Repeal and Replace or Repair and Rebrand?
With reconciliation instructions in the FY 2017 spending bill that initiate the House and Senate committees with health care jurisdiction to reduce the deficit, Republicans in both chambers are eager to use the fast-track, fifty-vote process to repeal and replace as much of the Affordable Care Act (ACA) as soon as possible. While many lawmakers have proposed their own strategies for changing the health care law, the plan currently gaining the most traction is the House Republicans’ Blueprint, released on February 16, 2017. The Blueprint, presented by House Committee on Energy and Commerce Chairman Greg Walden (R-OR) and House Committee on Ways and Means Chairman Kevin Brady (R-TX), builds upon the House Republicans’ Better Way White Paper from 2016 and is the first step in the repeal and replace effort. The legislation will provide a universal health care tax credit, reform Medicaid with a per capita allotment and repeal the Medicaid expansion with a transition period, utilize state innovation grants to improve insurance markets, and promote health savings accounts (HSAs) by increasing the maximum HSA contribution limit. A draft of the legislative text dated February 10 was leaked to the public on Friday, February 24 and included reconciliation recommendations from the House Committee on Energy and Commerce and the House Committee on Ways and Means. A mark up of an updated draft of the committees’ reconciliation recommendations is expected as soon as February 28 or March 1. Reportedly, Republican senators remain divided on how to approach Medicaid reform for states that have and have not expanded Medicaid under the ACA and republican governors have voiced similar concerns. While step one of the repeal and replace process can pass the senate with a fifty-vote margin through reconciliation, a broader replace effort that would require a sixty vote threshold in the Senate is looking increasingly more difficult. Former Speaker John Boehner, a Squire Patton Boggs Senior Strategic Advisor, recently said Members “shouldn’t have called it repeal and replace because that’s not what’s going to happen. They’re basically going to fix the flaws and put a more conservative box around it.” As the health reform debate continues will Republicans stay true to their repeal and replace rhetoric, or is repair and rebrand more likely?
Energy and Commerce Holds First Hearing on User Fees
On Thursday, March 2, the House Committee on Energy and Commerce Subcommittee on Health will hold a hearing titled “Examining FDA’s Generic Drug and Biosimilar User Fee Programs.” The Generic Drug User Fee Amendments of 2012 (GDUFA) and the Biosimilar User Fee Act of 2012 (BsUFA) are two of the user fee programs set to expire in September 2017. The user fee agreements for brand drug makers and medical devices must also be examined and will most likely be packaged into one bill. H.R. 749, the Lower Drug Costs Through Competition Act, introduced by Rep. Kurt Schrader (D-OR), will also be discussed at the hearing. The reauthorization of the Food and Drug Administration (FDA) user fee agreements are traditionally a bipartisan effort, but this year may be an exception. The Trump Administration has yet to nominate a FDA Commissioner and the President has indicated the new leadership may focus on deregulating the agency. This could greatly complicate the reauthorization process. Additionally, the topic of drug pricing could be raised making a bipartisan agreement more challenging. The House Committee on Energy and Commerce is the first committee to hold a hearing on the user fee programs and the Committee expects to hold multiple hearings to better understand the programs. The Senate Committee on Health, Education, Labor, and Pensions (HELP) has yet to announce a user fee program hearing date. Both the House and Senate are currently occupied with the ACA repeal and replace efforts, but stakeholders believe Congress will come together to get this “must pass” legislation reauthorized by September 30.
This Week’s Hearings:
- Monday, February 27: The House Committee on Veterans Affairs Subcommittee on Oversight and Investigations will hold a hearing titled “Assessing the VA’s Risks for Drug Diversion.”
- Tuesday, February 28: The House Committee on the Judiciary will markup H.R. 372, Competitive Health Insurance Reform Act of 2017; H.R. 1215, Protecting Access to Care Act of 2017; and H.Res. 111, Resolution of Inquiry.
- Tuesday, February 28: The House Committee on Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing titled “Ways to Improve and Strengthen the International Anti-Doping System.”
- Tuesday, February 28: The Senate Committee on Veterans Affairs and the House Committee on Veterans Affairs will hold a joint hearing titled “Legislative Presentation of Disabled American Veterans.”
- Wednesday, March 1: The House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies will hold its Members’ Day hearing.
- Wednesday, March 1: The House Committee on Education and the Workforce will hold a hearing titled “Legislative Proposals to Improve Health Care Coverage and Provide Lower Costs for Families.”
- Thursday, March 2: The House Committee on Energy and Commerce Subcommittee on Health will hold a hearing titled “Examining FDA’s Generic Drug and Biosimilar User Fee Programs.”
MedPAC and MACPAC Meetings This Week
On Thursday, March 2, and Friday, March 3, the Medicare Payment Advisory Commission (MedPAC) and the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) will hold meetings to discuss Medicare and Medicaid policy issues and questions, as well as develop recommendations for Congress.
The MedPAC agenda includes the following topics:
- Implementing a unified payment system for post-acute care;
- Hospital and Skilled Nursing Facility (SNF) use by Medicare beneficiaries who reside in nursing facilities;
- Medicare Part B drug payment policy issues;
- Refining Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) and encouraging primary care;
- Standardization issues in premium support; and
- Possible impacts of premium support.
The MACPAC agenda includes the following topics:
- Changing Medicaid approaches to treating opioid use disorders;
- State flexibility overview;
- State Medicaid responses to fiscal pressures;
- Congressionally requested study on mandatory/optional benefits and populations: review of methods, limitations, and policy issues;
- Alternative approaches to Medicaid financing: setting per capita caps;
- States’ experiences managing spending and use for high-cost drugs; and
- The role of section 1915(b) waivers in Medicaid Managed Care.