Senate Adopts Republican Budget

On Tuesday, May 5, the Senate voted 51-48 to pass a Republican-led budget adopted by the House last week. The vote follows nearly two months of negotiations between Republicans in the House and Senate and comes almost three weeks after the budget committee chairmen in both chambers had hoped to reach a decision.

The measure could achieve a balanced budget within 10 years and keeps funding for domestic agencies and safety net programs below spending caps. It would also increase funding for the Pentagon by seven percent while curbing Medicare payments to health care providers and would require Republicans to find about $1 trillion in savings over the next decade to replace revenue from ACA-related taxes.

Now that a budget resolution has passed, lawmakers will turn their attention to the 12 annual appropriations bills that fund the federal government. Senate Democrats have indicated that they will block GOP spending bills, which will struggle to clear the Senate’s 60-vote threshold without bipartisan support. House Republicans’ Medicare plan, which would give subsidies to people joining the system after 2024 to purchase health insurance on the open market rather than a guaranteed package of services, has failed to gain support in the Senate thus far.

Senate Version of 21st Century Cures Legislation Won’t Get Vote Until 2016

At a hearing on Wednesday, May 6, Senate Health Education Labor and Pensions Chairman Lamar Alexander (R-TN) indicated the Senate’s version of the 21st Century Cures medical innovation legislation will be completed near the end of this year and won’t reach the Senate floor until early in 2016. This timeline is significantly different from that of House Energy and Commerce Committee Chairman Fred Upton (R-MI), who has repeatedly said he hopes to bring the House bill to the floor before the end of June so it can reach the President’s desk before the end of the year. The timeline laid out by Senator Alexander would make that outcome impossible.

OMB Reviewing Final Rule on Medicare ACOs

A final rule on Medicare ACOs is now under review at the White House Office of Management and Budget (“OMB”).  OMB, which is the final stop before a rule is published, received the final rule (CMS-1461-F, RIN 0938-AS06) for review on May 5.  The final rule would update a 2011 final rule on ACOs.

When CMS released the proposed rule in December, it said the proposal would improve the program “through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements.”  CMS also said the rule would give more flexibility to ACOs seeking to renew their participation in the program. OMB is expected to release the final rule later this year.

House Preparing ACA Replacement for Post-King Decision

House and Senate Republicans continue to prepare legislative options in case the U.S. Supreme Court rules to prohibit federal exchange subsidies in the pending King v. Burwell case.  Republicans have been mulling over contingency plans since the beginning of the year in the event that states in the federal exchange are forced to deregulate their health insurance markets.

Republican staffers have said King contingency plans include offering dependent coverage until age 26, prohibiting insurers from imposing lifetime limits on benefits, and refundable tax credits.  The Supreme Court is expected to rule on the case by the end of June.  If the subsidies are struck down, House Republicans have said they want to be ready to present replacement options soon thereafter.

Bills Introduced This Week

Late last Friday, May 1, Rep. Michael Burgess (R-TX) introduced a bill (H.R. 2196) that would amend Title XVIII of the Social Security Act to provide for an increase in the limit on the length of an agreement under the Medicare independence at home medical practice demonstration program.  Sen. Thad Cochran (R-MS) introduced a bill (S. 1211) to amend Title XVIII of the Social Security Act to provide that payment under the Medicare program to a long-term care hospital for inpatient services shall not be made at the applicable site neutral payment rate for certain discharges involving severe wounds.

Next Week in Congress

The House returns from a week-long break on May 12.  The Senate will also be in session and, on May 14, the Senate Finance Committee will hold a hearing on the challenges facing Medicare patients with chronic care conditions. CMMI’s Patrick Conway and MedPAC’s Mark Miller will testify.