Supreme Court Decision Due Next Week
The U.S. Supreme Court issued a series of opinions on June 18 and June 21 but did not release the health care ruling. Monday is the last official opinion day on the court calendar, though it appears the court could hand down additional rulings as late as next Thursday (June 28). Check the Supreme Court blog on Monday around 10 AM EST for the next batch of opinions.
Below is a brief analysis of the three most likely outcomes for the health care decision:
Entire Law Is Upheld: This will mean the only chance to overturn the law would be through Congress. Republicans would have to defeat the President in November as he has stated he would veto any attempt to overturn the law. Republicans would also have to maintain control of the House and most likely gain control of the Senate.
Entire Law Is Struck Down: This would likely be a result of the individual mandate being declared un-severable. Should this occur, everything from the individual mandate to state exchanges will be scrapped. Congress would be forced to deal with provisions of the law that already are in effect. Businesses, trade groups and health providers will reengage with lawmakers as the groundwork is laid for health care reform in 2013 and beyond.
Individual Mandate Is Struck Down: Were the Court to maintain the law but strike the requirement for most Americans to purchase insurance, the next steps are less certain. The insurance industry would most likely be impacted, which then could affect hospitals and other health providers dealing with the uninsured. Business groups and providers would attempt to work with Republican lawmakers to repeal other provisions of the law.
MedPAC Releases Annual Report to Congress
The Medicare Payment Advisory Commission (“MedPAC”) released their 2012 report to Congress on June 15. Though the MedPAC recommendations do not always translate into legislation, they drive health policy on the Hill with much of the report usually appearing in proposals addressing health spending.
The June report recommended that Congress provide federal health officials more discretion to change parts of the Medicare benefit. Those changes include altering deductibles for hospital and physician services, caps on out-of-pocket expenses, additional charges for supplemental Medigap coverage and replacing coinsurance with copayments.
Altogether, MedPAC estimates their recommendations could reduce overall Medicare spending up to 0.5% if enacted by Congress.
Final Passage of FDA User Fee Bill Likely Next Week
On Wednesday, the House passed a five-year reauthorization of the FDA’s user fee programs. The bill would reauthorize the FDA’s ability to collect user fees for its prescription drugs and medical device approval process. The legislation is expected to help stabilize the FDA review process with modifications to enhance predictability and speed up review times. The Senate is expected to take up and pass the House bill as early as Monday.
HHS Announces More Community Health Center Grants
On Wednesday, HHS announced another $128.6 million in federal grants will go to 219 community health centers. Eligible applicants for the grants include public or nonprofit private entities that meet health center funding requirements. The funding stems from the health care law that allocated $9.5 billion to be used to build new clinics and expand health services. To date, more than $2 billion has been awarded. A listing of the grant awardees, their locations and amounts awarded can be found here.
AMA and AHA Differ on Hospital Governing Board Issue
In a sharp split from the American Hospital Association’s (“AHA”) call for CMS to revisit its conditions of participation requirement that at least one member of a hospital’s medical staff be part of the governing board, the American Medical Association (“AMA”) pressed CMS this week to keep the requirement on the premises that including a medical staff member is essential to delivering quality patient care.
Late last Friday, CMS sent a memo to state survey agencies that said hospitals are not responsible for meeting the requirement when the final rule it was a part of becomes effective on July 16 and that it will revisit the matter in future rulemaking. Thus, Medicare hospital accreditation programs are encouraged not to revise their standards until further notice from CMS. While AHA issued a statement saying it was pleased CMS has chosen not to enact this provision of the final rule, AMA said in its own letter to CMS that patients would be “astonished and appalled” to learn that in some cases medical staff would be precluded from being involved in governing the hospital where they were receiving care.
Bill for a New Medicare Physician Pay System Being Drafted
Two members of the House Doctors Caucus are circulating draft legislation to create a new Medicare payment system for doctors. Representatives Tom Price (R-GA) and Charles Boustany (R-LA) circulated their 27-page draft bill that includes a five-year period where physician payments would be updated annually while a new reimbursement system is created. The members are also seeking comments from health industry stakeholders. There is no timetable for introducing the legislation.
Legislation
The following health care-related bills were introduced this week:
- H.R. 5979: Introduced by Rep. Bill Cassidy (R-LA), the bill would set the federal government’s share of every state’s Medicaid expenditures at 74.18% (which is currently the highest of any state) and would determine federal payment to state Medicaid programs based on a risk-adjusted per capita calculation in four categories of Medicaid beneficiaries. The bill is unlikely to move this year but could be included in future entitlement reform legislation.
- H.R. 5994: Introduced by Rep. Devin Nunes (R-CA) the bill would create a demonstration program under which Medicare and Medicaid beneficiaries are provided a choice of health benefits coverage and access to a debit style card for the purpose of purchasing qualified health benefits coverage.
Next Week
The House is in Tuesday through Friday next week and should take up the Agriculture and Transportation spending bills. The House could also vote on legislation surrounding the expected Supreme Court decision. The Senate will be in all week and is expected to finalize the FDA user fee bill on Monday.
For more information, please contact John F. Williams, III at 317.977.1462 or jwilliams@hallrender.com.
