Weekly Congressional and Administration Health News

Cabinet Confirmation Hearings

Sen. Jeff Sessions (R) was the first potential member of President-elect Donald Trump’s Cabinet to begin the confirmation process. Seeking confirmation to become the Attorney General, his hearing took place on January 10. This hearing was expected to be centered around with Sessions’ questionable history on the topic of race. However, only his failure to attain a federal judgeship due to allegations of racism was brought up. Democrat questioners did not press this matter for long, as their primary focus was Sessions’ policy positions. Issues such as same-sex marriage and immigration were introduced to gauge Sessions’ potential stances. Sessions combatted these challenges by making it clear that he would do everything he could to remain impartial and “follow the law”.

Retired Marine General John Kelly also had his hearing on January 10. Being considered for the head of the Department of Homeland Security (DHS), Kelly is also expected to gain confirmation. The hearing’s lack of confrontation was comparable to Senator Sessions’ hearing. Sen. Tom Carper (D) introduced Kelly as an “exceptionally well-qualified” candidate for this position. This trend of approval from both Republicans and Democrats continued throughout the hearing. Kelly was asked about several of Donald Trump’s more alarming campaign promises, including increased torture, building a wall along our Southern border, and the targeting of Muslim Americans. These points would be Kelly’s top priorities if he is confirmed to lead the DHS In response to these issues Kelly vehemently emphasized his compliance with the law, and his awareness that following through on these issues would violate the Constitution.

Rex Tillerson, former ExxonMobil CEO and Chairman, began his hearing on January 11. This hearing has been marked by much more confrontation and ambiguousness than prior hearings. Senator Marco Rubio (R) was very persistent in his questioning of Tillerson, focusing on sanctions against Russia and his ties with Russian Prime Minister Vladimir Putin. Tillerson would not provide a clear answer on whether or not the US should exact sanctions against Russia over the recent hacking concerns. When Vladimir Putin’s characterization as a war criminal was addressed, Tillerson was similarly ambiguous. This highlighted the concern that both Democrats & Republicans have with  Tillerson’s dealings with Putin during his tenure with ExxonMobil. Tim Kaine (D) also pressed Tillerson for answers about his involvement with Russia and where he stands on recent issues regarding Putin. Kaine also asked about ExxonMobil withholding research regarding climate change.

Elaine Chao, who was nominated to the position of Secretary of Transportation, began her hearing on January 11. This hearing has been marked by “friendly” proceedings thus far. The FAA’s hold on air traffic control, and the need for increased measures of safety for trains were just some of the issues raised. Gaining funding for transportation was also a concern of questioners, but Chao express her faith in Donald Trump’s infrastructure plan. Chao insisted that she was already considering many of the issues that were illuminated by those questioning her.

Secretary of Defense nominee, James Mattis will have his hearing on Thursday, January 12. Ben Carson, up for Secretary  of Housing and Urban Development, will also have his hearing on this day. Following Carson will be Wilbur Ross, who is being considered for the position of Secretary of Commerce. Finally, the last hearing scheduled for this week is potential Director of Central Intelligence, Mike Pompeo. Betsy DeVos’ hearing will begin on January 17, as she was nominated to become Secretary of Education. Hearing dates are not official for Secretary of Labor nominee Andrew Pudzer, UN Ambassador nominee Nikki Haley, Secretary of Treasury nominee Steve Mnuchin, Secretary of the Department of Interior nominee Ryan Zinke, Secretary of Health and Human Services nominee Tom Price, and Energy Secretary nominee Rick Perry.

Obamacare Repeal Effort Clears First Big Hurdle in U.S. Senate

The U.S. Senate took the first step toward repealing Obamacare in a razor-thin vote early Thursday, even as House leaders were struggling to line up support for a vote later this week. The 51-48 vote fell almost entirely along party lines, an early sign of the contentiousness surrounding Republican plans to undo President Barack Obama’s signature health-care law. Senate Republicans held together to defeat Democratic amendments aimed at defending popular portions of the Affordable Care Act, including expanded Medicaid and Medicare drug benefits and allowing kids to stay on their parents’ insurance until 26.

The House is planning to vote on the budget as early as Friday, but the timing could slip because of intra-party angst. Doubts were growing among both moderate and conservative Republicans about the wisdom of voting for repeal without laying out more details about the eventual replacement. Republicans intend to come up with the repeal bill in the coming weeks, though they remain far apart over how it would work. The budget blueprint lets Republicans repeal much of Obamacare without any votes from Democrats, because follow-on legislation wouldn’t be subject to filibusters.

GOP leaders initially discussed setting an Obamacare repeal sometime months or even years in the future, with a replacement to be enacted by that date. But a revolt by rank-and-file members in both chambers, with apparent agreement from President-elect Donald Trump, has lawmakers looking for a near-simultaneous repeal and enactment of a new health-care law several weeks or months into the new administration. The budget resolution, S. Con. Res. 3, sets a Jan. 27 target for writing the first Obamacare replacement bill. A group of five Republicans proposed changing that target to March 3, but they withdrew the amendment late Wednesday after GOP leaders reassured them that there was no practical difference because missing the deadline doesn’t carry a penalty.

Senator Rand Paul of Kentucky said he voted against the budget resolution for an unrelated reason — it would allow the federal debt to increase by more than $9 trillion over the next decade. Republicans control the Senate 52-48, which meant that Republicans could afford only a single additional defection to advance the measure before Trump’s inauguration.

The “vote-a-rama” procedure for budget resolutions allows Democrats to force unlimited votes on amendments, which meant hours of votes before final approval of the measure. Democrats tried to use the amendments to demonstrate a split between where the country is on popular provisions and the Republican base. “The Republicans cannot please their base and the broader public at the same time,” Democratic leader Chuck Schumer of New York said on the Senate floor. “From a policy perspective, they can’t repeal the law and keep in place the provisions that are overwhelmingly popular with a majority of Americans. That’s why they’re in such a pickle.” An amendment on prescription-drug pricing — a hot topic in the wake of the furor over Mylan NV’s EpiPen price increases and others in the last year — received a vote. The provision aimed at allowing importation of drugs from Canada was defeated 46-52, with numerous Democrats and Republicans breaking from party ranks in what was a significant symbolic win for the powerful pharmaceutical industry. Provisions were also filed on numerous other issues, including the carried interest tax break, trade and veterans’ benefits, but most of them did not get roll-call votes. Previous “vote-a-ramas” have been nearly all-night affairs with proposed amendments on a wide range of topics, but Democrats focused most of their amendments on Obamacare. Democrats are due to get another chance at offering dozens of amendments later this year, when Republicans plan to vote on next year’s budget, including fast-track provisions intended to speed an overhaul of the tax code.

Most Republicans seemed inclined to vote against even items they support to avoid hiccups that could create an embarrassing start to GOP control of Washington. Several senators said many of the amendments are effectively meaningless. No Democratic amendments were adopted. But one, an attempt to create a 60-vote threshold on legislation that would harm rural hospitals, had the backing of four Republican senators — Shelley Moore Capito of West Virginia, Susan Collins of Maine, Dean Heller of Nevada and Rob Portman of Ohio. The attempt failed on procedural grounds, but could be a preview of the difficulty Republicans can expect in actually writing a repeal bill. Ideally, leaders want the House to adopt the Senate resolution later this week and move on, but it’s not clear yet whether Speaker Paul Ryan will have the votes to do so without changes to assuage his restive conference. Senior House Deputy Whip Dennis Ross of Florida said Wednesday he’s been advised by a colleague that more Republican votes must be found to adopt the resolution, since all Democrats are expected to oppose the measure. The vote is tentatively set for Friday, but Ross said that GOP leaders are preparing for the possibility that the vote may have to be moved to Saturday to allow more time to assemble enough support.

Some House Freedom Caucus members are opposed to the current plan, while Charlie Dent of Pennsylvania, who co-chairs a group of moderate Republicans, said he has “serious reservations” at this point about voting for the budget. Among the differences Republicans are struggling with are how to treat states that expanded Medicaid under Obamacare — a priority for senators like Capito — and whether to immediately repeal all of the Obamacare taxes or keep some of them in place for now to ensure funding for a robust replacement. Trump said Wednesday that he plans to weigh in on the outlines of a replacement after he takes office. “We’re going to be submitting, as soon as our secretary’s approved, almost simultaneously, shortly thereafter, a plan,” Trump told reporters. “We’re going to do repeal and replace, very complicated stuff, and we’re going to get a health bill passed.” Georgia Republican Representative Tom Price, the president-elect’s pick for Health and Human Services secretary, faces a hearing next week in front of the Senate’s health committee, although the key hearing for his confirmation hasn’t yet been scheduled.

Health Care News

GOP: Less Money for States, Better Flexibility for Medicaid

Rep. Pat Tiberi (R-OH) has said that a Republican ACA replacement plan will provide more flexibility with programs such as Medicaid, however states will have less federal funding for their Medicaid programs. Tiberi said that states will pay a larger share when State Medicaid programs merge into a “shared partnership” with the federal government, including those under the Affordable Care Act (ACA). This partnership would reportedly allow states to receive more grant waivers from the federal government in order to experiment with new coverage models which are designed to reduce their Medicaid budgets. “With a partnership, there might be less federal funding but there’s more flexibility for states to be innovative to deal with their own Medicaid population,” said Tiberi.

Republicans have yet to decide on a plan for replacing the ACA’s core benefits, including the billions of dollars that states are using to provide expanded Medicaid programs as well as subsidies for low income Americans who purchase health insurance on the individual marketplace. The development of a plan is still in progress and will require further debate by House Republicans, according to the GOP. In order to reduce state spending on Medicaid and advocate personal responsibility on participants behalf, many states have asked the Obama administration for waivers to federal requirements for their Medicaid programs. States would then be able to charge enrollees premiums or require participants to pay into a health savings account.

GOP Senate Doubts about Obamacare Repeal Process

President-elect Donald Trump’s promise to repeal Obamacare without a replacement is doubted by a fourth Republican senator.

Bob Corker (R-TN) said on Friday morning, “Repeal and replacement should take place simultaneously.”

Rand Paul (R-KY) plans to vote against the procedure that sets up Obamacare repeal because of budget concerns.

Republicans have yet to explain how the health insurance scheme would be replaced after the repeal. For six years, Republicans have been calling for repeal for the health-care law, but now are nervous they will take blame if millions of Americans lose coverage in the coming years.

Tom Cotton (R-AR), being the latest to call for a replacement to accompany any repeal, stated, “I think when we repeal Obamacare we need to have the solution in place moving forward. Again, that solution may be implemented in a deliberate fashion. But I don’t think we can repeal Obamacare and say we’re going to get the answer two years from now. Look, this is a very complicated problem.”

Rand Paul met with Tom Price (R-GA), who was picked by Trump to lead the Health and Human Services Department and said “it’s absolutely imperative that Congress votes on replacing Obamacare on the same day it repeals it. We’ve got about 100 bills to replace Obamacare, OK? We need to put together the best of them into one bill. You can’t wait six months or a year and leave people floundering about without an alternative.”

Mitch McConnell insists that Republicans will work on pieces of legislation later in the year that will provide better and less-expensive care. “We plan to take on this challenge in manageable pieces”, also saying there will be “bumps along the way.”

Republicans fear having to explain to constituents why they would be losing their health care if the Obamacare collapses after a standalone repeal, which they obtained when a Democrat was in-charge.

Medicare Provider Enrollment Ban Extension in Six States

Centers for Medicare and Medicaid Services (CMS) released a notice on Jan. 6 that federal bans in six states on new ambulance providers and home health agencies that are enrolling in the Medicare program have been extended for 6 more months.

The extensions takes into effect Jan. 29 and was necessary due to significant risks of fraud and abuse associated with ambulance providers and home health agencies in those states.

CMS focuses on potential fraud schemes associated with ambulance providers and home health services.

Health-care attorney, Gejaa Gobena says, “Data shows those types of fraud are on the decline in those regions, but no one is ready to declare “mission accomplished” yet.” She continues to say ”it is uncertain if there is a need for more companies providing these services.”

Gobena expresses concerns about people buying an existing provider and committing fraud.

“While there are enhanced screening and ownership measures in place, when I was at DOJ I saw several instances of people who wanted to commit fraud doing that [buying an existing provider] to get around the moratorium.”

As a way to combat fraud, waste, or abuse, the Affordable Care Act gave Medicare, Medicaid or Children’s Health Insurance Program enrollment for providers and suppliers.

The moratoria extension influences newly enrolling nonemergency ambulance providers in New Jersey, Pennsylvania, and Texas and newly enrolling home health agencies in Florida, Illinois, Michigan, and Texas.

CMS Demands Worker’s Comp Plan Repay

On Jan. 5 a federal court criticized the Centers for Medicare and Medicaid Services (CMS) for demanding reimbursement from workers compensation plans under the Medicare Secondary Payer Act. The U.S. District Court for the Central District of California said, “the practice of demanding a workers’ comp plan repay an entire medical bill line item, as long as it contained at least one diagnosis code covered by a primary payer, is improper.”

Judge Otis D. Wright II agreed and stated that a workers’ comp insurer is not responsible for repayment of the entire charge under the MSP because of the presence of one covered diagnosis code in a single billed charge.

The California Insurance Guarantee Association (CIGA) disputed repayment demands made by the CMS against three workers compensation plans. Alleging the repayment demands including treatments for services not covered by the plans, they also fought to block CMS from collecting on the noncovered treatments.

According to the CIGA, CMS demanded repayment for charges for treatments that were not covered by the workers’ compensation plans which were not subject to MSP repayment. The repayment demands included treatments for diabetes, bereavement, high blood pressure, tobacco use, eczema, ulcers, and giddiness.

Rule Created to Penalize Overcharging Drug Manufacturers

On Jan. 4, the Department of Health and Human Services Department released a rule (RIN: 0906-AA89) on civil monetary penalties which penalizes Drug Manufacturers who overcharge safety-net providers for medications under a federal discount program. This program requires drug manufacturers participating in Medicaid to agree to provide outpatient drugs to covered entities. This includes safety-net hospitals at reduced prices. However, this rule is under the Affordable Care Act which may be revised by the new Congress.  If manufacturers charge more than the “ceiling price”, they will pay a penalty. Each instance of overcharging a covered entity will be no more than $5,000. The rule was planned to be published Jan. 5th in the Federal Register and take effect March 6.

Pricey Drugs Creating Coverage Gap for Medicare

On Jan. 5, a government watchdog agency reported a coverage gap on spending in the Medicare Part D drug from high-priced outpatient drugs. Between 2010 to 2015, Federal funding tripled. The Department of Health and Human Services Office of Inspector General found the funding was as much as $33 billion.  Drugs used to treat hepatitis C, among 8 others account for a third of the spending. Congress’s Medicare advisors recommended a shift be made from taxpayers to drug plans in order to pay for the costs.

 

John Zang contributed to this report

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