Marilyn Singleton, M.D., J.D. summarizes health policy related bills under consideration in Congress.
Diverse Support for the IPAB’s Repeal
Earlier this year both houses of Congress introduced bills to repeal the ACA’s Independent Payment Advisory Board (IPAB). The House bill is sponsored by Reps. Phil Roe, M.D. (R-TN) and Linda Sánchez (D-CA) and has 222 co-sponsors, including 19 Democrats.
The IPAB consisting of 15 unelected unaccountable bureaucrats has not yet been empaneled by the president. If IPAB members are not appointed by the President, or IPAB does not act to cut Medicare spending within the law’s required timeframe, the board’s powers are automatically shifted to the HHS Secretary.
On May 5, 2015, over 500 organizations signed a letter to Congress urging the IPAB’s repeal. The letter began by noting, “an unelected board without adequate oversight or accountability would be taking actions historically reserved for the public’s elected representatives in the U.S. House and Senate.”
The letter further stated, “[The IPAB] would be devastating for patients, affecting access to care and innovative therapies. Already, the number of physicians unable to accept new Medicare patients due to low reimbursement rates has been increasing over the past several years (with almost one of every three primary care physicians, according to the American Medical Association, restricting the number of Medicare patients in their practice). IPAB-generated payment reductions would only increase the access difficulties faced by too many Medicare beneficiaries. Furthermore, payment reductions to Medicare providers will almost certainly result in a shifting of health costs to employers and consumers in the private sector.”
The signatories include multiple national and state physician organizations, including the American Medical Association; varied patient advocacy groups, including multiple AIDS groups, Arthritis Foundation, Easter Seals, National Alliance on Mental Illness, National Minority Quality Forum; national and local Chambers of Commerce; several major pharmaceutical companies, several AIDS groups, and the Vietnam Veterans of America.
Full text of letter on Dr. Roe’s congressional website: http://roe.house.gov/news/documentsingle.aspx?DocumentID=397856.
Tinkering on the Edges of the ACA
A Bill to Ensure Washington Suffers Equally in the ACA
On April 22, 2015, H.R. 1953, No Exemption for Washington from Obamacare Act was introduced by Rep. Ron DeSantis (R-FL) and referred to the House Energy and Commerce and House Administration Committees. The bill would add “political appointees” to the ACA requirement that “Members of Congress and congressional staff” be enrolled in health plans created under the ACA or offered through an Exchange established under the ACA. Additionally, no Member of Congress, a congressional staff member, the President, the Vice President, or a political appointee under this provision may receive a subsidy or tax credit, or reduced cost sharing.
Full text: https://www.govtrack.us/congress/bills/114/hr1953/text.
Bill to Repeal the Core Provisions of the ACA
On April 20, 2015, S. 1016, the Preserving Freedom and Choice in Health Care Act was introduced by Sen. Ron Johnson (R-WI) and referred to the Senate Finance Committee. The bill would provide for the following:
- Repeal the ACA’s individual mandate.
- Repeal the ACA’s employer mandate.
- Modify the ACA’s premium assistance credit so that it applies to the Federal exchanges until 2017 should King v Burwell conclude the ACA’s subsidies do not currently apply to Federal exchanges.
- Grandfather previous health plans. Allows individuals and employers to maintain the insurance coverage in place on the date of the ACA’s enactment as well as add their families and new employees to such coverage.
- Redefine “Essential health benefits package” as coverage, benefits and cost sharing required by the State in which a health plan is offered.
Full text: https://www.govtrack.us/congress/bills/114/s1016/text.
Bill to Give Some Discretion to the States with the Employer Mandate
On April 27, 2015, S. 1099, the Protecting Affordable Coverage for Employees Act (PACE Act) was introduced by Sen. Tim Scott (R-SC) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would amend the ACA to redefine a small employer as a 50 rather than less than 100 employees. The bill also gives States flexibility to determine the size of employers in the small group market ranging from 1 to 100 employees.
Full text: https://www.govtrack.us/congress/bills/114/s1099/text.
Bill to Repeal “Cadillac Tax”
On April 28, 2015, H.R. 2050, the Middle Class Health Benefits Tax Repeal Act of 2015 was introduced by Rep. Joe Courtney (D-CT) and referred to the House Ways and Means Committee. The bill would repeal the excise tax on high cost employer-sponsored health coverage (the ‘Cadillac tax”).
Full text: https://www.govtrack.us/congress/bills/114/hr2050/text.
An Additional ACA Religious Exemption
On April 28, 2015, H.R. 2061, the Equitable Access to Care and Health Act” (EACH Act) was introduced by Rep. Rodney Davis (R-IL) and referred to the House Ways and Means Committee. The bill would add another religious exemption for purposes of the ACA’s individual mandate. The ACA currently uses the standard IRS exemption, i.e., a member of a recognized religious sect or division thereof and is an adherent of established tenets or teachings of such sect or division by reason of which he is conscientiously opposed to acceptance of the benefits of any private or public insurance which makes payments in the event of death, disability, old-age, or retirement or makes payments toward the cost of, or provides services for, medical care (including the benefits of any insurance system established by the Social Security Act) (26 U.S.C. 1402(g)(1)).
The bill would add an exemption for “those who rely solely on a religious method of healing, and for whom the acceptance of medical health services would be inconsistent with the religious beliefs of the individual.” Medical health services does not include routine dental, vision, and hearing services, midwifery services, vaccinations, necessary medical services provided to children, services required by law or by a third party.
Full text: https://www.govtrack.us/congress/bills/114/hr2061/text.
Transition Plan if ACA Coverage is Lost under King v. Burwell
On March 4, 2015, S. 673, the Winding Down ObamaCare Act was introduced by Sen. Benjamin Sasse (R-NE) and referred to the Senate Finance Committee. The bill would provide COBRA-like transitional coverage to persons who would lose their coverage if the decision in King v. Burwell results in the enrollee losing coverage under the plan or making the enrollee ineligible to receive a tax credit with respect to such plan. (This would occur if the Supreme Court decides that the ACA’s subsidies do not apply to Federal exchanges.)
- The benefits must be the same as the prior coverage unless coverage is later modified under the plan for any group of similarly situated enrollees.
- The premiums cannot exceed 100 percent of the current premium, cannot increase during the coverage continuation period, and may be paid in monthly installments.
- The coverage will be for 18 months.
- Persons electing this coverage may receive a tax credit.
Full text: https://www.govtrack.us/congress/bills/114/s673/text.
Miscellanous Bills to Lessen the Sting of Federal Rules
Bill to Delay ICD-10
On April 30, 2015, H.R. 2126, the Cutting Costly Codes Act of 2015 was introduced by Rep. Ted Poe (R-TX) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would delay the implementation of the ICD-10 until the Comptroller General of the United States, in consultation with representatives of the medical community, conducts a study to identify steps that can be taken to mitigate the disruption on health care providers resulting from a replacement of ICD–9.
Full text: https://www.govtrack.us/congress/bills/114/hr2126/text.
Bill to Remove Cap on Flexible Savings Account Contributions
May 1, 2015, H.R. 2207, the Flexible Spending Account Act (FSA Act) was introduced by Rep. Mimi Walters (R-CA) and referred to the House Ways and Means Committee. The bill would repeal the dollar limitation on contributions to flexible spending accounts.
Full text: https://www.govtrack.us/congress/bills/114/hr2207/text.
Expansion of Federal Control via the FDA: “Medical Devices” Would Include EHRs
On April 27, 2015, S. 1101, the Medical Electronic Data Technology Enhancement for Consumers’ Health Act (MEDTECH Act) was introduced by Sen. Michael Bennett (D-CO) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would make it clear that the FDA’s regulation of medical “devices” does not include the regulation of certain medical software. This includes:
- Software that is intended for administrative and operational support of a health care facility or the processing and maintenance of financial records, appointment schedules, business analytics, communication, information about patient populations, and laboratory workflow processes; and
- Software that is intended for the purpose of maintaining or encouraging a healthy lifestyle and are unrelated to the diagnosis, cure, mitigation, prevention, or treatment of a disease or disorder. It does include software that analyzes or interprets imaging or laboratory data, electronic patient records, to the extent that such records are intended to transfer, store, convert formats, or display the equivalent of a paper medical chart and were created, transferred, or reviewed by a medical professional or persons supervised by a medical professional.
Full text: https://www.govtrack.us/congress/bills/114/s1101/text.
Expansions to Medicare Coverage
Recreational Therapy as a Covered Rehabilitation Therapy.
On April 21, 2015, H.R. 1906, the Access to Inpatient Rehabilitation Therapy Act of 2015 was introduced by Rep. Glenn Thompson (R-PA) and referred to the House Ways and Means Committee.
The Centers for Medicare & Medicaid Services uses an “intensity of therapy” requirement to determine which Medicare beneficiaries are appropriate for treatment in an inpatient rehabilitation hospital or unit. CMS uses the “Three Hour Rule” (42 C.F.R. 412.622(a)(3)(ii)) which requires the patient to be able to participate in three hours of rehabilitation therapy per day, five days per week, or 15 hours of rehabilitation therapy over a one-week period.
The current post-January 2010 rule limits the Three Hour Rule to only four services: physical, occupational, and speech therapy as well as orthotics and prosthetics. This bill would expand the qualifying services to those defined in the pre-January 2010 rule which allowed “other therapeutic modalities” that were determined by the physician and the rehabilitation team to count toward the satisfaction of the Rule. The bill specifically cites recreational therapy to be included as an “intensity of therapy” service.
Full text: https://www.govtrack.us/congress/bills/114/hr1906/text.
Coverage for Needle Disposal Equipment
On April 23, 2015, S. 1066, the Medicare Safe Needle Disposal Coverage Act was introduced by Sen. John Isakson (R-GA) and referred to the Senate Finance Committee. The bill would amend Medicare Part D (the Voluntary prescription Drug Benefit Program) to cover any devices approved for home use by the Food and Drug Administration (FDA) for the safe and effective containment, removal, decontamination, and disposal of home-generated needles, syringes, and other sharps through a sharps container, decontamination/destructive device, or sharps-by-mail program or similar program.
Full text: https://www.govtrack.us/congress/bills/114/s1066/text.
Coverage for Treatment During Colonoscopies
On April 27, 2015, H.R. 2035, the Supporting Colorectal Examination and Education Now Act of 2015 (SCREEN Act) was introduced by Rep. Richard Neal (D-MA) and referred to the House Energy and Commerce and on Ways and Means Committees. The bill would:
- Maintain 2015 Medicare reimbursement rates for colonoscopies for “providers” participating in colorectal cancer screening quality improvement registry.
- Eliminate Medicare beneficiary cost-sharing for certain colorectal cancer screenings, colorectal cancer screenings with therapeutic effect, and follow-up diagnostic colorectal cancer screenings covered under Medicare regardless of the code that is billed for the establishment of a diagnosis as a result of the screening test, for the removal of tissue or other matter during the screening test, or for a follow-up procedure that is furnished in connection with, or as a result of, the initial screening test.
- Waive the deductible with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the screening test, for the removal of tissue or other matter during the screening test, or for a follow-up procedure that is furnished in connection with, or as a result of, the initial screening test.”
- Fund a Medicare demonstration project to evaluate the effectiveness of a pre-operative visit prior to screening colonoscopy and hepatitis C screening.
- The bill requires budget neutrality in its implementation and would do so by adjusting the physician payment.
Full text: https://www.govtrack.us/congress/bills/114/hr2035/text.
