Legislative Activity

SGR/Individual Mandate Vote

House Republican Leadership has scheduled a vote on Friday to consider H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014. The bill represents a policy compromise of the three committees of jurisdiction, and would replace the current sustainable growth rate (SGR) formula with a stable payment period followed by a transition to a Merit-Based Incentive Payment system. The bill will also carry a provision that would delay the individual mandate provision of the Affordable Care Act (ACA). The Congressional Budget Office (CBO) previously reported that a one-year delay of the individual mandate would save over $9 billion. The measure is expected to face resistance from House Democrats, who are unwilling to dismantle a key element of the ACA.

The House is also expected to bring up a handful of non-controversial measures to modify the ACA, with bipartisan support under suspension of the rules. The bills include:

  • H.R. 1814, the Equitable Access to Care and Health Act (EACH Act), that would allow for an additional religious exemption from minimum ACA health coverage requirements for individuals whose religious beliefs would cause them to object to such care;
  • H.R. 3474, the Hire More Heroes Act of 2013, that would allow employers to exclude employees who have TRICARE, VA or DOD health coverage for purposes of counting full-time employees for the ACA applicable employer mandate of health coverage; and
  • H.R. 3979, the Protecting Volunteer Firefighters and Emergency Responders Act, that would clarify that volunteer firefighters, emergency medical services or ambulance services are not to be counted in determining the number of full-time employees for the ACA’s employer mandate of health coverage.

This Week’s Hearings:

  • Tuesday, March 11: The Senate Committee on Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging has scheduled a hearing titled “Access and Cost: What the U.S. Health Care System Can Learn from Other Countries.”
  • Wednesday, March 12: The House Committee on the Budget will hold a hearing on the President’s FY 2015 Revenue and Economic Policy Proposals. The House Committee on Ways and Means has scheduled a hearing on the President’s FY 2015 Budget Proposal with U.S. Department of Health and Human Services Secretary Kathleen Sebelius. The Senate Committee on Appropriations Defense Subcommittee has scheduled a hearing on Defense Health Programs.
  • Thursday March 13: The House Committee on Education and the Workforce Subcommittee on Workforce Protections has scheduled a hearing on “H.R. 3633, the Protecting Health Care Providers from Increased Administrative Burdens Act.” The House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will hold a budget hearing for the Department of Health and Human Services. The House Committee on Energy and Commerce Subcommittee on Health will hold a hearing titled “Keeping the Promise: Allowing Seniors to Keep Their Medicare Advantage Plans if They Like Them.” The Senate Committee on Health, Education, Labor and Pensions has scheduled a hearing titled “Protecting the Public Health: Examining FDA’s Initiatives and Priorities.”

Regulatory Activity

CMS Basic Health Program Final Rule/Federal Funding Methodology

The Centers for Medicare & Medicaid Services (CMS) released the Basic Health Programs; Eligibility and Enrollment in Standard Health Plans; Essential Health Benefits in Standard Health Plans; Performance Standards for Basic Health Programs; Premium and Cost Sharing for Basic Health Programs; Federal Funding Process; Trust Fund and Financial Integrity Final Rule. The rule “sets forth a framework for Basic Health Plan eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states, and federal oversight.”

The Federal Funding Methodology rule “provides the methodology and data sources to determine the federal payment amounts made to states in program year 2015 that elect to establish a Basic Health Program certified by the Secretary under section 1331 of the Patient Protection and Affordable Care Act to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Affordable Insurance Exchanges.”

IRS Employer Shared Responsibility Final Rule

The Internal Revenue Service (IRS) released the final regulations on employer obligations under the shared responsibility provisions of the ACA. The regulations change and clarify certain provisions of the IRS’ proposed regulations, and provide for substantial transition relief for employers in 2015.