ACA Repeal Heads to President’s Desk
On January 6, the House voted 240-181 to send an Affordable Care Act (“ACA”) repeal bill (H.R. 3762) to the president’s desk through the expedited budget reconciliation process that does not require 60 votes to pass the Senate. While the White House has said Obama will quickly veto the measure, the repeal bill establishes a framework for how Republicans are likely to proceed should they sweep the elections in November.
The measure, which the Senate passed in December, would remove the penalties used to enforce the mandates that most individuals have health coverage and that large employers offer coverage to their workers. In 2018, it would repeal the law’s Medicaid expansion and its subsidies’ provisions to individuals to purchase health coverage. The bill would also eliminate a number of different taxes used to offset the cost of the health law, including the medical device tax.
House Speaker Paul Ryan (R-WI) has indicated that an alternative to the ACA will be introduced in the House later in 2016.
Obama Announces Increased Mental Health Funding
On January 5, President Barack Obama announced a number of gun control measures that include an additional $500 million in mental health care funding. However, the $500 million in federal funds would have to be approved by Congress, and details on the funding remain limited. The package also includes a Health Insurance Portability and Accountability Act (“HIPAA”) change that would enable certain HIPAA entities to share information with the National Criminal Background Check System on individuals who are not permitted to possess firearms.
Mental health reform will be one of the biggest health-related issues Congress takes up in 2016. Bipartisan support currently exists in the House and Senate for legislation that includes providing funding to improve mental health services, increasing access to providers, altering privacy rules and relaxing the current prohibition on Medicaid reimbursements to large inpatient psychiatric facilities for adult treatment.
The House is likely to pass Rep. Tim Murphy’s (R-PA) Helping Families in Mental Crisis Act early this year. In the Senate, several different mental health bills could be merged into a more comprehensive mental health reform bill this spring. However, given the potential for mental health to be merged with the gun control debate, the odds of the two chambers being able to reconcile differences and get a bill to the president’s desk are less than 50 percent.
“Hospital Bill” and 21st Century Cures Top Congressional Health Reform Agenda for 2016
In addition to mental health reform, much of the health agenda for Congress in 2016 will focus on passing the 21st Century Cures initiative and a hospital payment reform bill. While it is unlikely for Congress to enact legislation that would change the way hospitals are reimbursed under Medicare, look for the House Ways and Means Committee to release a comprehensive hospital reform bill in the coming months.
The package will likely include previously introduced legislation by Ways and Means members that changes the post-acute delivery system, limits the penalties for technical violations of the Stark Law, reforms graduate medical education and creates site-neutral payment policy for certain inpatient and outpatient surgeries. The package could also include language from the Medicare Crosswalk IME Pool Act of 2015 (H.R. 3292). This bill would instruct HHS to give each teaching hospital a lump sum payment to reimburse indirect medical education costs instead of paying the hospital an additional percentage based on each inpatient case.
The Senate HELP Committee is expected to mark up companion legislation to the House 21st Century Cures Initiative, which passed that body with overwhelming bipartisan support last summer. The HELP Committee has held a number of hearings on the subject, and while bipartisan support for the measure seems to exist, differences in mandatory versus discretionary funding for NIH and the FDA could make final passage difficult. Also complicating matters is the limited congressional schedule. Lawmakers will be in session fewer than 120 days in 2016 because of the summer’s presidential conventions and fall elections, a much more limited schedule than past years.
Health-Related Bills Introduced This Week
No new health-related legislation was introduced this week.
Next Week in Washington
On January 12, President Obama will give his final State of the Union address before Congress. The House and Senate will be in session until Wednesday before breaking for policy retreats.