Marilyn Singleton, MD, JD summarizes the health policy related legislation introduced in February 2015:
There were several more attempts to dismantle the Affordable Care Act in the last few weeks.
On February 3, 2015, H.R. 596, the bill To repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010, after being introduced by Rep. Bradley Byrne (R-AL) on January 28, 2015. This bill repeals the Patient Protection and Affordable Care Act, effective as of its enactment. The bill also instructs committees in the House to come up with replacement legislation that: (1) foster economic growth and private sector job creation; (2) lower health care premiums through increased competition and choice; (3) preserve a patient’s ability to keep their health plan if they like it; (4) provide people with preexisting conditions access to affordable health coverage; (5) reform the medical liability system to reduce unnecessary health care spending; (6) increase the number of insured Americans; (7) protect the doctor-patient relationship; (8) provide states greater flexibility to administer Medicaid programs while reducing costs; (9) expand incentives to encourage personal responsibility for health care coverage and costs; (10) prohibit taxpayer funding of abortions and provide conscience protections for health care providers; (11) eliminate duplicative government programs and wasteful spending; or (12) do not accelerate the insolvency of entitlement programs or increase the tax burden on Americans.
The CBO was unable to prepare an estimate of the budgetary impact of the legislation because “there are hundreds of provisions in the laws that would be repealed and those provisions are in various stages of implementation.”
Full text: https://www.govtrack.us/congress/bills/114/hr596/text.
On January 13, 2015, S. 149, the Medical Device Access and Innovation Protection Act was introduced by Sen. Orrin Hatch (R-UT) and referred to the Senate Committee on Finance. This bill would repeal the excise tax on medical devices.
Full text: https://www.govtrack.us/congress/bills/114/s157/text.
On January 13, 2015, S. 158, the Employee Health Care Protection Act of 2015 was introduced by Sen. Bill Cassidy, M.D. (R-LA) and referred to the Senate Committee on Health, Education, Labor, and Pensions. This is an identical bill that was passed by the House in September 2014, H.R. 3522. The bill permits a health insurance issuer that has in effect health insurance coverage in the group market on any date during 2013 to continue offering such coverage for sale through 2018 outside of a health care exchange established under the ACA. Such coverage is treated as a grandfathered health plan for purposes of an individual meeting the requirement to maintain minimum essential health coverage.
Full text: https://www.govtrack.us/congress/bills/114/s158/text.
January 13, 2015, S. 157, the No Obamacare Mandate Act was introduced by Sen. Bill Cassidy, M.D. (R-LA) and referred to the Senate Committee on Finance. This 3-page bill repeals the ACA’s medical device tax, and the employer and individual mandates.
Full text: https://www.govtrack.us/congress/bills/114/s157/text.
On January 14, 2015 H.R. 370, a bill to repeal the Patient Protection and Affordable Care Act and health-care related provisions in the Health Care and Education Reconciliation Act of 2010 was introduced by Rep. John Fleming (R-LA). The bill was referred to the House Committee on Appropriations, House Committee on Education and the Workforce, and 7 other committees which will consider it before sending it to the House floor for consideration.
Full text at: https://www.govtrack.us/congress/bills/114/hr370/text.
On January 20, 2015, H.R. 420, the Obamacare Opt-Out Act of 2015 was introduced by Rep. David Schweikert (R-AZ) and referred to the House Ways and Means Committee. The bill would establish a certification process for individuals to request an exemption through a health care marketplace or on their federal income tax return from the minimum essential coverage requirements under the ACA. Senator John McCain introduced an identical bill, S. 121 in the senate.
Full text: https://www.govtrack.us/congress/bills/114/hr420/text.
On January 21, 2015, S. 203, the American Liberty Restoration Act was introduced by Sen. Orrin Hatch (R-UT) and referred to the Senate Finance Committee. The 2-page bill would repeal the federal mandate to purchase insurance.
Full text: https://www.govtrack.us/congress/bills/114/s203/text.
On January 21, 2015, S. 215, the Child and Dependent Care FSA Enhancement Act was introduced by Sen. Richard Burr (R-NC) and referred to the Senate Committee on Finance. The bill would amend the Internal Revenue Code to increase the amount of employer-provided dependent care assistance that an employee may exclude from gross income to $7,500. The bill also would allow an annual inflation adjustment to such increased amount after 2016.
On January 26, 2015, S. 254, Small Business Health Relief Act of 2015 was introduced by Sen. Rob Portman (R-OH) and referred to the Senate Finance Committee. This bill repeals provisions of the ACA that: (1) impose fines on large employers (those with more than 50 full-time employees) who fail to offer their full-time employees the opportunity to enroll in minimum essential health insurance coverage, and (2) require such large employers to file a report with the Secretary of the Treasury on health insurance coverage provided to their full-time employees. The bill also repeals ACA provisions that: (1) set limits on the annual deductible on health plans offered in the small group market, (2) allow catastrophic plans to be offered in the individual market to individuals under the age of 30, and (3) impose an annual fee on health insurance entities. The bill allows high deductible health plans to meet essential health benefits coverage requirements if the enrollee has established a health savings account. The bill repeals (1) restrictions on payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements; (2) the limitation to $2,500 of annual salary reduction contributions by an employee to a health flexible spending arrangement under a cafeteria plan. The bill allows a health plan to maintain its status as a grandfathered health plan regardless of any modification to the cost-sharing levels, employer contribution rates, or covered benefits.
Full text: https://www.govtrack.us/congress/bills/114/s254/text.
On February 2, 2015, S. 336, the ObamaCare Repeal Act was introduced by Sen. Ted Cruz (R-TX) and referred to the Senate Finance Committee. This One-page bill repeals the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 entirely.
Full text: https://www.govtrack.us/congress/bills/114/s336/text.
On February 3, 2015, H.R. 683, the Prevent IRS Overreach Act of 2015 was introduced by Rep. Randy Forbes (R-VA) and referred to the House Ways and Means Committee. The bill prohibits the Internal Revenue Service (IRS) from filling any position, by transfer or any other appointment taking effect on or after its enactment, if the duties and responsibilities of such position include the enforcement of any provision of, or amendment made by, the Patient Protection and Affordable Care Act or the Health Care and Education Reconciliation Act of 2010.
Full text: https://www.govtrack.us/congress/bills/114/hr683/text.
On February 4, 2015 U.S. Senator Richard Burr (R-NC), Senate Finance Chairman Orrin, Hatch (R-UT), and House Energy and Commerce Chairman Fred Upton (R-MI) re-issued a legislative proposal to replace the ACA. The proposal – which was originally issued in January 2014 – is called the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act.
The Patient CARE Act provides a legislative roadmap to fully repeal the President’s health care law, known as Obamacare, and replace the law with measures that would:
- Establish sustainable, patient-centered reforms:
- Adopt common-sense consumer protections;
- Create a new protection to help Americans with pre-existing conditions;
- Empower small business and individuals with purchasing power;
- Empower states with more tools to help provide coverage while reducing costs; and
- Expand and strengthen consumer directed health care.
- Modernize Medicaid to provide better coverage and care to patients:
- Transition to capped allotment to provide states with predictable funding and flexibility; and
- Reauthorize Health Opportunity Accounts to empower Medicaid patients.
- Reduce unnecessary defensive medicine practices and rein in frivolous lawsuits
- Increase health care price transparency to empower consumers and patients:
- Reduce distortions in the tax code that drive up health care costs by capping the exclusion of an employee’s employer-provided health coverage.
More detailed information: http://www.finance.senate.gov/newsroom/ranking/release/?id=5cebe1e1-963f-4a4d-b613-0bd5aa0f2e3a.
On February 11, 2015, H.R. 879, a bill to repeal the “Cadillac Tax” on middle class Americans’ health plans was introduced by Rep. Frank Guinta (R-NH) and referred to the House Ways and Means Committee.
Full text: https://www.govtrack.us/congress/bills/114/hr879/text.
Here are some bills that chip away at the employer and individual mandates.
On January 21, 2015, H.R. 440, the Helping Individuals Regain Employment Act was introduced by Rep. Charles Boustany, M.D. (R-LA) and referred to the House Ways and Means Committee. This bill would exclude from the definition of “full-time employee,” for purposes of the employer mandate to provide minimum essential health care coverage, any individual who is a long-term unemployed individual. The bill defines “long-term unemployed individual” as an individual who begins employment after enactment of this Act and has been unemployed for 27 weeks or longer. The aim is to not let the ACA discourage employers from adding new employees.
Full text: https://www.govtrack.us/congress/bills/114/hr440/text.
On January 22, 2015, H.R. 520: Student Job Protection Act of 2015 was introduced by Rep. Michael Turner (R-OH) and referred to the House Ways and Means Committee. The bill would exclude students who are employed by an institution of higher education (IHE) and carrying what the school considers a full-time academic workload from being counted as full-time employees in calculating the IHE’s shared responsibility regarding health care coverage under the ACA.
Full text: https://www.govtrack.us/congress/bills/114/hr520/text.
On January 22, 2015, H.R. 519, the Healthcare Tax Relief and Mandate Repeal Act was introduced by Rep. Michael Turner (R-OH) and referred to the House Ways and Means Committee. This bill would repeal the ACA’s employer and individual health insurance mandates.
Full text: https://www.govtrack.us/congress/bills/114/hr519/text.
On February 3, 2015, S. 352, Equitable Access to Care and Health Act (the EACH Act) was introduced by Sen. Kelly Ayotte (R-NH) and referred to the Senate Finance Committee. The bill would allow an additional religious exemption from the ACA’s minimum essential health care coverage requirements for individuals whose sincerely held religious beliefs would cause them to object to medical health care provided under such coverage. “Medical health care” means voluntary health treatment by or supervised by a medical doctor that would be covered under minimum essential coverage that: (1) includes voluntary acute care treatment at hospital emergency rooms, walk-in clinics, or similar facilities; and (2) excludes (a) treatment not administered or supervised by a medical doctor, such as chiropractic treatment, dental care, midwifery, personal care assistance, or optometry, (b) physical examinations or treatment where required by law or third parties, such as a prospective employer, and (c)vaccinations.
Full text: https://www.govtrack.us/congress/bills/114/s352/text.
H.R. 1814, the identical bill was passed by the House on March 11, 2014 but was never passed by the Senate. https://www.govtrack.us/congress/bills/113/hr1814/text.
On February 10, 2015, S. 432, the Small Business Fairness in Health Care Act was introduced by Sen. Michael Enzi (R-WY) and referred to the Senate Finance Committee. This bill would (1) exempt a small business concern, as defined by the Small Business Act, from the PPACA employer mandate to provide employees with minimum essential health care coverage; and (2) redefine “full-time employee,” for purposes of such mandate, as an employee who is employed on average at least 40 (currently, 30) hours a week.
Full text: https://www.govtrack.us/congress/bills/114/s432/text.
On February 12, 2015, S. 470, a bill to exempt elementary and secondary schools, any local or State educational agency, and institutions of higher learning from the ACA’s employer health insurance mandate was introduced by Sen. John Thune (R-ND) and referred to the Senate Finance Committee.
Full text: https://www.govtrack.us/congress/bills/114/s470/text.
On February 12, 2015, H.R. 954, a bill to exempt individuals who had coverage under a terminated qualified health plan funded through the Consumer Operated and oriented Plan (CO-OP) program was introduced by Rep. Adrian Smith (R-NE) and referred to the House Ways and Means Committee. CO-OPs are a new type of non-profit health insurer type that was created by the Affordable Care Act (section 1322). CO-OP Health Plans can operate locally, statewide, or across multiple states, and will be able to offer health plans inside or outside health insurance exchanges (marketplaces). These health plans are run by their members and are designed to offer both affordable health insurance and more options to individuals and families and small businesses. Initially, these could be funded by small loans from the federal government. These loans were halted due to the “fiscal cliff” negotiations.
Full text: https://www.govtrack.us/congress/bills/114/hr954/text.
Here is a bill to provide health care for all residents of the United States.
On February 3, 2015, H.R. 676, the Expanded & Improved Medicare For All Act was introduced by Rep. John Conyers (D-MI) and referred to the House Energy and Commerce and Ways and Means Committees.
The bill would establishes the Medicare for All Program to 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. The bill prohibits for-profit institutions from participating, and prohibits private health insurers from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits. The program would be paid for (1) from existing sources of government revenues for health care; (2) by increasing personal income taxes on the top 5% income earners; (3) by instituting a modest and progressive excise tax on payroll and self-employment income; (4) by instituting a modest tax on unearned income; and (5) by instituting a small tax on stock and bond transactions.
Full text: https://www.govtrack.us/congress/bills/114/hr676/text.
There were several bills designed to assist Medicare beneficiaries but the bills’ implementation would surely add to the debt.
On January 13, 2015 H.R. 290, the Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015 was introduced and referred to the House Ways and Means Committee by Rep. James Renacci (R-OH). The bill would eliminate the 3-day prior hospitalization requirement for Medicare coverage of extended care services in qualified skilled nursing facilities. This would help mitigate the current problem of patients treated in the emergency room with the popular prolonged “observation” status who need extended care for the condition treated.
Full text: https://www.govtrack.us/congress/bills/114/hr290/text.
On January 14, 2015, H.R. 380, the Medicare Identity Theft Prevention Act of 2015 was introduced by Rep. Sam Johnson (R-TX) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would prevent inclusion of Social Security numbers on Medicare cards.
Full text: https://www.govtrack.us/congress/bills/114/hr380/text.
On February 5, 2015, H.R. 795, the Medicare Payment Rate Disclosure Act of 2015 was introduced by Rep. Bill Huizenga (R-MI) and referred to the House Energy and Commerce and Ways and Means Committees.The bill would make publicly available on the official Medicare Internet site Medicare payment rates for frequently reimbursed hospital inpatient procedures, hospital outpatient procedures, and physicians’ services.
Full text: https://www.govtrack.us/congress/bills/114/hr795/text.
On February 5, 2015, H.R. 775, the Medicare Access to Rehabilitation Services Act of 2015 was introduced by Charles Boustany, M.D. (R-LA) with multiple bipartisan sponsors and referred to the House Energy and Commerce and Ways and Means Committees. The bill would repeal the caps on Medicare outpatient rehabilitation physical therapy services and speech-language pathology services.
Full text: https://www.govtrack.us/congress/bills/114/hr775/text.
On February 9, 2015, H.R. 818, the Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 (“PRIME Act of 2015”) was introduced by Rep. Peter Roskam (R-IL) and referred to the House Energy and Commerce and Ways and Means Committees. The provisions are lengthy but worth reading. Point number (7) illustrates the extent of government intrusion into private information in the name of health care.
The bill would (1) prohibit sponsors of prescription drug plans from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug’s prescriber; (2) requires the annual report regarding recovery audit contractors to describe and prioritize improper payment vulnerabilities and ways to address them; (3) requires HHS to retain an additional 5% of the recovered amounts to be made available to the HHS Inspector General to investigate improper payments or audit internal controls associated with Medicare or Medicaid payments; (4) requires HHS to develop an incentive program to encourage reporting of fraud and abuse; (5) appropriates funds for additional staff (currently 100 more needed) whose sole duty is to protect the integrity of the Medicare and Medicaid programs; (6) requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges; (7) give CMS access to information in the National Directory of New Hires in connection with the federal Child Support and Establishment of Paternity program to determine the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program under the ACA; (8) directs HHS to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program).
Full text: https://www.govtrack.us/congress/bills/114/hr818/text.
On February 11, 2015, H.R. 876, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) was introduced by Rep. Lloyd Doggett (D-TX) and referred to the House Ways and Means and House Energy and Commerce Committees. The bill would require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification which (1) explains the individual’s status as an outpatient under observation (or any similar status) and not as an inpatient; (2) explains the reason for that classification; (3) explains the implications of that outpatient status on eligibility for Medicare coverage of items and services as well as cost-sharing requirements; (4) includes the name and title of the hospital staff who gave an oral notification and its date and time; and (5) is signed by individual, if the notification is written, to acknowledge its receipt, or if such individual refuses to sign, the written notification is signed by the staff of the hospital who presented it.
Full text: https://www.govtrack.us/congress/bills/114/hr876/text.
On February 12, 2015, S. 484, the Preserving Access to Targeted, Individualized, and Effective New Treatments and Services (PATIENTS) Act of 2015 or the “PATIENTS Act of 2015” was introduced by Sen. Pat Roberts (R-KS). The bill would prohibit the data used from comparative effectiveness research to deny or delay coverage of services or items under federal health care programs. The bill also would 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/s484/text.
Some bills that directly affect physicians.
On February 11, 2015 H.R. 887, the Electronic Health Fairness Act of 2015 was introduced by Rep. Diane Black (R-TN) and referred to the House Energy and Commerce and Ways and Means Committees. This bill addresses problems with the HITECH Act of 2009 which did not cover ambulatory surgical centers. Meaningful EHR use means the health care professional must use EHR in 50 per cent or more of their patient encounters. Thus, physicians with patient encounters in an ambulatory surgical center are at a disadvantage when attempting to meet meaningful use requirements because there currently is not certified EHR technology for such centers.
Full text: https://www.govtrack.us/congress/bills/114/hr887/text.
On February 12, 2015, S. 488 was introduced by Sen. Chuck Schumer (D-NY) and referred to the Senate Finance Committee. This bill would allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs.
Full text: https://www.govtrack.us/congress/bills/114/s488/text.
