AHCA Revival or Retreat
Congress reconvenes this week after a two-week recess, with the possibility of a government shutdown looming at the end of the week. Speaker Ryan has made it clear to his colleagues that funding the government beyond April 28 will be his highest priority. With the American Health Care Act (AHCA) seemingly back on the table, efforts could accelerate this week for the House to approve a compromise version so that its action can be counted as a win for President Trump in his first 100 days in office. Before the April recess, Vice President Pence negotiated with members of the House Freedom Caucus and moderate Republicans in hopes of passing the AHCA out of the House of Representatives by the April recess. The idea of a risk-sharing fund gained support from some members of the conference, but it was not enough to deliver 216 votes. While members hosted fiery town hall meetings back home, House Republicans continued to negotiate the AHCA and warned members that if they reached a deal over the recess they would be called back to Washington, D.C. to vote on the bill. While a vote never occurred, it seems that Republicans are making progress. A summary of a potential amendment from Tuesday Group co-chair Rep. Tom MacArthur (R-NJ) was leaked to the press last week. The amendment text has not been officially released, but the draft of the tentative deal, brokered by Rep. MacArthur and Freedom Caucus Chair Mark Meadows (R-NC), would allow states to apply for limited waivers that would undermine the Affordable Care Act’s (ACA) protections for pre-existing conditions. Under the waivers, states could “opt-out” of ACA standards setting the minimum benefits that health plans must offer and a requirement forbidding insurers from charging different prices based on health status. Conservatives have pushed to eliminate these provisions and the draft makes elimination a possibility for states while also allowing states to maintain insurance protections including the community rating if they choose. Rep. Dan Donovan (R-NY) said he still opposes the bill and without legislative text it is difficult to predict which way other Republicans will fall. Could the MacArthur amendment be the key to AHCA revival, or is it another attempt at compromise that will fall short causing Republicans to retreat on health reform without a win?
This Week’s Hearings:
- On Wednesday, April 26, the Senate Health, Education, Labor, and Pensions (HELP) Committee has scheduled a hearing to consider the following measures:
- S. 652, Early Hearing Detection and Intervention Act of 2017;
- S. 309, National Clinical Care Commission Act;
- S. ___, Protecting Patient Access to Emergency Medications Act of 2017;
- S. 849, Strengthening Mosquito Abatement for Safety and Health (SMASH) Act; and
- Nomination of Scott Gottlieb to serve as the Commissioner of Food and Drugs.
- On Wednesday, April 26, the House Ways and Means Subcommittee on Social Security has scheduled a hearing titled “Stopping Disability Fraud: Risk, Prevention, and Detection.” The witnesses will be announced.
- On Thursday, April 27, the Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies has scheduled a hearing titled “Preventing Veteran Suicide.” The witnesses will be:
- Carolyn M. Clancy, M.D., Deputy Under Secretary for Health for Organizational Excellence, Veterans Health Administration;
- Harold S. Kudler, M.D., Chief Consultant for Mental Health Services, Veterans Health Administration;
- Stephanie A. Davis, Ph.D., Suicide Prevention Coordinator and Staff Psychologist, VA Eastern Kansas Health Care System, Veterans Health Administration; and
- Melissa Jarboe, Chief Executive Director, Military Veteran Project, Topeka, Kansas.
- On Thursday, April 27, The House Armed Services Subcommittee on Military Personnel has scheduled a hearing titled “Post-Traumatic Stress Disorder/Traumatic Brain Injury.” The witnesses will be:
- Captain Mike Colston, Director, Department of Defense, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE);
- Lieutenant Colonel Chris Ivany, Chief, Behavior Health Division, United States Army, HQDA, Office of the Surgeon General;
- Captain Thomas Johnson, Site Director, United States Navy, Intrepid Spirit Concussion Recovery Center Camp Lejeune, NC; and
- Colonel Steven Pflanz, Deputy Director of Psychological Health, United States Air Force.
CMS Issues IPPS and LTCH PPS Proposed Rule and Request for Information
On Friday, April 14, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released a proposed rule titled “Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices.” The proposed rule would update Medicare payment and policies when patients are admitted to hospitals for FY 2018. CMS also released a Request for Information (RFI) on suggestions of how to “better achieve transparency, flexibility, program simplification and innovation.” It states that feedback will be used to inform the discussion on future regulatory action related to inpatient and long-term hospitals. In addition, CMS asked for comments on the appropriate role of physician-owned hospitals within the delivery system. The proposed rule is scheduled to be published in the Federal Register on April 28, 2017, and CMS will accept comments on the proposed rule and RFI until June 13, 2017.