United States: Capitol Hill Healthcare Update - September 18, 2017

Graham, Cassidy Push Last-Ditch Effort on ACA Repeal

Republican senators pushing a last-ditch effort to overhaul the Affordable Care Act (ACA) say they are within one vote of having the support needed to pass their bill.

Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) said they would continue to push for a vote this month before the expiration of fast-track reconciliation legislation that allows Republicans to pass the bill on a party-line vote. The senators' bill would repeal the ACA's individual and employer mandate penalties and transform the law's Medicaid expansion into a trillion-dollar block grant for states, mostly by redirecting funding from states that expanded their Medicaid programs to those that did not.

Although not all of the 52 Senate Republicans have publicly announced their position on the bill, Cassidy said he has 49 commitments to back his legislation. Republicans would need only one more vote before Vice President Mike Pence could cast the tie-breaking vote.

Sen. Rand Paul (R-Ky.) announced last week that he would oppose the bill, and Sen. Susan Collins (R-Maine) has expressed reservations because it would block Planned Parenthood from receiving federal reimbursements. Sen. John McCain (R-Ariz.), who brought down the GOP leadership's last ACA repeal effort in July, declined to say how he would vote on Cassidy-Graham but said Sunday he preferred bipartisan legislation. Sen. Lisa Murkowski (R-Alaska) is a potential wildcard but shares Collins' concern over Planned Parenthood funding.

The Congressional Budget Office (CBO) must produce a detailed economic analysis of the bill – including its cost and coverage impact – before a Senate vote. Majority Leader Mitch McConnell (R-Ky.) has called on the CBO to accelerate its score of the bill, but that process could take weeks to complete.

Another process hurdle facing Cassidy and Graham is that the filibuster-proof protection of the reconciliation legislation expires September 30. That means if the Senate approves the bill this month, the House would have to pass it without any changes for it to go to the White House for President Trump's signature. Any House changes to the bill would trigger another Senate vote – and any Senate vote after September 30 would allow Democrats to block the bill with a filibuster.

One Republican Senate aide actively working on the bill said "everything would have to go right" for a Senate vote this month.

House Exploring Adding Other Health Items to CHIP Renewal

With Senate leaders agreeing to the outlines of a five-year reauthorization of the Children's Health Insurance Program (CHIP), House Republicans are exploring whether legislation to renew the popular program can be used to carry other healthcare provisions.

Key House lawmakers are weighing whether to include repeal of the Independent Payment Advisory Board and suspension of the 2.3 percent excise tax on medical device manufacturers. Also under consideration is a host of mostly narrow bipartisan Medicare provisions advanced by the House Ways and Means Committee.

The House's interest in a larger legislative package around CHIP does not guarantee it will occur. Senate Finance Committee staff say they would be open to a larger effort but want the House to propose specifics.

A larger CHIP legislative package also would likely increase its cost, with Energy and Commerce Committee staff saying they're looking at an overall of cost of between $20 billion and $30 billion over 10 years. Potential offsetting pay-fors include extending the Medicare sequester and changes to the prescription drug Medicaid rebate for line extensions, or new formulations. Also discussed have been changes to the 340B prescription drug program, including a two-year moratorium on new entities joining the program and tightening certain program definitions.

House and Senate committee leaders want Congress to act before CHIP technically expires on September 30, but they acknowledge most states will have adequate funding to carry them into December if Congress fails to authorize CHIP this month.

ACA Stabilization Could Be Introduced This Week

Leaders on the Senate HELP Committee may introduce legislation as soon as this week to stabilize insurance premiums in the ACA's individual markets.

The outlines of the agreement would extend the ACA's cost-sharing reduction payments to insurers to subsidize premiums for individuals while also providing states with increased flexibility to approve coverage plans. The waiver details are not settled and Democrats warn they will object to waivers that allow states to undermine the ACA's protections and coverage mandates.

Committee Chairman Lamar Alexander (R-TN) hopes to have a bill ready prior to this month's deadline for insurers to finalize their 2018 plans, but that timing is uncertain.

While there is bipartisan support on the committee to extend the insurance payments, Republicans want greater state waiver flexibility than Democrats are likely to approve. Senate Finance Committee Chairman Orrin Hatch (R-Utah) is another hurdle to reaching agreement as his committee has jurisdiction over some of the policy Alexander would include in his legislation.

Hatch Wants Details on Elder Abuse in Nursing Homes

The Chairman of the Senate Finance Committee is questioning whether the U.S. Department of Health and Human Services (HHS) will take enforcement action after an independent report revealed widespread elder abuse in federally funded nursing homes.

HHS's inspector general last month found injuries to 134 Medicare patients that may have been the result of abuse and neglect at long-term care facilities. Orrin Hatch (R-Utah) wrote to HHS Secretary Tom Price last week seeking more details and asking whether the department would change its procedures on reporting elder abuse or take enforcement actions.

The inspector general report found CMS is not enforcing a requirement that nursing homes notify employees of their obligation to report reasonable suspicions of a crime, including elder abuse.

Senate Trying To Pass Chronic Care Legislation

Senate leaders are gauging whether there is support to approve a package of chronic care legislation, including expanding Medicare's coverage of telehealth services.

The bill, which won unanimous approval in May in the Senate Finance Committee, would make it easier for private Medicare plans and accountable care organizations to offer telemedicine services. It would also expand a current program for house calls for the elderly and allow for reimbursement of home dialysis treatment.

Senate leaders are trying to "hotline" the bill, which would allow approval by unanimous consent. Budget Committee Chairwoman Diane Black (R-Tenn.) has introduced a separate chronic care bill in the House.

Democrats Seek Details from CMS on Drug Reimbursement

A group of House Democrats is seeking information from the Centers for Medicare & Medicaid Services (CMS) on the agency's agreement with Novartis for a "money-back guarantee" of the company's newly approved CAR-T immunotherapy treatment.

When Novartis won FDA approval this month for its drug Kymriah to treat an aggressive form of leukemia in children, Novartis and CMS announced that the company would not receive reimbursement if a patient failed to respond to the treatment.

Rep. Lloyd Doggett (D-Texas) and several other House Democrats are asking CMS to reveal details of the agreement, including whether the federal government would pay the full $475,000 price of the treatment if a patient relapsed, the criteria used to evaluate a successful treatment and who ultimately would judge that criteria.

House Lawmaker Drafting Medical Device Cyber Bill

Draft legislation circulating in the House would establish a working group at the National Institute for Standards and Technology to recommend voluntary frameworks and guidelines to increase cybersecurity for medical devices. Rep. Dave Trott (R-Mich.) is drafting the House legislation but it is not clear when a bill will be introduced. Other medical device cyber legislation is under development in the Senate.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions