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December 2017


December 22, 2017

Healthcare Today is taking a break for the holidays, and will return January 5th. We wish everyone good health and the happiest of holidays!

The House and Senate passed the conference report on the tax bill this week sending it to the President for his signature on Thursday afternoon. The final version of the tax bill repeals the individual mandate from the Affordable Care Act as anticipated. The final bill also preserved the tax-exempt status of private activity bonds many hospitals use to finance construction, and the deduction for medical expenses not only remained intact but its threshold was lowered from 10% of a person’s income to 7.5%. The final significant health provision in the bill was scaling back the Orphan Drug Tax Credit from 50% of qualified testing expenses to 25%.

After completing work on the tax bill and with only a couple of days before the continuing resolution expired, Congress turned their attention to the remaining items on the agenda including many expiring provisions. There was a wide divergence of opinions of how to resolve year-end issues in the House Republican Conference further delaying work on the wrap-up package. Early in the morning of December 21st, details emerged from the House on what was the last legislative package agreed to by the Congress.

This package is the bare minimum of actions Congress needed to complete before heading home for the holidays. The House package included the following:

  • A continuing resolution to keep the government open until January 19th;
  • Additional funding for some high priority defense needs such as missile defense and repairs to the damaged Naval ship;
  • A short-term extension of the Children’s Health Insurance Program (CHIP);
  • Short-term extensions of a limited number of other health programs (Community Health Centers, National Health Service Corps, Teaching Health Centers that Operate GME programs, and Special Diabetes Programs);
  • A provision to avoid budget sequestration from the tax bill implications on the deficit; and
  • Continuation of the Foreign Intelligence Surveillance Act (FISA).

There were many priority items that were not able to get into this package that will require quick action in January before the funding expires on the 19th. The priority items excluded from the package include the following:

  • Medicare Extenders
  • Full Reauthorization of CHIP
  • Funding for Medicaid in Puerto Rico
  • Tax Extenders
  • DREAMERS/DACA

These items will be in line for the next appropriation measure Congress will need to pass before January 19th. It is looking to be a busy month of January sorting through all this unfinished business.

  • GOP includes $2.8B for children’s health-care funding in stopgap bill – The Hill (Dec 21)
    “House Republicans have included $2.85 billion to extend funding for the Children’s Health Insurance Program (CHIP) in a stopgap spending measure intended to prevent a government shutdown on Saturday. The funding provides money for CHIPthrough the end of March as the GOP faces criticism from Democrats, who argued Republicans were prepared to leave town without extending a program that provides support for 9 million children across the country.”
  • McConnell: ‘We’ll probably move on’ from Obamacare repeal in 2018 – Politico (Dec 21)
    “Senate Majority Leader Mitch McConnell on Thursday said he wants the Senate to move past Obamacare repeal in 2018 in favor of stabilizing insurance markets and to other issues, prompting a backlash from one of the Senate’s most prominent advocates of repeal and an ally of President Trump. The Kentucky Republican told NPRthat the passage of the GOP’s tax overhaul, which also repealed the individual mandate, effectively “takes the heart out of Obamacare.” He gave a nod to a new attempt at Obamacare repeal – which the Senate tried unsuccessfully several times over the summer.”
  • No, Trump didn’t repeal Obamacare. But he may regret claiming as much. – Washington Post (Dec 21)
    “In the throes of his superlative-filled praise of the Republicans’ tax bill, President Trump said this Wednesday: “We essentially repealed Obamacare.” It is not true — and it could also have been a major political blunder for Trump and Republicans. Republicansdid pass a tax bill Wednesday that undoes one of the central components of Obamacare: the mandate that people have health insurance, or pay a fine. Health-care experts say that does not mean Obamacare is dead. It is just in trouble — and by extension, so are the health-insurance markets that have framed their business model around the law.”
  • CDC releases grim new opioid overdose figures: ‘We’re talking about more than an exponential increase’ – Washington Post (Dec 21)
    “The national opioid epidemic escalated in 2016, driven by an unprecedented surge in deaths from fentanyl and other synthetic opiates, according to new data released today by the Centers for Disease Control and Prevention. More than 42,000 Americans died of opioid overdoses in 2016, a 28 percent increase over 2015. The number of people fatally overdosing on fentanyl and other synthetic opiates more than doubled, from 9,580 in 2015 to 19,413 in 2016. Deaths due to heroin were up nearly 20 percent, and deaths from other opiate painkillers, such as hydrocodone and oxycodone, were up 14 percent.”

December 15, 2017

We’re heading into our favorite time of year as we near the holidays, but there is still so much to do in Washington. It’s our hope that next week will be the last week of the session before the end of the year, but nothing is very certain at this point. There’s a lot of moving parts in the healthcare world; we’ve taken a closer look below.

The tax bill is expected to be filed this afternoon at 5:30pm. We hear repeal of the individual mandate from the Affordable Care Act will remain in the bill, but details about the deduction for health care expenses and the status of private activity bonds are hard to come by. The latest rumor is that the House will vote on the bill Tuesday morning, with the Senate vote occuring later the same day.

The House is sending a package to the Senate to keep the government open beyond December 22nd that consists of: the full defense appropriations bill; a continuing resolution for the rest of the government until January 19th; the CHIP reauthorization bill that passed the House previously; and a provision to wipe the pay-as-you-go scorecard clean to avoid sequestration being triggered. Enough Democratic Senators have expressed their intention to not support that bill that we know it cannot pass the Senate. We expect the Senate will likely amend the bill to make it a CR until January 19th for both defense and non-defense spending with a CHIP reauthorization that both sides can support. There are many other possible policy provisions floating out there, including Medicare extenders, so it is possible more will be added to the package in the Senate.

Thanks to this abundance of uncertainty, many Members of Congress are not yet booking flights home. We hope they wrap all of this up next week – even if it takes them until next Friday.

  • Lawmakers battle Trump, PhRMA on discount drug rule – The Hill (Dec 14)
    “Lawmakers in both parties are seeking to block the Trump administration’s changes to a Medicare drug discount program, arguing it would have a negative impact on hospitals that serve low-income people. A rule from the Centers for Medicare and Medicaid Services (CMS) slated to go into effect on Jan. 1 would result in $1.6 billion in cuts to “safety net” hospitals that serve a significant number of low-income patients under the so-called 340B drug discount program.”
  • New CDC head faces questions about financial conflicts of interest – Washington Post (Dec 11)
    “After five months in office, President Trump’s new director of the Centers for Disease Control and Prevention has been unable to divest financial holdings that pose potential conflicts of interest, hindering her ability to fully perform her job. Brenda Fitzgerald, 71, who served as the Georgia public health commissioner until her appointment to the CDC postin July, said she has divested from many stock holdings. But she and her husband are legally obligated to maintain other investments in cancer detection and health information technology, according to her ethics agreement, requiring Fitzgerald to pledge to avoid government business that might affect those interests. Fitzgerald provided The Post with a copy of her agreement.”
  • Obamacare’s Individual Mandate: On Its Way Out, or Already Gone? – WSJ (Dec 10)
    “But some experts say the impact of undoing the so-called individual mandate might not be as devastating to the ACA as was thought a few years ago. Rising premiums mean more people are exempt from the insurance requirement, and exceptions or exemptions granted during the Obama administration have also reduced the number of people obligated to get coverage. Others say the penalty was never big enough to persuade a critical mass of people to buy insurance, so repealing it might not cripple the individual health-insurance market.”
  • Democrats rip ‘highly partisan’ bill to fund children’s insurance – The Hill (Dec 8)
    “In a letter sent Friday, 99 House Democrats urged leaders of the House and Senate to reject the House-passed CHIP extension and instead work on a bipartisan solution. The letter dismissed the House effort as a “highly partisan bill” that “seeks to provide healthcare for some at the expense of others, undermining CHIP’s mission.” Federal funding for CHIP expired in September. The Democrats said they want Congress to pass a five-year extension without any partisan funding offsets. The House bill would charge higher premiums to wealthier Medicare beneficiaries, cut money from ObamaCare’s public health fund and shorten the grace period for ObamaCare enrollees who fail to make premium payments.”

December 8, 2017

The tax bills that have passed the House and Senate are getting most of the attention in Washington these days. The expectation is that the leadership of the House and Senate will work for a close resolution of the differences in order to send a bill to the President before Christmas. We expect the final version of the bill to look a lot more like the Senate-passed version as many provisions were added to secure the necessary Republican votes for initial passage. Dropping or changing those provisions could spell problems for Leader McConnell as he seeks to round up 50 votes again.

There are a few significant provisions in the tax bills affecting healthcare. Repeal of the individual mandate of the Affordable Care Act is likely to remain in the bill given the over $300 billion in savings it generates. The Senate bill actually makes the deduction for medical expenses more generous than current law while the House bill repeals the deduction entirely. Preserving the deduction at least will be critical for getting the necessary votes in the Senate. Finally, the House bill eliminates the tax preference for private activity bonds which many hospitals use for construction projects. A number of House Republicans have urged their leadership to maintain the tax preference in the conference report.

The Centers for Medicare and Medicaid Services released numbers for enrollment in insurance plans on the federal exchange found at HealthCare.gov. The numbers were 20 percent higher for a similar period last year, but expectations are that overall enrollment is going to be down from last year with the Trump Administration cutting the enrollment period in half and significantly reduced the advertisement budget. The final date for enrollment this year is December 15, 2017.

  • Collins considers changing vote on tax bill over amendments – The Hill (Dec 7)
    “Sen. Susan Collins(R-Maine) said Thursday that she may change her vote on the final version of the GOP tax reform bill if her proposed amendments are not included in its final version. “I would. I’m going to look at what comes out of the conference committee meeting to reconcile the differences between the Senate and House Bill. So I won’t make a final decision until I see what that package is,” Collins told CBS WABI 5 when asked if she would consider changing her vote.”
  • Study: ObamaCare bills backed by Collins would lower premiums – The Hill (Dec 6)
    “Two bipartisan ObamaCare fixes being pushed by GOP Sen. Susan Collins (Maine) would reduce premiums by 18 percent in 2019, according to a new study. The study fromAvalere, a consulting firm, finds that the two bills would more than cancel out the projected premium increase from repealing ObamaCare’s mandate that most individuals purchase health insurance. Collins secured a commitment from Senate Majority Leader Mitch McConnell (R-Ky.) to support passage of the two bills before the end of the year in exchange for her vote for tax reform, which includes repeal of the ObamaCare mandate.
  • Health law sign-ups seen as falling short though more enroll – Associated Press (Dec 6)
    “Americans are signing up in growing numbers for the Affordable Care Act’s subsidized health insurance, the government said Wednesday. But with enrollment season cut in half and just over a week to go, experts say the final tally will likely fall short. About 3.6 million people signed up through Dec. 2 in states served by the federal HealthCare.gov website, according to the Centers for Medicare and Medicaid Services. That’s about 20 percent higher than the comparable period last year.”
  • Justice Dept. investigating use of fetal tissue – CNN (Dec 8)
    “The Justice Department is looking into Planned Parenthood’s practices related to human fetal tissue, according to a letter obtained by CNN. The letter— from the Justice Department’s head of its Office of Legislative Affairs — does not mention Planned Parenthood by name but asks the Senate Judiciary Committee to turn over unredacted documentation supporting a December 2016 report titled “Human Fetal Tissue Research,” which purports to describe the organization’s practices.”
  • Nothing Protects Black Women From Dying in Pregnancy and Childbirth – ProPublica (Dec 7)
    “In recent years, as high rates of maternal mortalityin the U.S. have alarmed researchers, one statistic has been especially concerning. According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 300 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.”

December 1, 2017

As we write this, the Senate is trying to wrap up consideration of the tax bill that includes the repeal of the individual mandate in it.  The expectation is the Republican Leadership will make changes to the bill via a yet-to-be seen amendment from Senator McConnell that addresses the remaining concerns with the bill and pass the bill tonight.  Republican Leadership in both the House and Senate are planning to race to a compromise between the House and Senate passed tax bills to get a final vote in December.  There is a strong likelihood the individual mandate repeal will remain in the bill.

With the individual mandate repeal moving forward it is also much more likely that the Alexander-Murray bill to stabilize the individual insurance market will move forward as well.  There are no predictions yet on the exact timing of its consideration.

The Trump Administration took some additional steps in its efforts to address the opioid crisis in the country.  Attorney General Jeff Sessions announced $12 million in grant funding to fight the illegal manufacturing of methamphetamine, heroin and prescription opioids.  The Justice Department also announced opening a new Drug Enforcement Administration office in Kentucky to improve enforcement in the Appalachian mountain region.  President Trump also asked his Counselor Kellyanne Conway to lead and coordinate efforts from the White House in the Administration’s fight against the opioid epidemic.

  • Alex Azar, Trump’s HHS nominee, says addressing drug prices would be his top priority – Stat News  (Nov 29)
    “Alex Azar, President Trump’s pick to lead the Health and Human Services Department, didn’t mince words when he described his top priority for the agency, telling lawmakers Wednesday that drug prices are too high and must be lowered. “The president has made this clear, so have I,” Azar said.”
  • Enrollment in ACA health-care plans is still running ahead of last year – Washington Post (Nov 22)
    “The number of Americans signing up for health-care plans under the Affordable Care Act continues to run ahead of last year in states relying on the federal insurance exchange, according to federal figures released Wednesday that span nearly half of an abbreviated enrollment season. Between the start of the current sign-up period on Nov. 1 and Saturday, nearly 2.28 million people chose health-care plans for the coming year – slightly more than during the first four weeks of the ACA enrollment period a year ago, reports from the Centers for Medicare and Medicaid Services show.”
  • Stabilization Bill Couldn’t Fix the Damage of Repealing Obamacare’s Mandate – Bloomberg (Nov 29)
    “The CBO has estimated that scrapping the mandate would result in 4 million people losing health coverage in 2019 and premiums in the individual market to increase by 10 percent. On Wednesday, the nonpartisan Congressional agency said a stabilization proposal backed by some Republican Senators would have no impact on its calculations.”
  • McConnell promises Collins tax bill won’t lead to Medicare cut – The Hill (Nov 30) “Senate Majority Leader Mitch McConnell (R-Ky.) is promising the GOP tax bill, which is projected to add $1.4 trillion to the deficit over the next decade, will not result in cuts to Medicare next year. McConnell offered the vow to Sen. Susan Collins (R-Maine), a key swing vote, during a Wednesday meeting in his office. He said that he would stop an automatic spending cut to Medicare next year that is required by the “pay-as-you-go” or “pay-go” budgetary rule.”