Shutdown Could Create Opportunity to Advance Health Care Policy
The need for lawmakers to fund the government and raise the debt ceiling could create an opportunity for a number of health policy items to move through Congress. Unfortunately, because many congressional staffers are furloughed and not working on new legislation, the odds of advancing legislation to permanently replace the Medicare physician pay formula, known as “SGR,” have become very long. Despite the potential setback on that important issue, Congress may be able to advance other health care-related reforms that have been considered in the past.
Now that they appear to have temporarily abandoned their attempt to defund or delay the Affordable Care Act, look for House Republicans to push the following narrowly targeted health care-related policies as they negotiate with the Obama Administration to raise the debt ceiling and end the partial government shutdown.
Medical device tax repeal. Repeal of the 2.3% excise tax would cost the government $29 billion over 10 years. Although over 70 Senators are now on record in support of repeal, the President has remained opposed. Despite his opposition, many on Capitol Hill believe the Administration would not allow a debt default over a policy so widely supported.
Rebasing Medicaid bonus payments for disproportionate share hospitals. This would merely extend current policy and would not go into effect until 2023. However, since this would generate nearly $4 billion in savings, it is likely to be included in either a debt limit or “doc fix” bill this year or early 2014.
Increased Medicare means-testing. If Congress raised the eligibility age for future Medicare beneficiaries, it would generate significant savings for the program. Thus, it continues to be a policy both sides have supported in some form.
Medical malpractice reform. Republicans have long viewed limits on monetary damages as necessary to reduce overall health care spending. However, they have repeatedly tried to advance medical malpractice reform in the past without success, and the odds of them making significant progress now remain low.
Government Shutdown May Delay CMS, OMB Final Rules
The release of several final regulations, due by the end of October, may be delayed due to the government shutdown. While the home health final rule has moved to the Office of Management and Budget (“OMB”), which is the last stop a regulation makes before being released to the public, the annual physician fee, hospital outpatient and dialysis rules are still at CMS. With much of the CMS and OMB staff furloughed during the partial government shutdown, it is unclear whether these rules will be implemented by the expected date of January 1, 2014. Since rules are subject to a 60-day congressional review period once they are released to the public by OMB, these three would have to be released no later than October 31 in order to take effect as planned.
House Bill Creates “Working Group” to Negotiate Impasse
On October 9, the House passed a bill (H.R. 3273) that would create a bipartisan, bicameral “working group” to begin negotiations on a temporary spending measure to reopen the government and increase the nation’s debt limit.
Under the House proposal, the working group would be tasked with seeking an agreement on overall levels of discretionary spending, raising the debt limit and overhauling direct-spending programs. The group would consist of twenty members of the House and Senate. Speaker John Boehner (R-OH) would appoint ten house members, including four democrats chosen by the House minority leader, and Senate Majority Leader Harry Reid would appoint ten senators, including four Republicans chosen by the Senate Minority leader.
While similar to the 2011 Super Committee, the working group could not report any recommendation unless a majority of the panel members from each chamber supports it. In response, the White House issued a veto threat against the bill and urged the House to instead pass a continuing resolution and debt limit increase with no policy riders attached.
Health Care-Related Bills Introduced This Week
There was no specific health care-related legislation introduced this week. The introduction of all legislation has slowed due to government shutdown-related staff furloughs.
Next Week
Although Congress and the White House are expected to continue negotiating an end to the partial government shutdown and an increase in the debt ceiling over the weekend, it is highly likely the shutdown will continue at least into early next week.
For more information, please contact John F. Williams, III at 317-977-1462 or jwilliams@hallrender.com.
Please visit the Hall Render Blog at http://blogs.hallrender.com for more information on topics related to health care law.
