AHCA Passes the House

On May 4, the American Health Care Act (“AHCA”) passed the House of Representatives by a vote of 217 to 213. The bill now moves to the Senate where lawmakers have already indicated that they intend to write their own bill instead of taking up what passed in the House.

The measure was resurrected last weekend after leaders for the moderate Tuesday Group and conservative Freedom Caucus agreed on an amendment that allows states to apply for a waiver from the Affordable Care Act’s (“ACA’s”) essential health benefits requirement if the state can prove the waiver will reduce average premiums, increase enrollment, stabilize the market, stabilize premiums for individuals with preexisting conditions or increase the choice of health plans. Many Republicans supported the amendment on the belief that an overwhelming majority of states would not seek such a waiver. The last few votes needed for passage of the bill came after another amendment was added to provide $8 billion in additional funding for high-risk pools that would help cover people with preexisting conditions.

Although Republican leadership in the Senate has said their version of the measure would not go through the committee process, it must still pass a number of significant hurdles before it receives a vote. First, moderate and conservative senators will need to agree on what their version will contain. The biggest changes the Senate could make is delaying the House repeal of Medicaid expansion in 2020 to provide relief to states who have already expanded their programs, adding even more funding for high-risk pools and giving states more regulatory flexibility. The Senate could also strip the Medicaid provision out altogether.

Whatever the Senate does, most agree it will have to be significantly different from what passed the House in order to get the 50 votes needed for passage. If that occurs, the measure will be sent back to the House where lawmakers will have to decide whether to pass the Senate’s more moderate version or leave the ACA in place. Given the procedural hurdles that must still be cleared in the Senate, a vote in that body isn’t expected until June.

Congress Passes FY 2017 Spending Bill

On May 5, the President signed into law the fiscal year (“FY”) 2017 omnibus appropriations bill, one day ahead of the midnight deadline that would have triggered a government shutdown. The Consolidated Appropriations Act of 2017 (H.R. 244) enjoyed wide bipartisan support in both the House and Senate and provides discretionary funding for the federal government through September 30, 2017.

The bill includes $73.5 billion for Health and Human Services, a $2.8 billion increase from FY 2016. The Health Resources and Services Administration (“HRSA”) would receive a $6 million increase for rural health programs and $5 million increase for the Children’s Hospital Graduate Medical Education program. Within the HRSA account, telehealth would receive an extra $1.5 million for telehealth, bringing its total to $18.5 million. A $2 million increase was provided for Rural Hospital Flexibility grants and the State Offices of Rural Health were provided a nearly $500,000 increase over FY 2016.

Comprehensive Telehealth Bill Introduced in the Senate

A bipartisan group of senators led by Sen. Brian Schatz (D-HI) reintroduced legislation that seeks to expand telehealth services in Medicare. The Senate bill (S. 1016) builds on a number of provisions previously included in the Senate Finance Committee’s CHRONIC Care Act, such as the expanded use of telehealth in accountable care organizations and Medicare Advantage. It would also expand the use of remote patient monitoring for certain patients with chronic conditions and expand the use of tele-mental health.

Health-Related Bills Introduced This Week

Reps. Joe Crowley (D-NY) and Ryan Costello (R-PA) introduced a bill to expand the current statutory cap on the number of Medicare-supported training slots for physicians. The bill would increase the number of Medicare-supported hospital residency positions by 15,000 (3,000 slots per year over five years), which would bring the total number of slots available to 105,000.

Rep. Sean Duffy (R-WI) introduced a bill that seeks to expand coverage of telehealth services under Medicare to provide coverage for home-based monitoring for congestive heart failure and chronic obstructive pulmonary disease. The bill (H.R. 2291) expands telehealth services to rural clinics and Metropolitan Statistical Areas of 70,000 people or fewer.

Sen. Mike Crapo (R-ID) introduced a bill (S.1001) to amend Title XVIII of the Social Security Act to modernize payments for ambulatory surgical centers under Medicare.

Next Week in Washington

The House is out next week, but the Senate returns Monday, May 8 to begin the process of passing a health care reform bill. The Senate Health Education Labor and Pensions Committee will mark up legislation reauthorizing the FDA user fees, and the full Senate is expected to confirm Scott Gottlieb nomination to lead the FDA on Wednesday.