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Tuesday, November 24, 2015

Health Policy on the Hill: What Congress Is Doing on Health Care for the Rest of 2015

Jane Sheehan

Senior Government Affairs Manager

Last month, Congress and President Obama worked out a budget deal that provides relief from the sequester caps, raises the debt ceiling, and prevents a steep scheduled rise in Medicare Part B premiums and deductibles. Despite this welcome show of bipartisanship, the remainder of this legislative session will likely include continued attempts to undermine the Affordable Care Act (ACA) and funding for Planned Parenthood.

Budget deal raises sequester caps and debt ceiling, but hurdles remain

The budget deal raises the spending caps that were put in place by sequestration for the next two years, and it provides much-needed relief for domestic programs that help vulnerable populations. Importantly, it also prevents a dramatic increase in premiums for Medicare Part B that would have occurred without such a deal. In addition, the agreement raises the debt limit until 2017 without any significant, harmful structural changes to entitlement programs. 

Harmful legislative riders could derail negotiations around government spending

While the budget deal reflects agreement on overall spending levels, Congress still has a lot of work to do in terms of finalizing spending legislation for fiscal year 2016. This negotiation process presents an opportunity for opponents of the ACA and Planned Parenthood to threaten important health care programs. 

Government programs are currently funded through December 11, when short-term funding runs out. And newly elected Speaker of the House Paul Ryan has made no promises to avoid a government shutdown. 

Some conservatives in Congress may try to attach controversial provisions, known as legislative riders (which have little to do with the overarching legislation), to the legislation. These riders could attack health care programs and health care providers like the ACA, Medicaid, and Planned Parenthood

Attacks on the ACA and Planned Parenthood through budget reconciliation continue

Some members of Congress will continue to use the budget reconciliation process as an avenue for attacking the ACA.

Current action in the Senate: The Senate is expected to vote on a budget reconciliation bill some time during the next few weeks, but it is hitting hurdles in the form of procedural limitations and disagreements on what the bill should include. Senate rules regarding reconciliation bills can be strict, and some argue that the text of the House bill (which was passed last month—see below) does not comply with those rules.

Some Senate Republicans believe the House reconciliation package does not go far enough in undermining the ACA. One option being floated is to vote to roll back exchange subsidies (premium tax credits) and Medicaid expansions, which would have a dramatic impact on the 17.6 million consumers who have gained health insurance through the ACA. Low-income adults and their families, who have benefited from Medicaid expansion, would be disproportionately affected. Meanwhile, moderate GOP Senators may find it difficult to vote to defund Planned Parenthood when there is strong support for this critical safety net provider in their states. 

Action last month in the House: In October, the House of Representatives passed a budget reconciliation bill that would damage the ACA’s framework and financing by repealing critical pieces of the law, including both the individual and employer mandates, as well as the law’s excise tax on medical devices. 

The Congressional Budget Office estimates that repealing the individual mandate would result in 14-15 million fewer people being insured and a 20 percent increase in premiums in the individual market. Additionally, CBO expects that repealing the employer mandate (which currently requires businesses with 100 or more full-time employees to offer affordable, comprehensive coverage) will cause some Americans to become uninsured and may disrupt the health care system.

The House bill also zeroes out for one year funding for Planned Parenthood, an important health care provider for women and men in low-income communities and in communities of color. 
President Obama will surely veto any legislation that does significant damage to the ACA. However, ACA opponents would view it as a milestone if they could pass a bill repealing the ACA that made it to the President’s desk.

Other threats: suspension of medical device tax, GOP-led task force on Medicaid

Outside of the reconciliation process, efforts are being made to include a two-year suspension of the medical device tax in a year-end tax package. The medical device tax is an important source of revenue for the ACA. The tax is small (2.3 percent) compared to how much device companies are likely benefiting from new customers that now have health coverage thanks to the ACA. 

A full repeal of the tax, as advocated for in the reconciliation bill, would increase the federal deficit by about $23.9 billion over the 2016-2025 period. However, even a temporary suspension would cause trouble for the ACA. It is unclear how a suspension of the tax would be offset by spending cuts or additional revenue sources.

House committee establishes Medicaid Task Force

Another troubling development concerns Medicaid. The House Committee on Energy and Commerce has recently dedicated several hearings to scrutinizing the Medicaid program and has announced the creation of an all-Republican Medicaid Task Force to "strengthen and sustain" the program. While it is within the jurisdiction of this committee to examine Medicaid, we are concerned that the Task Force includes only Republicans. This will likely be another partisan attempt to undermine and weaken Medicaid, a program that provides vital health coverage for American families, children, and seniors.

Though major changes to the structure of Medicaid are unlikely to become law this year, it is important to defend this program and explain how structural changes like per capita caps and block grants could significantly harm vulnerable populations.

As with the Medicaid Task Force, the House budget reconciliation bill remains for now a messaging tool for ACA detractors. In addition to these attempts at negative messaging, it will be important to monitor year-end spending negotiations for provisions that endanger critical health care programs and health care providers. 

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