Supreme Court Rules for White House in ACA Subsidies Case

On June 25, the U.S. Supreme Court ruled that the Affordable Care Act’s (“ACA”) health insurance subsidies can continue to flow to residents of states that are using HealthCare.gov.  The 6-3 decision in King v. Burwell preserves the structure of the ACA and marks the second major win for the Obama Administration before the Supreme Court. 

The majority ruled that the ACA as written does allow residents of states using the federal insurance exchange to receive premium subsidies for their coverage.  The ruling avoids what would have been a difficult debate in Congress over how to restructure the ACA to prevent or deal with millions of individuals losing federal subsidies.  While several lawsuits against the ACA are still pending, including one that challenges the law’s contraception mandate, King v. Burwell was seen as the last serious legal challenge to the health care reform law.

In Congress, many Republicans have already turned their attention to a budget procedure known as reconciliation that would allow the party to repeal substantive provisions of the ACA. The process requires only 51 votes in the Senate to advance, instead of the typical 60-vote threshold.  However, Republicans would have to find a way to pay for the cost of full repeal, which the Congressional Budget Office (“CBO”) has estimated would add over $100 billion to the deficit.

Senate Committee Moves Batch of Health Bills

On June 24, the Senate Finance Committee voted to advance a number of health care-related bills to the Senate floor.  Below are some of the bills the committee passed by voice vote:

  • S. 1347 – Electronic Health Fairness Act of 2015. The bill would exempt Medicare patients treated in ambulatory surgical centers from counting toward the requirement that doctors see at least half of their patients in settings with electronic health records.
  • S. 607 – The Rural Community Hospital Demonstration Extension Act of 2015. The bill would extend that demonstration for five years.
  • S. 1461 – A one-year extension of the enforcement instructions on supervision requirements of outpatient therapeutic services in critical access hospitals and small rural hospitals.
  • S. 1362 – The PACE Innovation Act of 2015. The bill prohibits CMS from waiving the requirement to offer all items and services covered by Medicare and Medicaid.
  • S. 861 – Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015. The bill is designed to fight fraud and abuse in the Medicare and Medicaid programs.
  • S. 466 – Quality Care for Moms and Babies Act. The bill would encourage the development of maternity care quality measures.

OSHA Expands List of Hazards for Hospitals

On June 25, the Occupational Safety and Health Administration (“OSHA”) announced it has added a list of hazards for OSHA inspectors to look for when inspecting hospitals and nursing homes.

Under the new enforcement memorandum, inspectors will review hospitals’ equipment, staff training procedures and processes for tracking and treating workplace injuries to evaluate how they are protecting their employees from musculoskeletal disorders, workplace violence, bloodborne pathogens, tuberculosis, slips, trips and falls.  Facilities that fail to control those hazards may be issued penalties that range from $7,000 to $70,000 for hospitals where administrators deliberately neglected to mitigate the problem.

CBO Releases Estimate of Cures Cost

On June 23, CBO released a report that provides cost estimates for provisions included in the 21st Century Cures Act (H.R. 6).  The Cures bill, which was passed unanimously in the House Energy and Commerce Committee in May, carries a price tag of $106.4 billion over the 2016-2020 time period.

CBO reports that the bill’s offsets, including selling oil from the Strategic Petroleum reserve, changing payment policies for imaging services and limiting Medicaid payments for durable medical equipment, could save the government up to $13 billion.  An additional $5 billion in savings is expected to come from the Medicare Part D program.  CBO’s total score is significantly higher than that of the Committee, which had estimated that the Cures Act would cost between $12 and $13 billion.

Objections to the bill’s offsets have prevented it from getting a floor vote.  Energy and Commerce Chairman Fred Upton is pushing for a vote when Congress returns following the July 4 recess.

House Votes to Repeal Medicare Cost-Cutting Board

On June 23, the House voted 244-154 to repeal the ACA’s Independent Payment Advisory Board.  The Protecting Seniors’ Access to Medicare Act (H.R. 1190) is intended to prevent rationing of care by giving Congress sole discretion on health care cost cutting decisions.

Created by the ACA, the 15-member board is intended to monitor Medicare spending growth and develop and submit recommendations, if necessary, to reduce the growth rate.  Medicare spending has remained under targeted levels so far, and President Barack Obama hasn’t nominated anyone to serve on the board.

The vote marks the second time legislation to repeal the Independent Payment Advisory Board has passed the House.  The first vote, in 2012, passed 223-181, but the bill didn’t advance to the Democratic-controlled Senate.  The White House has promised to veto the bill if it reaches President Obama’s desk.

Bills Introduced This Week

Rep. Lynn Jenkins (R-KS) introduced a bill (H.R. 2878) to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2015.

Rep. Mike Pompeo (R-KS) introduced legislation (H.R. 2895) to amend Title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting.

Senator Robert Menendez (D-NJ) introduced a bill that would amend Title XVIII of the Social Security Act to make changes to the Medicare home health face-to-face encounter requirements.

Next Week in Congress

The House and Senate are out next week for the Independence Day recess.  Both chambers return on July 7.  Upon return, the House is expected to have a floor vote on the 21st Century Cures legislation.  The Senate plans to take up education reform.