Health Policy Legislative Update – 10/06/2015

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Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill.

Five Parts of ACA On Path to Be Repealed via Reconciliation

On September 29, 2015, the House Ways and Means Committee passed (23-14) reconciliation legislation to repeal five core parts of the Affordable Care Act: the individual mandate, the employer mandate, the Independent Payment Advisory Board (IPAB), the medical device tax, and the excise tax on high-cost health plans (“Cadillac tax”). This legislation can “dismantle ObamaCare and reach the President’s desk … it repeals two mandates, two taxes and one board of bureaucrats,” explains Chairman Paul Ryan.

Because the House was unable to get any ACA repeal bills to be taken up by the Senate, it is using the reconciliation tool to march the bill to the president’s desk.

“Reconciliation” works like this: In the budget resolution passed by both chambers of Congress earlier this year, three House committees were given instructions for advancing reconciliation legislation. Specifically, each committee—Ways and Means, the Energy and Commerce Committee, and the Education and the Workforce Committee—must produce at least $1 billion in savings each. This week, all three will pass their pieces of reconciliation and report them to the House Budget Committee. The Budget Committee will then put them together before sending one unified reconciliation bill to the floor for the full House to consider.

Video of the House Ways and Means Committee markup discussion and vote on this reconciliation directive conferred by section 2002 of S.Con.Res. 11 is available here: https://youtu.be/F0H_Q-DkXOI

The Citizens’ Council for Health Freedom asks the question: is partial repeal the right gamble? “If Obama plays to win the endgame (Obamacare Forever), the GOP gamble could go sideways. Congress must keep its eye on 2017. They must make sure they don’t lose the public will for repeal — and the chance to send a Republican president a one-page bill like H.R. 132 (King) that repeals Obamacare in just six lines of text!” More at: http://www.cchfreedom.org/cchf.php/1086

Recent Bills that Passed in the House of Representatives

The Defund Planned Parenthood Act of 2015

On September 18, 2015, the House passed H.R. 3134, the Defund Planned Parenthood Act of 2015, introduced in July 2015 by Rep. Diane Black (R-TN). It will now go to the Senate for consideration.

This bill redirects $235 million to Federally Qualified Health centers (FQHCs). The bill prohibits, for a one-year period, the availability of federal funds for any purpose to Planned Parenthood Federation of America, Inc., or any of its affiliates or clinics, unless they certify that the affiliates and clinics will not perform, and will not provide any funds to any other entity that performs, an abortion during such period. Additional funding for community health centers is provided for that one-year period.

The restriction will not apply in cases of rape or incest or where a physical condition endangers a woman’s life unless an abortion is performed.

The Department of Health and Human Services and the Department of Agriculture must seek repayment of federal assistance received by Planned Parenthood Federation of America, Inc., or any affiliate or clinic, if it violates the terms of the certification required by this Act.

Full text: https://www.govtrack.us/congress/bills/114/hr3134/text.

The Born-Alive Abortion Survivors Protection Act

On September 18, 2015, the House passed H.R. 3504, the Born-Alive Abortion Survivors Protection Act, authored by Rep. Trent Franks (R-AZ). It will now go to the Senate for consideration.

This bill strengthens the Born Alive Infants Protection Act of 2002 by imposing criminal penalties for providers who violate it. This bill amends the federal criminal code to require any health care practitioner who is present when a child is born alive following an abortion or attempted abortion to:

(1) exercise the same degree of care as reasonably provided to any other child born alive at the same gestational age, and

(2) ensure that such child is immediately admitted to a hospital.

The term “born alive” means the complete expulsion or extraction from his or her mother, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut.

Also, a health care practitioner or other employee who has knowledge of a failure to comply with these requirements must immediately report such failure to an appropriate law enforcement agency.

An individual who violates the provisions of this Act is subject to a criminal fine, up to five years in prison, or both. An individual who commits an overt act that kills a child born alive is subject to criminal prosecution for murder.

The legislation bars the criminal prosecution of a mother of a child born alive for conspiracy to violate the provisions of this Act, for being an accessory after the fact, or for concealment of felony.

A woman who undergoes an abortion or attempted abortion may file a civil action for damages against an individual who violates this Act.

Full text: https://www.govtrack.us/congress/bills/114/hr3504/text.

The Equitable Access to Care and Health (EACH) Act Expands Religious Exemption to the ACA

On September 28, 2015, the House passed H.R. 2061, the Equitable Access to Care and Health (EACH) Act, introduced by Rep. Rodney Davis (R-IL) to expand the religious liberty exemption to the Affordable Care Act’s individual mandate. It will now go to the Senate for consideration.

This bill amends the Internal Revenue Code to expand the religious conscience exemption under the Patient Protection and Affordable Care Act to exempt individuals who rely solely on a religious method of healing and for whom the acceptance of medical health services would be inconsistent with their religious beliefs from the requirement to purchase and maintain minimum essential health care coverage.

Full text: https://www.govtrack.us/congress/bills/114/hr2061.

The Protecting Affordable Coverage for Employees Act Redefines Small Employer

On September 28, 2015, the House passed H.R. 1624, the Protecting Affordable Coverage for Employees Act, authored by Rep. Brett Guthrie (R-KY) with 235 bipartisan cosponsors. It will now go to the President.

Section 1304 of the Affordable Care Act (ACA) changed the federal definition of the small group insurance market to include employers with 1-100 employees. (Under the ACA, health insurance offered in the small group market must meet certain requirements that do not apply to the large group market, including the requirement to cover the essential health benefits.) The states have been allowed to continue defining the small group market as employers with 1-50 employees until January 1, 2016.

This bill would allow the states to continue defining the small group health insurance market as employers with 1-50 employees and include employers with 51 to 100 employees as large employers for purposes of health insurance markets. The bill would also authorize $205 million for the Medicare Improvement Fund, which was cut by the ACA.

Full text: https://www.govtrack.us/congress/bills/114/hr1624/text.

Bills in the Works

Senate Bill to Repeal the ACA’s Cadillac Tax

On September 17, 2015, S. 2045, the Middle Class Health Benefits Tax Repeal Act of 2015 was introduced by Sen. Dan Heller (R-NV) and referred to the Senate Finance Committee. The bill amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost “Cadillac” plans).

Full text: https://www.govtrack.us/congress/bills/114/hr3513/text

Bills to Provide More Affordable Prescription Medications

Bill to Allow Payment for Imported Prescription Drugs

On July 16, 2015, S. 1790, the Safe and Affordable Prescription Drugs Act of 2015 was introduced by David Vitter (R-LA) and referred to the Health, Education, Labor, and Pensions Committee. The bill would amend the Federal Food, Drug, and Cosmetic Act (FFDCA) to require the Department of Health and Human Services (HHS) to issue regulations within 180 days permitting individuals to import a prescription drug purchased from an approved foreign pharmacy that: (1) is dispensed by a pharmacist licensed in that country; (2) is purchased for personal use in quantities not greater than a 90-day supply; (3) is filled using a valid prescription issued by a physician licensed to practice in the United States; and (4) has the same active ingredient or ingredients, route of administration, dosage form, and strength as a prescription drug approved under the FFDCA. The bill has exceptions, including for controlled substances and biological products.

The bill also establishes a certification process for approving pharmacies in certain foreign countries and requires HHS to publish a list of approved foreign pharmacies.

Full text: https://www.govtrack.us/congress/bills/114/s1790/text

Lowering Medicare Prices through Negotiation, Closing Donut Hole, Rebates, and Transparency

On September 10, 2015, S. 2023, the Prescription Drug Affordability Act of 2015 was introduced by Sen. Bernie Sanders (I-VT) and referred to the Senate Finance Committee. The House companion bill, H.R. 3513 is sponsored by Elijah Cummings (D-MD). The bill would direct the Health and Human Services Secretary to negotiate lower Medicare Part D prices on behalf of Medicare beneficiaries. Nothing in the law would change current formularies. Also private insurers and Medicare Advantage and prescription drug program (PDP) sponsors are not prevented from negotiating on their own.

The bill would also accelerate the closing of the Medicare Part D donut hole from 2020 to 2017. The bill states a “sense of congress” that the United States Trade Representative should not negotiate agreements that would raise the prices of prescription drugs, extend the periods of market exclusivity otherwise available for prescription drugs, or remove flexibility in Federal or State law regarding pricing of prescription drugs.

The bill would also require drug manufacturers to provide drug rebates for drugs dispensed to low-income individuals.

It would require Drug manufacturers to report the following regarding their domestic sales:

  • the total expenditures of the manufacturer on drug research and development and clinical trials; materials and manufacturing; acquisition costs, including costs for the purchase of patents and licensing; and marketing and advertising for the promotion of the drug to consumers and prescribers;
  • the total profit to the manufacturer attributable to such drug;
  • total amount of financial assistance the manufacturer has provided through patient prescription assistance programs with respect to such drug, if any;
  • any Federal benefits received by the manufacturer, including tax credits, grants from the National Institutes of Health, and other Federal benefits with respect to such drug; and
  • any additional information the manufacturer chooses to provide related to drug pricing decisions, such as total expenditures on drug research and development or clinical trials on drugs that failed to receive approval by the Food and Drug Administration.

Full text (Senate): https://www.govtrack.us/congress/bills/114/s2023/text.

Full text (House): https://www.govtrack.us/congress/bills/114/hr3513/text.

From the States:

California Physician Assisted-Suicide Bill Signed Into Law

The San Jose Mercury News reports: “Gov. Jerry Brown on Monday signed the End of Life Option Act. … Brown’s signature concludes a 23-year effort to pass a ‘right-to-die’ law in a state of 39 million, more than quadrupling Americans’ access to life-ending drugs, with one in eight people living in states where it is now legal. California is the fifth state to take such a step, and its implementation of the new law — which will go into effect next year — will be closely watched throughout the nation. Brown, a former Jesuit seminarian, expressed his extensive deliberations over the historic bill.”

Utah Medicaid Expansion

Despite past defeats, the GOP Governor and Legislature are once again working to push through Medicaid Expansion in Utah. One shocking aspect of the latest plan: a new tax on physicians and hospitals. The Governor and House are holding the first open hearing on Tuesday, October 6 to discuss the plans they crafted behind closed doors.

Read More: http://eepurl.com/bAxxyL

“Big Brother” in Raleigh

An AAPS member in NC writes in: “North Carolina Republicans passed a budget which includes a provision requiring Medicaid providers to participate with the NC Health Information Exchange; and to dump clinical and demographic data into the electronic database twice daily. It essentially requires the adoption of electronic health records for Medicaid physicians, and the sharing of these records electronically. Also passed: Medicaid Reform that incorporates Obamacare-style ACO’s into the state Medicaid system.”

Read More: http://www.triadconservative.com/2015/09/big-brother-in-raleigh.html

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