Washington Watch

Carter L. Alleman, J.D.

Administration Declares Opioid Epidemic Public Health Emergency

The White House hosted an event on the opioid epidemic during which President Trump declared it a nationwide public health emergency. The declaration will allow federal agencies additional flexibility to waive regulations and will result in a realignment of federal resources to address the crisis. The declaration will focus on expanding access to telemedicine treatment services, temporary appointment of specialists to crisis areas, and allowing people eligible for HIV/AIDS programs to also receive substance use disorder treatment. Additionally, Dislocated Worker Grants will be made available to people in treatment for opioid addiction.

The President highlighted that federal employees who prescribe opioids will now be required to receive special training, and that the inspection of imported packages will be strengthened to better detect the flow of Fentanyl into the country.

Because the President opted not to declare a national Stafford Act emergency, the announcement comes with no additional money and will have to be renewed every 90 days until no longer needed. There has never been a public health or national emergency declaration for a drug epidemic. Questions remain on how long it will last and what metrics will determine its conclusion. The Administration has stated that it is in discussions with Congress about including additional funding to address the epidemic as a part of the end of the year-end spending bill.

The Centers for Disease Control and Prevention (CDC) announced the latest statistics on the epidemic last week, estimating that fatal drug overdoses have increased by more than 200 percent in the last 16 years. Overdose is now the leading cause of death in the nation.

Negotiations Continue with White House and House on Alexander-Murray Bill

President Trump has weighed in with specific requests for the Alexander-Murray health deal aimed at stabilizing the individual insurance market. The White House is asking that the penalties for failure to comply with the individual and employer mandates be lifted for the years 2015, 2016, and 2017. The Administration has also asked for additional state waiver flexibility, expanded use of health savings accounts (HSAs), and increased use of short-term, limited duration health insurance plans.

House Freedom Caucus Chairman Mark Meadows (R-N.C.) has stated that the bill must be revised to be “substantially more conservative” in order to have a chance of passing the lower chamber. The changes that Meadows is working on with Sens. Lindsey Graham (R-S.C.), Ron Johnson (R-W.I.), and Rep. Tom MacArthur (R-N.J.) largely align with those requested by the White House.

The Congressional Budget Office (CBO) estimates that the Alexander-Murray plan would reduce the deficit by $3.8 billion between 2018 and 2027, according to the score released last week. CBO reports that the legislation would not substantially change the number of people with health insurance coverage compared to the existing baseline.

Judge Rejects Motion to Restore CSR Payments

A federal judge in California has rejected an emergency motion to temporarily restore the cost sharing reduction (CSR) payments to health insurers under the Affordable Care Act (ACA), which the President announced he would stop paying earlier this month. The judge said he was skeptical that cutting off the payments would cause immediate injury to residents because of preparatory steps taken by states in anticipation of the Administration’s decision. The motion for a temporary restraining order had been signed by 18 states and the District of Columbia.

House Passes Senate Budget Resolution

The House of Representatives passed the Senate-adopted budget resolution H. Con. Res. 71. The resolution will allow lawmakers to begin work on a $1.5 trillion tax cut through the fast-track budget process known as reconciliation. The budget resolution also calls for $5 trillion in spending cuts over the next decade. This resolution included the Senate reconciliation instructions which will allow passage of tax reform by a simple majority vote in the Senate, bypassing normal order.

Bipartisan Deal Reached for Health Insurance Market

Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) announced that they had reached an initial agreement on a bipartisan package of legislation to stabilize the individual health insurance market. The deal would resume cost- sharing reduction (CSR) payments to insurers for two years and provide states with more flexibility to change Obamacare’s insurance regulations.

The Alexander-Murray health care plan is the culmination of three months of negotiations to provide a short-term fix for the rising premiums facing the individual market. Sen. Alexander hopes that the bill will stabilize premiums and provide Congress with more time to debate longer-term changes to the 2010 health care law.

Under the bill, States would be allowed to use existing section 1332 waivers to alter some of the ACA’s insurance parameters for policies offered on the Exchange. The agreement does not alter the current law coverage guardrails related to pre-existing conditions and essential health benefits (EHB). Current law requires “coverage that is at least as comprehensive” as ACA coverage offered through Exchange and requires “coverage to at least a comparable number of its residents.” Waivers could be used to approve insurance plans outside of Obamacare’s insurance regulations if they maintain the ACA’s coverage requirements and are of “comparable affordability” to plans in the current exchanges. Proposals are currently judged against a standard of “at least as affordable” as ACA coverage.

The legislation would streamline and expedite the 1332 waiver the federal waiver review period from 180 days to 90 days while also creating a pathway. The maximum waiver period would be extended from five to six years, and state proposals during each individual year. States seeking a waiver that matches another state’s previously approved waiver would be automatically granted. The deal would also restore $106 million in Obamacare outreach and advertising funding to publicize the open enrollment period. President Trump had rescinded these funds earlier this year.

The Alexander-Murray agreement would loosen the ACA’s limitations on catastrophic health insurance plans, also known as “copper plans.” These high-deductible plans are currently only available to people under the age of 30 or those who can demonstrate that purchasing a plan with more robust benefits would pose an economic hardship. This legislation would allow anyone to buy a copper plan, regardless of age or income level.

Finally, the plan would require the U.S. Department of Health and Human Services (HHS) to issue regulations regarding health care choice compacts that would allow individuals to purchase coverage across state lines.

Open enrollment for Americans to begin signing up for 2018 coverage begins on November 1 and ends on December 15.

Lawmakers Approach Deal on Medicare Extenders

The Senate Finance Committee is working to finalize a draft bipartisan bill that would renew funding for a series of Medicare extenders before their expiration at the end of this calendar year. The legislation would address provisions to assist low-volume or rural health care providers, reauthorize federally backed outreach to low-income beneficiaries, and eliminate an annual limit on beneficiary spending for certain physical therapy services.

The House Energy and Commerce Committee and House Ways and Means Committee reached a similar bipartisan agreement last week on permanent repeal of the per-patient therapy Medicare expenditures known as therapy caps. The Finance Committee draft does not detail how the cost of the bill would be offset.

Senate Passes FY18 Budget Resolution

The Senate passed a fiscal year (FY) 2018 budget resolution that sets up consideration of tax reform under the fast-track process known as reconciliation. Under the resolution’s reconciliation instructions, Republicans would need just fifty votes to pass $1.5 trillion in tax cuts over the next decade. The legislation calls for the Senate Finance Committee to report a tax bill by November 13. It also outlines the GOP’s budgetary priorities, initially maintaining spending at 2017 levels, followed by cuts to non-defense spending totaling $106 billion by 2027. It proposes a $473 billion reduction to Medicare’s baseline spending and a $1 trillion cut to the Medicaid program over the next decade.

Tiberi Announces Resignation from Congress

Rep. Pat Tiberi (R-Ohio) has announced his resignation from Congress. He has not yet decided upon an exact departure date, but he will be leaving his position as an elected official before January 31, 2018. Rep. Tiberi chairs the House Ways and Means Health Subcommittee.

Hargan Named Acting HHS Secretary

President Trump announced that Eric Hargan will fill the position of Acting Secretary for the U.S. Department of Health and Human Services (HHS) following Tom Price's resignation last month. Hargan was recently confirmed by the Senate as Deputy Secretary of Health and Human Services.
 

GOP Ends Plans to Repeal and Replace in 2017

Senate Republicans did not to hold a vote on the Graham-Cassidy-Heller-Johnson proposal to repeal and replace the Affordable Care Act (ACA) after it became apparent that they lacked the 50 votes needed to successfully pass the legislation. The plan would have eliminated insurance mandates and converted Obamacare funding into block grants for states to set up and regulate their own health insurance markets.

IPAB Repeal Advances in the House

The House Ways and Means Committee approved H.R. 849, the Protecting Seniors’ Access to Medicare Act of 2017, last week. The bill would repeal the Independent Payment Advisory Board (IPAB) and was passed by a vote of 24-13.

Senate Finance Makes Opioid Fraud Scheme Inquiry

Republicans on the Senate Finance Committee have written to the U.S. Department of Health and Human Services (HHS) requesting additional information on the health care fraud takedown that resulted in the identification of $1.3 billion in false billings and 412 charges of participation in fraud schemes related to improper opioid related diversion and abuse. The lawmakers also ask for details on what HHS is doing to combat opioid fraud and abuse in the Medicare Part D program. They request that HHS engage with the Committee on policy options to review Medicare and Medicaid payment initiatives related to the treatment of pain and addiction.