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Tag Archive | "CBO"

Capital Thinking Podcast

This week will begin with the Medicare Advisory and Payment Commission (MedPAC), which advises Congress on Medicare payment policy, releasing its annual March report to Congress.  MedPAC is required to review and make recommendations on payment policies for specific provider groups, such as home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and outpatient dialysis services, among others.  The House Ways and Means Health Subcommittee will hold a hearing on Tuesday and will hear from MedPAC’s Chairman, Glenn Hackbarth.  Additionally, the Senate Finance Committee will hold a hearing in which HHS Secretary Sebelius will testify on lessons learned from health reform during its first year of implementation.

Secretary Sebelius outraged Republican lawmakers last week for writing that the House-passed FY 2011 spending bill, H.R.1, would prohibit the Centers for Medicare and Medicaid Services to use funds to administer payments based on any rate calculated on the basis of the provisions in the Affordable Care Act.  Additionally, she stated that if the bill became law CMS would not have the legal authority to pay Medicare Advantage plans, claims for wellness visits (a new requirement under the health reform law) would not occur, and anti-fraud programs would be halted.  House Ways and Means Chairman Dave Camp and Senate Finance Committee Ranking Member Orrin Hatched called her claims baseless and referred to her letter as a senior scare tactic.

Last week, the Department of Health and Human Services held a press conference call to discuss efforts to support state flexibility in implementing the Affordable Care Act.  HHS and Treasury released a Proposed Rule detailing a process for approval of “State Innovation Waivers” under the Affordable Care Act.  Starting in 2017, States that meet specified standards for providing comprehensive and affordable coverage without increasing the federal budget deficit may be exempted from major requirements of the law.  State flexibility has been a major topic of discussion after several Governors testified on Capitol Hill about their concerns about a lack of flexibility under Medicaid.  Sens. Ron Wyden and Scott Brown introduced a bill, that President Obama has publicly supported, that allows stated to apply for waivers to set up their own health care exchanges, rather than implement the exchange model authorized in the health reform law.

The Congressional Budget Office (CBO) released the latest version of its report on spending and revenue options.  It includes a range of potential targets to offset new spending or reduce the deficit, although most are likely to provoke significant political and/or stakeholder opposition.  Among the health-related provisions of potential interest are proposals to block grant Medicaid long-term care payments; reduce GME funding for teaching hospitals; eliminate the Medicare critical access hospital and sole community hospital programs; impose limits on medical malpractice liability awards; and reduce Medicare payment rates in “high-spending” areas of the country.

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CBO Provides Analysis of ACA Repeal Legislation

Today, the Congressional Budget Office (CBO) sent a preliminary budget analysis of the “Repealing the Job-Killing Health Care Law Act” (H.R. 2) to House Speaker John Boehner.


The CBO estimates that enacting the legislation to repeal the Affordable Care Act would increase the budget deficit by $145 billion over 2012-2019. The repeal would also result in having 32 million fewer nonelderly people being insured in 2019 equating to a total of 54 million nonelderly individuals being uninsured.

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Legal Challenges to Reform Loom

The Congressional Budget Office (CBO) released the score of the health care reform bill with the package of reconciliation fixes. The legislation will cost $940 billion, reduce the deficit by $130 billion over 10 years, and cover 95 percent of Americans.

While political battles still loom in both the House and Senate before health care reform reaches the President’s desk, many are braced for potential legal challenges to reform.

First, the constitutionality of “deem and pass” has been called into question. POLITICO reporter Fred Barbash notes that Supreme Court rulings in 1983 and 1998 held that the only way to enact a law according to the Constitution is to pass a bill through both houses of Congress and have the President sign the legislation.

House Republicans have responded to the discussion of using what has been coined as the “Slaughter Solution” by proposing H. Res. 1188 to ensure an up or down vote on the underlying health care legislation.

In addition, Idaho Governor Butch Otter (R) signed a bill into law yesterday that directs the State Attorney General to file a lawsuit if the health care reform bill enacted by the U.S. Congress includes an individual mandate. As many as 30 other states are considering similar legislation. Even if both Houses pass health care reform legislation prior to the Spring recess, it is clear that the debate on health care reform will not be done.

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Treading on Transparency

House and Senate Leadership have agreed to forgo the formal conference process to reconcile differences in their respective health care reform bills. Rather the House and Senate will engage in a process known as “amendment exchange.”  A detailed report from CRS explains the procedure.

The decision to forgo the conference process means that there will not be a corresponding Conference Report for the final health care reform legislation. Such reports are helpful in clarifying Congressional intent. And while a joint explanatory statement (often called the managers’ statement) can be submitted to the Congressional Record, it is not a required action in the amendment exchange process.

Last December, C-SPAN sent a letter to House and Senate Leadership urging them allow media coverage of negotiations to reconcile the differences in the bills. On January 5, Rep. Chris Van Hollen (D-MD) responded that the health care legislation has been subjected to an increased level of scrutiny.  He indicated that the House will continue to have an open process and continue to inform the public. However, at that time, Congressional Leadership had not made the decision to pursue an amendment exchange strategy to reconcile the bills. Senate Majority Leader Harry Reid (D-NV) has also responded by saying that he is committed to ensuring that the public has an opportunity to review a final bill before its passage. Nonetheless, Republicans (and some Democrats) have continued to call for open negotiations and petitions have gone viral.

House Ways and Means Committee Chairman Charles Rangel (D-NY) indicated his hope to have changes to the bill sent to the Congressional Budget Office by Friday or Saturday.

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