The latest legislative update from Marilyn Singleton, MD, JD:
It has been quiet on the health care scene since the epic fail of the Senate’s half-hearted attempt to pass a “repeal and replace” healthcare bill.
On May 4, 2017 the House passed the American Health Care Act of 2017 (AHCA). The vote was initially scheduled for March 24, 2017 but was cancelled after the House Freedom Caucus pledged to oppose the AHCA because it did not go far enough to repeal the Affordable Care Act. After some revisions the AHCA passed.
The bill then went to the Senate. The Senate released the draft of their version, the Better Care Reconciliation Act of 2017 (BCRA) on June 22nd. A second draft was released on July 13th. Then a vote on a clean repeal failed. On July 28th the Senate voted on the “skinny” repeal amendment, the Health Care Freedom Act, that would have repealed the individual and employer mandates but offered no replacement. That failed. End of discussion.
The Republicans should be embarrassed after promising to “repeal and replace” for the last seven years.
An interactive comparison of the various bills to repeal or reform the Affordable Care Act is available at:
http://www.kff.org/interactive/proposals-to-replace-the-affordable-care-act/.
Single-payer proposal is gaining support
On January 24, 2017, H.R. 676, Expanded & Improved Medicare for All Act, was introduce by Rep. John Conyers (D-MI) and referred to the House Ways and Means and Energy and Commerce Committees. Until now the bill had no newsworthy support but the failure of “repeal and replace” has breathed new life into the push for single payer. As mentioned in previous updates, Conyers has introduced this bill in every session of Congress since 2003.
The Medicare for All Program would provide all individuals residing in the United States and U.S. territories with free health care that includes all “medically necessary” care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
Only public or nonprofit institutions may participate. Nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities may participate.
Patients may choose from participating physicians and institutions.
Health insurers may not sell health insurance that duplicates the benefits provided under this bill. Insurers may sell benefits that are not medically necessary, such as cosmetic surgery benefits.
The bill sets forth methods to pay institutional providers and health professionals for services. Financial incentives between HMOs and physicians based on utilization are prohibited.
The program is funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill.
The program must give employment transition benefits and first priority in retraining and job placement to individuals whose jobs are eliminated due to reduced clerical and administrative work under this bill.
The Department of Health and Human Services must create a confidential electronic patient record system.
The bill establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
The Indian Health Service must be integrated into the program after five years. Congress must evaluate the continued independence of Department of Veterans Affairs health programs.
Full text: https://www.govtrack.us/congress/bills/115/hr676/text.
“Improvements” to the ACA
Federal Reinsurance
On July 19, 2017, H.R. 3311, the Individual Health Insurance Marketplace Improvement Act, was introduced by Rep. James Langevin (D-RI) and referred to the House Ways and Means and Energy and Commerce Committees. This bill would establish an Individual Market Reinsurance fund to provide funding for State individual market stabilization reinsurance programs. Health insurers would be reinsured by the federal government with respect to high-cost individuals enrolled in qualified health plans offered by such issuers that are not grandfathered health plans or transitional health plans for any plan year beginning with the 2018 plan year. A “high-cost individual” is an individual enrolled in a qualified health plan (other than a grandfathered health plan or a transitional health plan) who incurs claims in excess of $50,000 during a plan year.
Full text: https://www.govtrack.us/congress/bills/115/hr3311/text.
Insurance Across State Lines
On Jul 12, 2017, S. 1546, the Commonsense Competition and Access to Health Insurance Act, was introduced by Sen. Mark Warner (D-VA) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would amend the ACA to provide greater flexibility in offering health insurance coverage across State lines. The bill directs the HHS Secretary to request that the National Association of Insurance Commissioners submit a report with models for providing insurance across state lines.
Full text: https://www.govtrack.us/congress/bills/115/s1546/text
Tax Deduction for Health Insurance Premiums
On July 18, 2017, H.R. 3277 was introduced by Rep. Andy Biggs (R-AZ) and referred to the House Ways and Means Committee. This bill would amend the Internal Revenue Code to allow an individual taxpayer a deduction from gross income of insurance premiums paid for the health care coverage of the taxpayer and the taxpayer’s spouse and dependents. The bill makes the deduction available whether or not the taxpayer itemizes other deductions.
Full text: https://www.govtrack.us/congress/bills/115/hr3277/text.
Tax Deduction for Medical Expenses
On May 24, 2017, H.R. 2647, the Deducting Expenses Derived from Use of Care and Treatment Act (DEDUCT Act), was introduced by Rep. James Sensenbrenner (R-WI) and referred to the House Ways and Means Committee. This bill amends the Internal Revenue Code to repeal the requirement that unreimbursed medical expenses exceed 10% of a taxpayer’s adjusted gross income before the taxpayer is allowed to claim an itemized deduction for the expenses.
Full text: https://www.govtrack.us/congress/bills/115/hr2647/text.
HSAs for Health Sharing Ministries
On May 3, 2017, H.R. 2310, the Faith in Health Savings Accounts Act of 2017, was introduced by Rep. Mike Kelly (R-PA) and referred to the House Ways and Means Committee. This bill would amend the Internal Revenue Code to treat membership in a tax-exempt health care sharing ministry as coverage under a high deductible health plan for purposes of the tax deduction for contributions to a health savings account.
Full text: https://www.govtrack.us/congress/bills/115/hr2310/text.
Mandatory Continuing Education in Opiate Prescribing
On July 13, 2017, S. 1554, the Safer Prescribing of Controlled Substances Act, was introduced by Sen. Edward Markey (D-MA) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill would required training in opiate prescribing as a condition of granting or renewing the registration of a covered practitioner under this part to dispense, or conduct research with, controlled substances in schedule II, III, IV, or V.
The training would include (A) best practices for pain management, including alternatives to prescribing controlled substances and other alternative therapies to decrease the use of opioids; (B) responsible prescribing of pain medications, as described in the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain; (C) methods for diagnosing, treating, and managing a substance use disorder, including the use of medications approved by the Food and Drug Administration and evidence-based nonpharmacological therapies; (D) linking patients to evidence-based treatment for substance use disorders; and (E) tools to manage adherence and diversion of controlled substances, including prescription drug monitoring programs, drug screening, informed consent, overdose education, and the use of opioid overdose antagonists. The government must provide at least one training module that is online and free of charge.
Full text: https://www.govtrack.us/congress/bills/115/s1554/text.
