As we enter the second month of the 115th Congress, Marilyn Singleton, MD, JD is out with her review of the latest medical care related proposals on Capitol Hill, from full ACA repeal to Medicare for all and everything in between.
Full Repeal of the Affordable Care Act
On January 9, 2017, 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. Bill Flores (R-TX) and referred to the House Appropriations, House Committee on Education and the Workforce Committee, and 7 other committees. The bill would repeal the Patient Protection and Affordable Care Act and the health care provisions of the Health Care and Education Reconciliation Act of 2010. The repeal is effective on January 1, 2020. Provisions of law amended by the repealed provisions are restored.
The budgetary effects of this bill must not be entered on the PAYGO scorecards maintained by the Office of Management and Budget.
Full text: https://www.govtrack.us/congress/bills/115/hr370/text.
On January 12, 2017, S. 106, the ObamaCare Repeal Act, was introduced by Sen. Ted Cruz (R-TX) and referred to the Senate Finance Committee. The bill repeals the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 and restores provisions of law amended by those Acts, effective January 1, 2018.
Full text: https://www.govtrack.us/congress/bills/115/s106/text.
Some of the Latest “Replacement” Plans and News
We mentioned Sen. Rand Paul’s “ObamaCare Replacement Act” in our last update, and since then the full bill, S. 222, has been released. Read a summary here and the full text here.
Rep. Darrell Issa appears to be set to reintroduce his “Access to Insurance for All Americans Act.” It was know as H.R. 138 in the 114th Congress and would “offer Federal employee health benefits plans to individuals who are not Federal employees.”
Senators Cassidy and Collins are back with S. 191, the “Patient Freedom Act of 2017.” It would be a partial repeal tied to provisions that allow states to keep ACA on a state-by-state basis or fund state-based market-oriented reforms.
Amid the replacement plans there are reports that the GOP is shifting from “Repeal and Replace” to “Repair” as well as reminders that, “Yes, We Can Repeal Every Word of ObamaCare.”
Also there’s talk of extending the repeal time frame and discussion about how soon-to-be HHS head Dr. Tom Price “will have plenty of room to singlehandedly shift health care toward a free-market system… .”
Changes to the Affordable Care Act
There is much repetition in these bills. It seems everyone wants to get in on the ACA changes. What this telegraphs is that the ACA will likely not be repealed any time soon.
On January 10, 2017, H.R. 407, the Tax Free Health Insurance Act of 2017, was introduced by Rep. Steve King (R-IA) and referred to the House Ways and Means Committee. The 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/hr407/text.
On January 12, 2017, H.R. 499, the 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, and 2 other committees. The bill amends the Patient Protection and Affordable Care Act to extend the requirement for participation in a health insurance exchange to the President, Vice President, executive branch political appointees, and employees of congressional committees and leadership offices of Congress. Currently, this requirement applies to Members of Congress and their staff.
The government is prohibited from contributing to or subsidizing the health insurance coverage of officials and employees subject to this requirement
Full text: https://www.govtrack.us/congress/bills/115/hr499/text.
On January 13, 2017, H.R. 521, Protection from Insurance Exchange Monopolies Act, was introduced by Rep. Mark Amodei (R-NV) and referred to the House Ways and Means Committee. This one page bill would amend the Internal Revenue Code of 1986 to provide an exemption to the individual mandate to maintain health coverage for individuals residing in counties with fewer than two health insurance issuers offering plans on an Exchange.
Full text: https://www.govtrack.us/congress/bills/115/hr521/text.
On January 13, 2017, H.R. 537, Budget Process Accountability Act, was introduced by Rep. Andy Biggs (R-AZ) and referred to the House Energy and Commerce and House Administration Committees, and 2 other committees. The bill would amend the Internal Revenue Code to exempt individuals from the requirement to maintain minimum essential health care coverage if they reside in a county where fewer than two health insurers offer insurance on the health insurance exchange. This bill amends the Patient Protection and Affordable Care Act to extend the requirement for participation in a health insurance exchange to the President, Vice President, executive branch political appointees, and employees of congressional committees and leadership offices of Congress. Currently, this requirement applies to Members of Congress and their staff.
The government is prohibited from contributing to or subsidizing the health insurance coverage of officials and employees subject to this requirement
Full text: https://www.govtrack.us/congress/bills/115/hr537/text.
On January 13, 2017, H.R. 563, the Unaffordable Care Act, was introduced by Rep. Luke Messer (R-IN) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code to exempt from the requirement to maintain minimum essential health coverage an individual who: (1) resides in a location with fewer than two qualified health plans offered through an exchange established under the Patient Protection and Affordable Care Act, or (2) was covered under minimum essential coverage for the last month of the preceding year and the premium is at least 125% percent of the premium for that month.
Full text: https://www.govtrack.us/congress/bills/115/hr563/text.
On January 24, 2017, H.R. 633, the Patient Fairness and Relief Act of 2017, was introduced by Rep. Gregg Harper (R-MS) and referred to the House Energy and Commerce and House Ways and Means Committees. The bill would authorize health insurance issuers to continue to sell health insurance coverage that was offered in the individual market before the enactment of the Affordable Care Act in satisfaction of the minimum essential health benefits.
Full text: https://www.govtrack.us/congress/bills/115/hr633/text.
On January 24, 2017, H.R. 661, the Employee Fairness and Relief Act of 2017, was introduced by Rep. Brett Guthrie (R-KY) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would authorize health insurance issuers to sell previously available health insurance coverage in the small group market in satisfaction of the minimum essential health insurance coverage requirement.
Full text: https://www.govtrack.us/congress/bills/115/hr661/text.
On January 13, 2017, H.R. 562, Obamacare Regressive Tax Relief Act, was introduced by Rep. Luke Messer (R-IN) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code of 1986 to return the penalty to 1 percent of the excess of the taxpayer’s household income that is above the yearly tax filing requirement (gross income of at least $10, 350 (individuals), $20,700 (married filing jointly). Currently the law increased the penalty to 2.5 percent as of 2015.
Full text: https://www.govtrack.us/congress/bills/115/hr562/text.
On January 17, 2017, S. 147, the Obamacare Taxpayer Bailout Prevention Act, was introduced y Sen. Marco Rubio (R-FL) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill repeals the provision of the Patient Protection and Affordable Care Act that directs the Department of Health and Human Services to establish a program of risk corridors for 2014, 2015, and 2016 under which qualified health plans must participate in a payment adjustment system based on the ratio of a plan’s allowable costs to its premiums. (Qualified health plans are sold on health insurance exchanges, are the only plans eligible for premium subsidies, and fulfill an individual’s requirement to maintain minimum essential coverage.)
Full text: https://www.govtrack.us/congress/bills/115/s147/text.
On January 27, 2017, H.R. 710, the Health Coverage State Flexibility Act of 2017, was introduced by Rep. Bill Flores (R-TX) and referred to the House Ways and Means Committee. The bill amends the ACA to better align the grace period required for non-payment of premiums before discontinuing coverage with the grace periods provided for under State law.
Full text: https://www.govtrack.us/congress/bills/115/hr710/text.
Independent Payment Advisory Board (IPAB)
On February 1, 2017, S.J. Res. 16 regarding the Independent Medicare Advisory Board was introduced by Sen. Ron Wyden (D-OR) and referred to the Senate Finance Committee. The resolution approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act.
The resolution also requests that Congress approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board.
Full text: https://www.govtrack.us/congress/bills/115/sjres16/text.
On February 1, 2017, S.J. Res. 17 regarding the Independent Medicare Advisory Board was introduced by Sen. John Cornyn (R-TX) ad referred to the Senate Finance Committee. (Exact wording as S.J. Res 16). The resolution approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act.
The resolution also requests that Congress approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board.
Full text: https://www.govtrack.us/congress/bills/115/sjres17/text.
On January 31, 2017, H.J. Res 51 regarding the Independent Medicare Advisory Board was introduced by Rep. David Roe (R-TN) and referred to the House Energy and Commerce and Ways and Means Committees. Exact wording as S.J. Res 16). The resolution approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act.
The resolution also requests that Congress approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board.
Full text: https://www.govtrack.us/congress/bills/115/hjres51/text.
Health Savings Accounts
On January 4, 2017, S. 28, the Health Savings Account Expansion Act of 2017, was reintroduced by Sen. Jeff Flake (R-AZ). The House companion bill, H.R. 247 was introduced by Rep. Dave Brat (R-VA). This bill amends the Internal Revenue Code to modify the requirements for health savings accounts (HSAs) to increase the maximum contribution amounts, permit the use of HSAs to pay health insurance premiums and direct primary care expenses, repeal the restriction on using HSAs for over-the-counter medications, eliminate the requirement that a participant in an HSA be enrolled in a high deductible health care plan, and decrease the additional tax for HSA distributions not used for qualified medical expenses.
Full text (Senate): https://www.govtrack.us/congress/bills/115/s28/text
Full text (House): https://www.govtrack.us/congress/bills/115/hr247/text
On January 10, 2017, S. 85, the Restoring Access to Medication Act of 2017, was introduced by Sen. Pat Roberts (R-KS) and referred to the Senate Finance Committee. The sister bill in the House, H.R. 394, was introduced on January 10th by Rep. Lynn Jenkins (R-KS) and referred to the House Ways and Means Committee. These bills would repeal provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs).
Full text (Senate): https://www.govtrack.us/congress/bills/115/s85/text.
Full text (House): https://www.govtrack.us/congress/bills/115/hr394/text.
Contraception/Abortion-Related
On January 13, 2017, H.R. 7, the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2017, was introduced by Rep. Christopher Smith (R-NJ). The bill passed in the House on January 24, 2017 and goes to the Senate next for consideration. Title I–Prohibiting Federally Funded Abortions (Sec. 101). This section makes permanent the prohibition on the use of federal funds, including funds in the budget of the District of Columbia, for abortion or health coverage that includes abortion. The prohibitions in this bill, and current prohibitions, do not apply to abortions in cases of rape or incest, or where a physical condition endangers a woman’s life unless an abortion is performed.
Abortions may not be provided in a federal health care facility or by a federal employee.
Title II–Application under the Affordable Care Act (Sec. 201). This section amends the Internal Revenue Code and the Patient Protection and Affordable Care Act to prohibit qualified health plans from including coverage for abortions. (Qualified health plans are sold on health insurance exchanges, are the only plans eligible for premium subsidies and small employer health insurance tax credits, and fulfill an individual’s requirement to maintain minimum essential coverage.) Currently, qualified health plans may cover abortion, but the portion of the premium attributable to abortion coverage is not eligible for subsidies.
Sec. 202 revises notification requirements for qualified health plans regarding abortion coverage and charges for abortion coverage.
In the 114th Congress, similar legislation (H.R.7) passed the House by a vote of 242-179.
Full text: https://www.govtrack.us/congress/bills/115/hr7/text.
On January 10, 2017, S. 93, Allowing Greater Access to Safe and Effective Contraception Act was introduced by Sen. Joni Ernst (R-IA) and referred to the Senate Finance Committee. The sister bill, H.R. 421 was introduced by Rep. Mia Love (R-UT) and referred to the House Energy and Commerce and Ways and Means Committees.
This bill requires the Food and Drug Administration (FDA) to prioritize review of supplemental drug applications (applications to modify the approved use of a drug) for contraceptive drugs intended for routine use that would be available to individuals aged 18 and older without a prescription. The FDA must waive user fees for such supplemental drug applications. Any drug that is eligible for this priority review must be a prescription drug for individuals under age 18.
This bill repeals provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 to allow health savings accounts and health flexible spending accounts (HFSAs) to be used to pay for medicine without a prescription and to remove the limit on salary reduction contributions to a HFSA under a cafeteria plan, effective as if the provisions had never been enacted.
Full text (Senate): https://www.govtrack.us/congress/bills/115/s93/text.
Full text (House): https://www.govtrack.us/congress/bills/115/hr421/text.
Medicaid
On January 6, 2017, H.R. 352, State Health Flexibility Act of 2017, was introduced by Rep Todd Rokita (R-IN) and referred to the House Appropriations, House Committee on Education and the Workforce Committee, and 6 other committees. The bill amends the Social Security Act (SSAct) to replace federal requirements for Medicaid and the Children’s Health Insurance Program (CHIP) with health care block grants to states. A state may use block grant funds to: (1) provide health care services to indigent individuals; (2) fund risk adjustment mechanisms for the purpose of subsidizing the cost of private health insurance for the high-risk population; and (3) support other welfare-related programs, as specified by the bill.
In addition to repealing titles XIX (Medicaid) and XXI (CHIP) of the SSAct, the bill repeals: (1) the Patient Protection and Affordable Care Act, and (2) the Health Care and Educational Reconciliation Act of 2010.
With respect to an alien not lawfully admitted for permanent residence in the United States, a state may use grant funds to provide only emergency health care services, as specified by the bill.
The bill limits the authority of any federal agency to supervise a state’s use of funds received under the block grant program.
Full text: https://www.govtrack.us/congress/bills/115/hr352/text.
Changes to Medicare
On January 5, 2017, S. 41, Medicare Prescription Drug Price Negotiation Act of 2017, was introduced by Sen. Amy Klobuchar (D-MN) and referred to the Senate Finance Committee. This bill amends title XVIII (Medicare) of the Social Security Act to require the Centers for Medicare & Medicaid Services (CMS) to negotiate with pharmaceutical companies regarding prices for drugs covered under the Medicare prescription drug benefit. Current law prohibits CMS from doing so.
Full text: https://www.govtrack.us/congress/bills/115/s41/text.
On January 10, 2017, H.R. 409, the Putting Patients and Providers Ahead of Compressed Regulatory Timelines Act of 2017, was introduced by Rep. Steve King (R-IA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would amend title XVIII (Medicare) of the Social Security Act to eliminate provider penalties for failure to comply with electronic health records (EHR) use requirements.
Under current law, certain hospitals, Medicare Advantage organizations, and professionals participating in Medicare are subject to negative payment adjustments if they fail to comply with established requirements for EHR use. The bill eliminates these penalties and requires the Centers for Medicare & Medicaid Services to reimburse such providers for payments that they would have received within a specified timeframe had such penalties not been applied.
Full text: https://www.govtrack.us/congress/bills/115/hr409/text.
On January 10, 2017, H.R. 410, Protecting Life Until Natural Death Act, was introduced by Rep. Steve King (R-IA) and referred to the House Energy and Commerce and House Committee on Ways and Means Committees. The bill amends title XVIII (Medicare) of the Social Security Act to exclude from Medicare coverage advanced planning services, with the exception of certain hospice-related services that may include advising on end-of-life or advanced care planning.
Full text: https://www.govtrack.us/congress/bills/115/hr410/text.
On January 12, 2017, H.R. 508, Seniors Have Eyes, Ears, and Teeth Act of 2017, was introduced by Rep. Lucille Roybal-Allard (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill amends title XVIII (Medicare) of the Social Security Act to expand Medicare coverage to include eyeglasses, hearing aids, and dental care.
Full text: https://www.govtrack.us/congress/bills/115/hr508/text.
On January 27, 2017, H.R. 707, the Health Care Choices for Seniors Act, was introduced by Rep. Marsha Blackburn (R-TN) and referred to the House Energy and Commerce and House Ways and Means Committees. The bill amends title II (Old Age, Survivors, and Disability Insurance) (OASDI) of the Social Security Act to require the Department of Health and Human Services (HHS) to establish the Medicare Alternative Voucher (MAV) Program, under which a voucher may be used as a contribution into a health savings account and for the payment of enrollment premiums under a high-deductible health plan. HHS must establish a procedure under which an individual otherwise entitled to Medicare benefits may waive such entitlement and be automatically enrolled in the MAV Program.
Additionally, the bill amends the Internal Revenue Code to increase the amount of the deduction from gross income for health savings accounts by the amount of the MAV that is contributed to an individual’s health savings account.
The bill also suspends Medicare late enrollment penalties for an individual between ages 65 and 70.
Full text: https://www.govtrack.us/congress/bills/115/hr707/text.
Medicare for All!?
On January 24, 2017, H.R. 676, the Expanded and Improved Medicare for All Act, was reintroduced by Rep. John Conyers (D-MI) and referred to the House Energy and Commerce and Natural Resources Committees. Conyers has introduced this bill in every session of Congress since 2003.
This bill aims to establish 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.
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.
