United States: Capitol Hill Healthcare Update - January 30, 2017

At GOP retreat, consensus on healthcare elusive

House and Senate Republicans emerged from a policy retreat last week in Philadelphia with no agreement on next steps in their plan to repeal and replace the Affordable Care Act (ACA).

Most congressional leaders, including House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), urged rank-and-file lawmakers to proceed cautiously, given the policy intricacies and political dynamics of changing health insurance for more than 20 million people. Walden recently has talked up his plans to "repair" the ACA, which represents a shift from the party's previously stated position of wiping the law from the statutes.

Conservative lawmakers in the House – including members of the House Freedom Caucus – are pressing leaders to identify an ACA replacement plan by March. Conservatives also want a rapid transition to whatever replaces the health law, while moderate Republicans are calling for a longer runway to smooth out any disruptions during the transition.

While Republicans didn't emerge from their retreat with a concrete plan to go forward, all signs point to a February or early March vote repealing key provisions of the ACA using a special procedure known as budget reconciliation, which Senate Democrats can't block with a filibuster. Republicans hope to attach some ACA replacement language to the reconciliation bill, too.

Walden said Congress will then take up a series of stand-alone health bills that GOP leaders hope to approve over the coming months. Those bills would be subject to filibuster in the Senate, so Republicans will need at least some Democratic support to approve them.

Price's HHS nomination to advance

The Senate Finance Committee on Tuesday is scheduled to vote on – and likely approve – the nomination of Rep. Tom Price (R-Ga.) as secretary of the U.S. Department of Health and Human Services (HHS).

Price survived two hearings this month as Democrats sharply criticized the orthopedic surgeon for his personal ethics and his support for dismantling the ACA.

The committee's vote will send Price's nomination to the full Senate, where he is expected to win confirmation. Republicans in Congress and the White House are eager to see Price at HHS so they can get guidance on what ACA provisions HHS could roll back through rulemakings and what legislation lawmakers would need to approve.

Committee Chairman Orrin Hatch, (R-Utah) praised Price in a statement Sunday, saying, "There's no question Dr. Price has the experience, fortitude and judgment needed to lead HHS."

House panel to consider insurance market bills

A key House health panel this week will consider a series of bills Republicans hope will foster stable insurance markets as the party plans to replace the ACA.

The Energy and Commerce Health Subcommittee on Thursday will consider four bills, including one that would reduce from five to three the number of age-rating bands that prevent insurers from charging older people much more than younger people. Other legislation would require verification before a patient signs up for a plan outside of the standard open enrollment period.

Subcommittee Chairman Michael Burgess (R-Texas) said the bills are designed to ensure the individual and group insurance markets are stable and health insurance premiums don't rise dramatically during the ACA transition.

Democrats have sharply criticized Republicans' plans with Rep. Frank Pallone (D-N.J.), the top Democrat on the committee, saying the GOP's dismantling of the health law will prompt chaos among insurers, providers and patients nationwide.

Trump's hiring freeze could impact FDA

Stakeholders were weighing how President Trump's executive order last week creating a government-wide hiring freeze may impact key federal health agencies like FDA.

Trump's order is in place until the White House's Office of Management and Budget implements a comprehensive plan for reducing the federal workforce. How it impacts FDA is a moving target, including unfilled FDA jobs based on user fee funding, not money appropriated by Congress. It's also not immediately clear whether FDA falls under the "public safety" exemption of the executive order.

OMB is expected, perhaps as soon as this week, to provide agencies with guidance on how to implement the order. The federal Office of Personnel Management also may announce additional guidance.

Incoming HHS Secretary Tom Price would be able to grant exemptions from the order for vacancies that are related to national security or public safety. FDA personnel who work on bioterrorism research may fall under those exceptions, but it's not clear if staff reviewing drug or device applications would be exempt.

The chairmen of the House and Senate Veterans' Affairs committees – Rep. Phil Roe (R-Tenn.) and Sen. Johnny Isakson (R-Ga.), respectively – wrote to Trump last week asking for explicit guidance that filling of positions for VA direct care providers would be exempt from the president's hiring freeze.

House hearing probes Medicaid oversight

A House oversight panel on Tuesday will examine recent government reports on duplication, inefficiency and fraud in Medicaid.

The Government Accountability Office (GAO) said in a report that the Centers for Medicare and Medicaid Services won't be able to rule whether eligibility determinations are being properly met for state Medicaid programs expanded under the ACA.

Witnesses scheduled for the Energy and Commerce oversight subcommittee hearing include Carolyn Yocom, director of GAO's healthcare group; Ann Maxwell, an assistant inspector general at HHS; Paul Howard of the Manhattan Institute; Josh Archambault of the Foundation for Government Accountability; and Timothy Westmoreland, a health law professor at Georgetown University.

Trump rule nixes FDA Hill briefing

FDA last week canceled a congressional staff briefing on the new pharmaceutical and medical device user fee agreements following a Trump administration directive temporarily restricting agencies' external communications.

There was some indication last week that agencies like FDA were interpreting the order more broadly than intended by the White House, which had meant only to freeze agency rulemaking and formal guidance, not routine interaction with Congress or stakeholders.

Pharma companies contacted congressional offices last week seeking assistance in understanding the directive. Staff on Capitol Hill said they were urging the Trump White House to clarify agency latitude on external communications.

Walden to introduce bill on pre-existing conditions

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said he will introduce legislation this week that would require health plans to cover patients with pre-existing conditions.

Republicans oppose the individual mandate, and Walden didn't say how he would maintain the pre-existing coverage requirement without roiling insurance markets.

Last summer Republicans outlined their healthcare plan in broad strokes. Their plan, called "A Better Way," would guarantee people who maintain continuous insurance coverage the ability to purchase coverage at favorable rates regardless of pre-existing conditions. Those who failed to obtain or maintain coverage would be eligible for basic coverage but with higher premiums in state high-risk pools.

Walden didn't say how he would structure his bill or whether it would include federal subsidies to offset the higher premiums for coverage in the high-risk pools. Too small a subsidy would make coverage unaffordable for the sick, but too generous a subsidy would incentivize people to seek insurance only after they become sick.

Senate committee to examine individual insurance markets

The Senate HELP Committee on Wednesday will hold a hearing on the individual insurance markets and policies Congress may consider to stabilize them during the transition from the ACA.

Marilyn Tavenner of America's Health Insurance Plans and Janet Trautwein of the National Association of Health Underwriters are among the witnesses scheduled to testify.

Also testifying before the committee, which is chaired by Sen. Lamar Alexander (R-Tenn.), will be Kentucky Gov. Steve Beshear (R-Ky.) and Julie Mix McPeak, commissioner of the Tennessee Department of Commerce and Insurance.

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