Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
January 31, 2015

January 30, 2015

Feds Warn of Tax Consequences Linked to Individual Mandate

The Department of Health and Human Services is bringing out the stick – the specter of fines for failing to get covered — and partnering with tax preparers to help Americans make sense of federal tax forms about health insurance that are being mailed to most people by Monday.

Up to 4 percent of taxpayers – or more than 5.8 million– could face a penalty for not complying with the health care overhaul’s individual mandate in 2014, according to federal officials on a call with reporters on Wednesday. But the officials do not yet know how many people may face a fine for getting too much of a subsidy in buying coverage.

The fee for individuals who didn’t have coverage in 2014 is the higher of 1 percent of the person’s yearly household income or $95 per person ($47.50 per child under 18). Penalties increase every year: for 2015, it’s the higher of 2 percent of yearly household income or $325 per person.

The Treasury estimates for the number of people who could face a fine are higher than previous Congressional Budget Office projections. The percentage of people hit with the tax could be lower if people take advantage of any of more than a dozen different hardship exemptions from the penalty.

People who got federal subsidies will see their reported subsidies on the new 1095-A form, which HHS officials are in the process of sending. The form serves as evidence that the person had insurance and identifies the amount of subsidy. People who believe that the form’s information is wrong should call the federal call center hotline, said Kevin Counihan, the official in charge of the federal marketplace.

About 3 to 5 percent of taxpayers – or up to more than 7 million people – got subsidies in 2014, federal officials said.

In the most recent monthly enrollment report, HHS officials said that so far this year, 87 percent of people getting coverage through the federal marketplace received subsidies. Last year, about 83 percent of people did.

The focus on the fine for foregoing insurance comes two days after the Internal Revenue Service announced it would waive certain late payment penalties for people who got bigger federal subsidies than they should have.

The IRS is not waiving the requirement that people pay back the subsidy overpayments, but said that because 2014 was the first year that the subsidies were in effect, the agency would not add on fines for not paying back the excess credits to the IRS by April 15 and for not making quarterly payments in 2014. Taxpayers have to report that they got too much money, though, and have to pay all other taxes as normally required by April 15.

Federal health officials aren’t talking about any plans to give people a chance to buy insurance after the Feb. 15 close of the open enrollment period to buy into plans under the health law.

“I’m sure that’s a question that if it arises, we’ll address it later,” said Centers for Medicare and Medicaid Services Principal Deputy Administrator Andrew Slavitt on the call. When pressed, he later said, “We’re not making a decision on that yet. It’d be a mistake for people to assume they had opportunities beyond Feb. 15. We think people need to come back in the next two to three weeks.”

He added that federal officials will deal with special situations once they get past Feb. 15.

Seeking Cures, White House Looks for Precision

President Obama today will offer additional details (view fact sheet) on a “precision medicine initiative” he briefly noted in last week’s State of the Union address. The proposal seeks a $215 million investment to develop patient-customized disease treatments. The additional funding for new precision medicines is spread between the National Institutes of Health, the Food and Drug Administration and the agency charged with coordinating the development of advanced health information technologies.

Anticipating the White House’s suggestion on medical advances and following up on long-running congressional examinations of ways to streamline the development of new types of drugs and medical devices, groups of lawmakers this week offered several other medical research-oriented legislative measures.

A long-awaited discussion draft of House Energy and Commerce Committee “21st Century Cures” proposal was unveiled this week to broad but qualified support. Democrats greeted the measure with caution due to uncertainty over long-term funding for federal medical research programs. Democrats offered several measures, which seek to steady funding for the National Institutes of Health (HR 531 and S 289).

Separately this week, Senate committees advanced legislation that exempts veterans from the Affordable Care Act’s employer health insurance mandate calculations (HR 22) and easily approved the legislative renewal bill for senior citizen social and nutrition assistance programs (S 192).

January 29, 2015

CDC Survey: Skipping Drug Doses to Save Money

The high cost of prescription drugs forces some people to adjust drug dosage save money. The Centers for Disease Control and Prevention, in its annual health survey, asked about ways people reduce impact of the cost of prescription drugs. The survey keyed on 18 percent of respondents who paid for drugs out-of-pocket. Overall, the report found that 8 percent did not take their medication, 15 percent asked for a lower-cost drug, while others sought drugs out of the country or used alternative therapies.

Adults under 65 years old are more likely to avoid taking prescribed medication to save money, with uninsured persons more likely to skip doses than people covered by Medicaid or private health insurance.

By Paul Jenks Posted at 10:15 a.m.

Pace of Sign-Ups on Federal Marketplace Slips

The latest weekly health law enrollment data from the federal marketplace provide another reminder of how deadlines motivate people to sign up for health insurance. As the monthly deadline passed, interest waned in the week ending Jan. 23, with 137,298 people choosing plans compared to 400,253 the week before.

The deadline for coverage that starts Feb. 1 was Jan. 15, which probably drove a lot of interest the previous week.

The next deadline is the last one for most people until the next sign-up period for coverage that starts in 2016. This year’s open enrollment season ends Feb. 15.

People who have a long list of changes in their personal circumstances, including a change in their family’s size or a move, could still sign up after the Feb. 15 deadline through so-called special enrollment periods.

Senate Committee Begins Health Law Adjustment Action

The Senate Finance Committee on Wednesday approved by roll call vote, 26-0, House-passed legislation (HR 22) to exempt veterans from employer health insurance mandate calculations under the Affordable Care Act. Senators on the committee expressed a desire to offer amendments when the bill reaches the floor. Democrats are plotting veterans’ minimum wage adjustments and Republicans are likely to seek mandate exemptions for other groups of people. Committee chairman Orrin G. Hatch, R-Utah, said he chose the most bipartisan bill he could find for the panel’s first markup of the 114th Congress. A separate set of more controversial bills (HR 30 and S 30) adjusting the mandate’s full-time workweek threshold awaits Senate committee action. The full-time workweek standard that triggers employer coverage requirements currently is set at 30-hours and the legislation seeks to expand it to 40-hours.

Separately, the Senate Health, Education, Labor and Pensions Committee approved by voice vote legislation (S 192) re-authorizing senior citizen social and nutrition assistance programs. Action on the long-delayed re-authorization of the Older Americans Act was assured by a new funding agreement.

January 28, 2015

Medicare Advisers to Focus on Cancer Tests

A panel of Medicare advisers will review evidence of how well certain tests work in helping doctors gauge the progress of lung, breast and colon cancer and what help these diagnostics can provide in choosing treatments.

A March 24 meeting of the Medicare Evidence Development and Coverage Advisory Committee has been scheduled to look at products that are meant to pick up on genetic variations produced in cancer cells.

Medicare is seeking the opinions of its advisers on about whether such tests can help patients live longer as a result of better treatment decisions and avoid complications from certain chemotherapies.

A report released last year raised questions about the ultimate benefits of some of the tests.

Doctors rely on the products in shaping discussions with patients about whether their prognosis is better or worse than average, according to the report from the Agency for Healthcare Research and Quality. Much of the available evidence focuses on determining prognosis, but there’s been little emphasis on how the information may affect the outcomes of treatment for patients, such as with the selection of medicines, the report stated.

“Such changes in management may be occurring and may be of benefit, or possibly harm, to patients, but they have not been measured and studied, with the notable exception of the Oncotype DX assay in breast cancer,” the authors wrote.

They added that there is “a sizeable body of evidence” to suggest Oncotype DX results in fewer recommendations for chemotherapy, and thus less exposure for some patients to the harms of this treatment, but noted that there are still questions about the effect on this test on outcomes for patients.

The deliberations of MedCAC panels are meant to aid the Centers for Medicare and Medicaid Services in setting payment policies, but are not binding. At the March meeting, the advisers’ discussion is intended to help CMS shape decisions “about the extent to which it may wish to use existing evidence as the basis for any future determinations about coverage for tests that estimate cancer prognosis.”

As part of the discussion, Medicare intends to have this expert panel weigh in on one of the liveliest current topics in the arena of diagnostics.

Among the questions to be considered by the panel is whether the regulatory status of a test should count in considering evidence of how it will work. The Food and Drug Administration last year kicked off what promises to be lengthy tussle with academic health centers and companies that make diagnostic products, by officially unveiling a new framework for regulating certain tests used in cutting-edge medicine.

The FDA is reconsidering what had long been a hands-off approach to lab-developed tests. Decades ago, lab-developed tests often were used by doctors and pathologists working in a single medical center. But advances in genetics have blurred the distinction between the lab-developed tests and other diagnostics. Many large companies now market medical tests nationwide and even globally without getting FDA clearance.

The Oncotype DX diagnostics from Genomic Health, for example, are considered lab-developed tests. Redwood City, California-based Genomic Health calls these a service, through which its laboratory provides through an analysis of the genes expressed in certain tumors. The company has agreements with distributors in more than 90 countries, and reported product revenue of $206.6 million for the nine months ended in September 2014.

By Kerry Young Posted at 10:30 a.m.

Health Savings Account Balances Increase

A Health Savings Account (HSA) is a tax-exempt account used to pay for health care expenses. Ideally, the account allows an individual to monitor and better manage health care services. A separate Health Reimbursement Arrangement (HRA) is a similar type of account but is employer-funded and reimburses an employee for medical expenses. Together, over $22 billion is invested in the two types of accounts. This week, the Employee Benefit Research Institute reported on details of the two types of plans. The EBRI notes that the overall average account balance for HSAs and HRAs was $2,077 in 2014, up from $1,356 in 2008. The report also notes that accounts with an employer contribution had a higher average balance ($2,403) than those without one ($2,046).


Draft Proposal Seeks to Spur Medical Breakthroughs

The House Energy and Commerce Committee on Tuesday unveiled a discussion draft (view summary) of a long-awaited plan (view accompanying white paper) to spur medical breakthroughs. The early version of the measure — dubbed the 21st Century Cures Act — seeks to promote the development of new medical advances for drugs and medical devices through an overhaul of the product and federal agency regulatory process and modernizing the development and examination of new treatments in clinical trials.

The discussion draft is billed as a starting point and the committee release noted that the inclusion of a policy should not be considered an endorsement. Democrats on the committee did not immediately endorse the draft proposal and rallied around a separate effort initiated this week (HR 531) to ramp up funding additional basic research at the National Institutes of Health.

January 27, 2015

Boehner Plot Puts Mental Health Back in Spotlight

The recent indictment of a former Ohio country club bartender for allegedly threatening to shoot or poison House Speaker John A. Boehner is one more example that Rep. Tim Murphy uses to buttress his legislation for more aggressive mental health treatment.

The bartender, Michael R. Hoyt, had a history of mental problems; country club members told the Dayton Daily News that Hoyt’s demeanor had changed since he suffered a concussion when he was mugged two years ago, and the club fired him last fall.

Murphy, a Pennsylvania Republican and a psychologist, not only wants to improve mental health treatment, he wants to allow the government to treat more people with serious mental illness without their permission — the most controversial of his prescriptions.

He introduced his bill in December 2013, a year after the deadly shooting at Sandy Hook Elementary School in Connecticut put a renewed focus on mental illness.

Murphy, who chairs the Energy and Commerce Subcommittee on Oversight and Investigations, has had a steady stream of incidents to help him make his case.

After the Defense Department released a report last March on the September 2013 Navy Yard shooting in which 12 victims died, Murphy said the report “missed the point” by focusing on the security clearance process.

“We can take a gun out of the shooter’s hand, we can keep them out of a secured area, but until the individual displaying psychosis is referred and placed into acute psychiatric treatment, these tragedies will continue,” Murphy said.

Two months later, after six victims died in Isla Vista, Calif., in a near-campus shooting, Murphy said he was heartbroken for the victims and their families but also angered “because once again, our mental health system has failed and more families have been destroyed because Washington hasn’t had the courage to fix it.”

He plans to introduce a revised version of his bill in this Congress.

By Melissa Attias Posted at 10:19 a.m.
Mental Health

IRS Waives Some Premium Tax Credit Penalty Fees

The IRS is offering some relief to taxpayers trying to reconcile their 2014 income tax return with a surplus of advance health insurance premium tax credits. The tax agency on Monday offered relief from late payment and estimated tax fees when a taxpayer discovers that they have a balance due on their 2014 taxes, due to the premium tax credits. Of course, the taxpayer is responsible for the balance due, plus interest if not paid by April 15, but the waiver eliminates the additional penalties for failing to plan ahead for the excess tax. The waiver of the poor planning penalties only applies to the 2014 tax year.

CBO Cuts Health Law Cost Estimate

The Congressional Budget Office on Monday set the stage for the start of the congressional budgeting season with its annual long-term economic outlook report. The budget analysis agency estimates that the long-term cost 2010 Affordable Care Act is about $101 billion lower than an earlier estimate. The total net cost of the law over the next 10 years is $1, 350 billion, which is a 7 percent reduction from previous estimates and substantially lower than original estimates. Aiding the reduced cost is a $68 billion reduction in the cost of subsidizing insurance purchased on state and federal insurance exchanges. However, the lower costs are partially offset by increased Medicaid spending. The CBO also reports that 42 million people in the United States were uninsured in 2014, a number that would have been 12 million larger without the health law. In 2015, the number of uninsured will be about 36 million.

Additionally, the report notes that federal spending on the Medicare program will grow by nearly 7 percent a year over the next 10 years. The CBO estimates that the number of people enrolled in Medicare will rise to about 73 million in 2025, from 54 million last year.  Overall, the federal annual deficit is projected to fall to $468 billion in fiscal 2015, and again in fiscal 2016, before topping $1 trillion again in 2025.

January 26, 2015

Poll Finds Support for Global Health Spending

More Americans support spending on global health needs instead of foreign aid in general, according to a new poll by the nonpartisan Kaiser Family Foundation – in part because the public thinks medical aid abroad protects them at home.

About 36 percent of 1,505 adults who were polled in early December said that the United States spends “the right amount” on health services overseas, 26 percent said “too much” and 27 percent saying it was “too little.” That’s compared to 24 percent who said the country spends the right amount on the broader category of foreign aid, 56 percent who said the nation spends too much on general foreign aid and 11 percent who said it was too little.

But people’s attitudes on overall foreign aid change when they learn how little the federal government actually spends on foreign assistance as measured by a percentage of the budget, the poll found. When told that all foreign aid spending is about 1 percent of the federal budget, the number of people saying it is too much fell from 56 percent of respondents to 28 percent of those polled. The number of people saying it was the right amount grew to 34 percent and the number saying it was too little grew to 26 percent of people surveyed.

People may more supportive of global health spending than foreign aid because they see a benefit for Americans. About 69 percent said that improving health in developing countries protects the health of Americans by preventing the spread of diseases like SARS, bird flu, swine flu, and Ebola.

40-Hour Workweek Bill Will Need More Democratic Support

The first GOP-led attempt this year at changing the Affordable Care Act is slowly advancing toward a Senate vote. Further action looms on legislation changing the health care law’s employer coverage threshold for a full-time worker from 30 hours to 40 hours per week. Earlier this month the House passed its measure (HR 30) adjusting the threshold by a vote of 252-172. Senate Republicans are aware of the need to gain Democratic support for the measure, in order to possibly over-ride an expected White House veto. Two Democrats, Joe Manchin of West Virginia and Joe Donnelly of Indiana are among the 34 backers of the Senate version of the bill (S 30). However, many more Democrats will be needed to overcome a presidential veto. Only 12 Democrats voted for the House version of the bill.

Last week, a Senate panel last week debated the merits of a bill and Democrats on Health, Education, Labor and Pensions Committee Democrats appeared unified and seemingly adamant in opposition to the bill.

Health Committees Get to Work

The Senate Health, Education, Labor and Pensions Committee begins legislative action this week. The committee is set for votes on organizational rules on Wednesday along with a measure re-authorizing programs for the elderly (S 192). On Thursday, the committee examines the promise and pitfalls of employer wellness programs.

Separately on Tuesday, a House Energy and Commerce panel holds a hearing on a batch of public health bills (view Democratic committee staff memo) including measures overhauling enforcement and state monitoring of prescription drug diversion and the federal process of scheduling restricted drugs. The subcommittee will also examine bills seeking to streamline the licensing of emergency medical technicians and bills re-authorizing trauma care programs.

Also this week, both House and Senate Budget committees prepare for upcoming action on fiscal 2016 budget plans and spending bills with an economic forecast presentation offered by the Congressional Budget Office. Next week, the White House is slated to release its annual budget proposal, which officially begins the process of developing a separate congressional budget blueprint.

January 23, 2015

States Focus On Health Care

State governments and lawmakers have long focused on health care policy-making. The state portion of funding for the state-run but federally supervised Medicaid program takes up a large portion of the budgets of all 50-states. CQ Roll Call this week unveiled a new source for information on policy developments forged in the states: the CQ State Report. One can almost guarantee that health care policy topics will be included any weekly assortment of stories from the states. Here is a sample from this week:

California: Bill Would Expand Undocumented Immigrant Care

California: State Will Cover Medicaid Patients Stuck in Limbo

Arkansas: Hutchinson Seeks Task Force for Medicaid Changes

Missouri: Nixon Focuses On Education, Medicaid Expansion

By Paul Jenks Posted at 10:34 a.m.

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