ACA Repeal Could Pass the House by Easter

The House Republican leadership announced to their members this week that committee hearings to mark up ACA replacement legislation will begin by the middle of next week. The strategy outlined will take up the remainder of March and possibly the first week of April with the goal of sending a budget reconciliation bill that repeals large portions of the ACA to the Senate before the Easter break.

To pass the legislation, three House committees, Budget, Energy and Commerce and Ways and Means, will need to combine legislative text into a single reconciliation bill before going to the House floor for a simple majority vote. The text of the House bill is not expected to change dramatically from the text that was leaked last week. There are also rumors circulating on Capitol Hill that the latest version does not restore the Medicaid DSH cuts and would prohibit wealthy Americans from receiving tax credits to buy individual policies. The total cost of the bills also remains unclear. However, several lawmakers who serve on the relevant committees said this week they would proceed with hearings even if the Congressional Budget Office has not “scored” the bill.

The Senate path also remains unknown. Republican senators are largely split over the repeal of Medicaid expansion, which could create winners and losers among states. The latest legislative draft in circulation still includes a plan to phase out the ACA’s Medicaid expansion and replace it with capped payments to states based on the number of enrollees.

OMB Proposes Broad Cuts to Nondefense Discretionary Spending

On February 27, the Office of Management and Budget (“OMB”) released the President’s budget blueprint that includes discretionary spending numbers. The affected federal agencies, including HHS and CMS, will now review and provide feedback on the blueprint to OMB, which expects to release a final blueprint by March 16. The budget agency made clear this blueprint is not a full-blown budget and that a formal budget request won’t be released until early May. The blueprint does not address mandatory spending, entitlement reform, revenue projections or broader policies.

The topline nondefense number is $462 billion. This amounts to a $54 billion cut to nondefense discretionary spending with corresponding raise in defense spending of $54 billion. However, under the Budget Control Act of 2011, spending on defense and domestic programs is capped, and Democrats will most likely demand that any lifting of those caps for defense be matched by a higher ceiling for other nondefense programs.

New CMS Leadership Coming Soon

On March 1, the Senate Finance Committee voted along party lines to advance Seema Verma’s confirmation as the next administrator of CMS. Verma will now go before the full Senate for a final confirmation vote, which is expected to be favorable. Also this week, Modern Healthcare reported that Brian Neale would be nominated to serve as the new Director of the Center for Medicaid and CHIP Services at CMS. Neale most recently worked for Sen. Dan Coats (R-IN) as the director of the Congressional Joint Economic Committee and served as health care policy director for Vice President Mike Pence when he was governor of Indiana. Neale worked with both Verma and Pence to create the state’s Medicaid expansion plan known as HIP 2.0. Neale’s experience will be important as Congress attempts to overhaul Medicaid as part of its efforts to repeal and replace the ACA.

Health-Related Bills Introduced This Week

Rep. Doug Collins (R-GA) introduced a bill (H.R. 1316) to amend Title XVIII of the Social Security Act of provide pharmacy benefits manager standards under the Medicare prescription drug program and Medicare Advantage program to further transparency of payment methodologies to pharmacies.

Rep. Lynn Jenkins (R-KS) introduced a bill (H.R. 1284) that would amend Title XVIII of the Social Security Act to allow physician assistants to provide primary care to hospice patients, which is not currently covered under Medicare payment policy.

Rep. Steve King (R-IA) introduced medical malpractice reform legislation called the Protecting Access to Care Act, which would cap damages that can be paid by doctors, hospitals and nursing homes at $250,000. Although the House Judiciary Committee quickly marked up the bill (H.R. 1215) this week on a party line vote, it is not expected to move in the Senate.

Rep. Frank LoBiondo (R-NJ) introduced a bill (H.R. 1254) that directs Veterans Affairs to carry out a pilot program under which eligible veterans may elect to receive hospital care and medical services at non-VA hospitals.

Sen. Jon Tester (D-MT) introduced a bill (S. 455) that would amend Title XVIII of the Social Security Act to count time spent in a critical access hospital as resident time spent in a non-provider setting for purposes of making Medicare direct and indirect graduate medical education payments.

Sen. Roy Blunt (R-MO) introduced a bill (S. 527) intended to improve access to emergency medical services.

Sen. Bill Cassidy (R-LA) introduced a bill to amend Title XIX of the Social Security Act to reform payment to states under the Medicaid program. A bill number and text for the Cassidy bill has not been released.

Next Week in Washington

Although neither committee has formally announced a date and time, the House Energy and Commerce and Ways and Means committees are expected to begin marking up ACA replacement legislation sometime next week.