropriations in that funding would have peaked at $2 billion in 2015 under the ACA, creeping from $1 billion, to $1.25 billion, to $1.5 billion in fiscal years 2012, 2013, and 2014, respectively.^[3] In other words, from fiscal years 2012 through 2022, while the ACA would have allocated $19.75 billion to the Prevention Fund, the Middle Class Tax Relief and Job Creation Act only allocates $13.5 billion, resulting in a net loss of $6.25 billion over the 10 year period.

In 2010, the Department of Health and Human Services (HHS) allocated $500 million Prevention Fund among a number of priorities. HHS awarded $70 million to help prevent and contain disease outbreak, $31 million went to data collection and analysis, $23 million went to workforce and training programs at the CDC and $250 million was devoted to developing the nation’s primary care workforce.^[4] From the $750 million budgeted for 2011, the Fund allocated nearly $300 million to community-based prevention efforts, $182 million to clinical prevention efforts, $137 to public health infrastructure, and $133 million to data collection and research.^[5]

[1] P.L. 112-96.
[2] Sec. 3205 of the Middle Class Tax Relief and Job Creation Act
[3] P.L. 111-148 & 111-152
[4] Jennifer Haberkorn et al., The Prevention and Public Health Fund, Health Affairs. February 23, 2012.
[5] Id.

House approves CLASS repeal

mmcdowell — Thu, 02 Feb 2012 17:18:09 +0000

By a vote of 267-159, the House approved a bill (H.R. 1173) yesterday to repeal a long-term care program, Community Living Assistance Program and Supports (CLASS), a provision of the Affordable Care Act (ACA). Twenty-eight Democrats joined a unanimous Republican Conference in support of the repeal. CLASS was added to the ACA as the first federally sponsored long-term care program available to most working adults on a voluntary basis. This repeal comes after an announcement in October 2011 from the Obama administration, stating that they had no intention of implementing the program due to financing issues. The repeal of the (CLASS) program has been a priority of the Republican controlled House, but it seems there is little chance that a similar bill would pass in the Democratic-controlled Senate.

Prominent Republican Discusses Importance of Medicaid on Senate Floor

Mark Dorley — Mon, 19 Dec 2011 19:52:53 +0000

Senator Charles Grassley (R-IA), Ranking Member of the Senate Judiciary Committee, gave a speech on the Senate floor warning members of the dire consequences to Congressional powers if the Supreme Court finds in favor of States on the ‘Medicaid Commandeering’ argument. The Court has agreed to hear oral arguments on multiple challenges to the Affordable Care Act (ACA) over a three day stretch in late March of 2012. These challenges include an objection by States of the Medicaid expansion provisions of the ACA, which require States to expand Medicaid eligibility to 133% of the federal poverty level (FPL) in order to receive additional federal dollars.

For more information on the Medicaid eligibility changes under health reform, click here.

Sen. Wyden (D-OR) joins Rep. Ryan (R-WI) on Medicare Plan

mmcdowell — Sun, 18 Dec 2011 16:50:26 +0000

Democratic Sen. Ron Wyden of Oregon teamed up with Republican Rep. Paul Ryan of Wisconsin on a Medicare overhaul plan that would provide beneficiaries with a fixed amount to buy private coverage or pay for a traditional fee-for-service plan. Different from the Ryan plan introduced earlier this year, the Ryan-Wyden proposal would not do away with Medicare, but instead would leave it is an option for beneficiaries to purchase with their vouchers. However, this plan would not ensure that the voucher would make Medicare affordable, nor would it preclude private insurance policies from designing benefit plans to exclusively attract healthy beneficiaries.

House passes bill with 2-year SGR fix

Mark Dorley — Sat, 17 Dec 2011 00:57:24 +0000

Introduced by Republican leadership only days earlier, the U.S. House of Representatives has passed a legislative package, some of which is paid for by reducing funding of certain components of the Affordable Care Act (ACA). The legislation provides funding for the controversial Keystone XL pipeline, preempts certain rules issued by the Environmental Protection Agency, extends unemployment insurance, and prevents a reduction in physician payments under Medicare (the “SGR fix”), among other provisions. The legislation is paid for, at least in part, by increasing the amount of ineligible premium sharing tax-credit money that can be recoped by the IRS under the ACA, and by cutting the Public Health and Prevention trust fund by $8 billion.

House votes to include Social Security in Medicaid eligibility formula

mmcdowell — Fri, 28 Oct 2011 05:47:13 +0000

On October 27th, the House voted 262-157 to pass H.R. 2576, a bill to strike out a “glitch” in the Affordable Care Act (ACA) that would have allowed middle-class couples to enroll in Medicaid starting in 2014. Under the ACA, before the new bill passed, the majority of Social Security benefits were not taxed, and thus not reviewed when determining Medicaid eligibility. A couple earning as $60,000 per year could have gained access to Medicaid. H.R. 2576 moves to include Social Security benefits as income when calculating modified adjusted gross income (MAGI). MAGI is used to determine Medicaid eligibility. On Tuesday, October 25th, the Obama administration publicly supported the bill.

Ways and Means Committee moves to redefine MAGI

mmcdowell — Thu, 13 Oct 2011 18:13:04 +0000

Today, the House Committee on Ways and Means approved, 23-12, largely along party lines, legislation that would affect eligibility under federal health care reform law. The proposed legislation, H.R. 2576, revises the computation of modified adjusted gross income (MAGI) for the purpose of determining eligibility for premium assistance tax credits and Exchange subsidies, Medicaid, and CHIP. Under the current definition, MAGI equals adjusted gross income (AGI) plus any tax-exempt interest and foreign earned income otherwise excluded from AGI. Because a portion of Social Security benefits is currently excluded from gross income (and therefore from AGI) for income tax purposes, the current MAGI definition allows only the taxable portion of Social Security benefits to count toward eligibility requirements. Representative Diane Black (R-TN) introduced H.R. 2576 to expand the definition of MAGI to include the entire amount of Social Security benefits received. The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) estimate that the legislation would reduce deficits by almost $3 billion over the 2012-2016 period and by about $13 billion over the 2012-2021 period. CBO and JCT have found that adding nontaxable Social Security income to the MAGI definition would reduce Medicaid enrollment, beginning in 2014, by between 500,000 and on million people, depending on the year. The number of people purchasing insurance through the Exchanges could increase as a result.

Click here for H.R. 2576 background and proposal explanation.