Marilyn Singleton, MD, JD summarizes recent healthcare-related legislative activity on Capitol Hill.
Senator Mike Lee Takes Bold Step to Repeal ObamaCare
The Washington Post and Freedom Works are reporting on Senator Lee’s plan to force the Senate to take a substantive vote on repealing ObamaCare. If successful, only 51 votes would be needed to proceed on the repeal amendment instead of 60. Lee’s effort ties into the highway funding bill and votes are likely to be taken in a Sunday, July 26th session of the Senate. Freedom Works is urging Americans to ask their Senators to support this plan to repeal ObamaCare.
Bills that Assume the ACA is Here to Stay.
Expansion HSAs under the Affordable Care Act
On July 9, 2015, H.R. 3006, the Helping Save Americans’ Health Care Choices Act was introduced by Rep. John Fleming (R-LA) and referred to the House Ways and Means Committee. The bill would allow the treatment of a high deductible health plan as a qualified health plan under PPACA.
The bill would amend the Affordable Care Act to repeal:
- the 20% penalty for distributions from a health savings account (HSA) or an Archer medical savings account (Archer MSA) not used for qualified medical expenses,
- the prohibition on distributions from an HSA for over-the-counter drugs, and
- the limitation on health flexible spending arrangements under cafeteria plans.
The bill would amend the Internal Revenue Code to allow:
- a retirement savings tax credit for contributions to an HSA;
- payment of premiums for high deductible health plans from an HSA;
- a tax deduction for medical expenses incurred prior to the establishment of an HSA;
- an increase of the HSA maximum allowable contribution amount to match the limit on deductible and out-of-pocket expenses under an HSA;
- an exclusion from gross income of employer-provided coverage for qualified long-term care services that is provided through a flexible spending or similar arrangement;
- eligibility for veterans with a service-connected disability, participants in Tricare, and certain Medicare beneficiaries for participation in an HSA;
- both spouses to make catch-up contributions to the same HSA account; and
- a tax deduction for amounts paid by patients to their primary physician in advance for the right to receive medical services on an as-needed basis.
Full text: https://www.govtrack.us/congress/bills/114/hr3006/text.
Attack on ACA Provisions that Could Ration Care
On July 8, 2015, S. 1718, the Four Rationers Repeal Act of 2015 was introduced by Sen. Pat Roberts (R-KS) and referred to the Senate Finance Committee. The bill would repeal:
- the ACA’s Independent Payment Advisory Board;
- the ACA provisions establishing the Center for Medicare and Medicaid Innovation.
- the provisions with regard to preventive health services that prohibit cost sharing requirements for evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force.
- The ACA requirements that: (1) the Director of the Agency for Healthcare Research and Quality convene an independent Preventive Services Task Force, and (2) the Director of the Centers for Disease Control and Prevention (CDC) convene an independent Community Preventive Services Task Force. Restores provisions of law amended by such provisions.
The bill would prohibit the Secretary of Health and Human Services (HHS) from using data obtained from comparative effectiveness research to deny or delay coverage of an item or service under a federal health care program. It also requires the Secretary to ensure that comparative effectiveness research conducted or supported by the federal government accounts for factors contributing to differences in the treatment response and preferences of patients, including patient-reported outcomes, genomics and personalized medicine, the unique needs of health disparity populations, and indirect patient benefits.
Full text: https://www.govtrack.us/congress/bills/114/s1718/text.
Changes to Medicare
Expanding Government Control Over Medicare Program
On July 14, 2015, H.R. 3061, the Medicare Prescription Drug Price Negotiation Act of 2015 was introduced by Rep. Peter Welch (D-VT) and referred to the House Energy and Ways and Means Committees. The bill would require the Secretary of Health and Human Services (HHS) to negotiate with pharmaceutical manufacturers the prices that may be charged to Medicare part D prescription drug plan (PDP) sponsors and Medicare Advantage (MA) organizations for covered part D drugs for part D eligible individuals who are enrolled under a PDP or under an MA-Prescription Drug (MA-PD) plan.
Full text https://www.govtrack.us/congress/bills/114/hr3061/text.
Medicare Advantage Changes
On June 17, 2015, H.R. 2570, the Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act of 2015 which was introduced by Rep. Diane Black (R-TN) passed the House. The bill combines some issues addressed piecemeal in earlier bills. First, the bill revises criteria for qualifying as a meaningful user of electronic health records (meaningful EHR user). For any payment year after 2015 any patient encounter of an eligible professional occurring at an eligible ambulatory surgical center shall not be treated as one in determining whether an eligible professional qualifies as a meaningful EHR user.
The bill also requires the Department of Health and Human Services (HHS) to establish a three-year demonstration program to test the use of value-based insurance design methodologies under the eligible Medicare Advantage (MA) plans offered by MA organizations under part C (Medicare+Choice Program). “Value-based insurance design methodology” is one for identifying specific prescription medications, and clinical services payable under Medicare, for which copayments, coinsurance, or both would improve the management of specific chronic clinical conditions because of the high value and effectiveness of such medications and services for such specific chronic clinical conditions, as approved by HHS. Hopefully, this will not be a stepping stone to rationing.
Expansion of Medicare Telehealth Services
On July 7, 2015, H.R. 2948, the Telehealth Parity Act of 2015 was introduced by Rep. Mike Thompson (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would expand Medicare coverage of telehealth services. The bill would expand the term “originating site” to include federally qualified health centers and any rural health clinic where the patient is located. The bill authorizes as additional telehealth providers certified diabetes educator or licensed respiratory therapist, audiologist, occupational therapist, physical therapist, or speech language pathologist.
The bill requires the Comptroller General (GAO) to study the effectiveness of remote patient monitoring on decreasing hospital readmissions for specified chronic conditions, and the savings to the Medicare program associated with use of such monitoring.
On July 15, 2015, H.R. 3081, the TELEmedicine for MEDicare Act of 2015” or the “TELE–MED Act of 2015 was introduced by Rep. Devin Nunes (R-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would permit certain Medicare providers licensed in a state to provide telemedicine services to Medicare beneficiaries in a different state. Any disciplinary actions would be under the jurisdiction of the health provider’s licensing state.
Full text: https://www.govtrack.us/congress/bills/114/hr3081/text.
On July 15, 2015, the identical bill in the Senate was introduced by Sen. Mazie Hirano (D-HI) with bipartisan support and referred to the Senate Finance Committee.
Full text: https://www.govtrack.us/congress/bills/114/s1778/text.
Bill to End All Restrictions on Abortion Coverage
On July 8, 2015, H.R. 2972, the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act of 2015 was introduced by Rep. Barbara Lee (D-CA) and 25 co-sponsors and referred to the House Energy and Commerce and Oversight and Government Reform Committees. The bill would overturn the 1976 congressional ban on providing federal funds for abortions. Specifically, the bill would require the federal government to: (1) ensure coverage for abortion care in public health insurance programs including Medicaid, Medicare, and the Children’s Health Insurance Program;
(2) in its role as an employer or health plan sponsor, ensure coverage for abortion care for participants and beneficiaries; and (3) in its role as a provider of health services, ensure abortion care is made available to individuals who are eligible to receive services in its own facilities or in facilities with which it contracts to provide medical care.
The bill would also prohibit any federal or state restrictions on private insurance coverage of abortion care.
On May 21, 2015, S. 1438, the Allowing Greater Access to Safe and Effective Contraception Act was introduced by Sen. Kelly Ayotte (R-NH) and Sen. Cory Gardner (R-CO) and referred to the Senate Finance Committee. The bill would require priority review by the FDA of applications for contraceptive drugs intended for routine use and the drug is intended for those 18 years and older. This would pave the way for over-the-counter hormonal contraceptives.
Is this a Joke?
On July 20, 2015, H.R. 3117, the Fund Essential Menstruation Products Act of 2015 or the FEM Products Act of 2015 was introduced by Rep. Grace Meng (D-NY) and referred to the House Ways and Means Committee. The bill would provide for reimbursement from health flexible spending arrangements for feminine hygiene products, such as tampons, pads, liners, cups, sponges, douches, wipes, sprays, and similar products used by women with respect to menstruation or other genital-tract secretions.
Full text: https://www.govtrack.us/congress/bills/114/hr3117/text.
Bill to Improve Surveillance and Education About Overdoses
Fortunately, the bill does not take the “punish the doctor” approach.
On June 23, 2015, S. 1654, the Overdose Prevention Act was introduced by Sen. Jack Reed (D-RI) and referred to the Senate Health, Education, Labor, and Pensions Committee. The preamble to the bill notes that nearly 44,000 people in the United States died from a drug overdose in 2013. More than 80 percent of those deaths were due to unintentional drug overdoses, and many could have been prevented. Opioid medications such as oxycodone and hydrocodone were involved in nearly 46 percent of all unintentional drug poisoning deaths in 2013.
Accordingly, this bill would require the Substance Abuse and Mental Health Services Administration (SAMHSA) to enter into cooperative agreements to reduce deaths from drug overdoses by: (1) purchasing and distributing naloxone (a medication that rapidly reverses overdose from heroin or other drugs with effects similar to opium) or a similar drug; and (2) educating or training the public, first responders, or health professionals on drug overdose prevention or response. The Centers for Disease Control and Prevention must improve drug overdose surveillance by entering into cooperative agreements to: (1) provide training to improve identification of drug overdose as the cause of death, and (2) establish a national program for reporting drug overdoses. The National Institute on Drug Abuse (NIDA) must prioritize, conduct, and support research on circumstances that contribute to drug overdose, drugs associated with fatal overdose, and overdose prevention methods. NIDA must support research on drug overdose treatments that can be administered by lay persons or first responders.