Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
January 29, 2015

Posts by Paul Jenks

292 Posts

January 28, 2015

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

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

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.

Regulating Precision Medicine

President Obama touted a very precisely-worded initiative in his State of the Union address this week, a “precision medicine initiative.” While the speech offered no further details on the plan, the concept hinges on the mapping genomes and learning more about the genetic mechanisms of tumors and other aspects of disease development. Patients would be treated based on their individual genetic profiles, enabling professionals to customize drug treatments instead of taking a one-size-fits-all approach.

However, CQ HealthBeat’s Georgina Gustin reports (subscription) that some policymakers are questioning whether the Food and Drug Administration (FDA) is capable of evaluating the safety and efficacy of the next-generation  of precision medicines. The key for the FDA lies in collecting vast amounts of genetic data and handling what could be a flood of applications for promising cures. Some members of Congress say that the pace of approvals already is too slow – and some patient advocacy groups are looking to lawmakers to speed things further.

This Week: Precision Medicine Initiative and Abortion Bill Swap

President Barack Obama, in the annual State of the Union address this week, laid out his agenda for 2015. Republican lawmakers applauded 31 times but are unlikely to accept all of the president’s prescriptions. A prominent proposal in the address featured a “precision medicine initiative” that would advance efforts to address cures for diseases like cancer and diabetes. The president offered no details on the initiative and Republican lawmakers largely accepted the concept as an endorsement of ongoing development of a medical research and drug product approval process overhaul package.

Separately, on Thursday, in a vote timed to coincide with an annual anti-abortion rally in Washington, DC, the House approved – in a 242-179 roll call vote – a measure (HR 7) seeking to permanently block federal funding for abortion services. Lawmakers originally planned on voting on a bill that seeks to prohibit abortions in cases where the probable age of the fetus is 20 weeks or later (HR 36). However, the funding restriction bill was substituted instead after a group of GOP lawmakers objected to abortion ban exception language included in the abortion ban measure.

Veterans’ Mental Health Bill Quickly Advances

January 22, 2015

Veterans’ Mental Health Bill Quickly Advances

A veterans’ mental health bill is racing to become one of the early measures signed into law this year. After failing to gain approval in the Senate last year, the bill (HR 203) bolstering military and veterans mental health programs sped through the Senate Veterans Affairs Committee and is headed toward quick Senate approval.

The measure focuses on Pentagon and Veterans Affairs Department suicide prevention programs and seeks a third-party annual review of programs and promotes collaboration between the VA and non-profit mental health organizations to stem the epidemic of veteran suicides.

The bill named for Clay Hunt, a Marine veteran of the wars in Iraq and Afghanistan who was diagnosed with post-traumatic stress disorder and committed suicide in 2011 at age 28, faltered in the waning hours of the last Congress when then-Sen. Tom Coburn objected to a unanimous consent request to pass the bill. Coburn, an Oklahoma Republican, objected that the bill would cost too much money and would duplicate existing services. The Senate committee chairman noted on Wednesday that the bill explicitly prohibits the authorization of new funds to implement the programs.


Medicaid Programs Face Congressional Renewal Pressure

Several Medicaid and Children’s Health Insurance Program (CHIP) payment elements are subject to congressional action – or inaction this year. Funding for CHIP, which provides health coverage to more than 10 million children and teens, is set to expire in September 2015. If Congress does not provide a fresh injection of cash, 2 million people enrolled in the program may not be eligible to receive coverage from Medicaid, the federal-state health program for the poor, or through health care law insurance exchanges.

The Affordable Care Act allowed the program to continue through 2019 but only authorized funding for it through Sept. 30, 2015. Democrats last year eyed possible action on a renewal bill before the end of the last year. However, Republicans, seeking possible changes to the program, were reluctant to push for a renewal so far ahead the September 31, 2015 expiration. Separately, a temporary Medicaid primary care physician payment increase promoted by the 2010 health law and designed to match physician payments with Medicare rates expired on Dec. 31. Physician groups are seeking congressional action to extend the higher rates and a retro-active adjustment for current payments.

January 21, 2015

Pharmacists Press for Care Coordination Role

Pharmacist are seeking to forge a broader role in health care delivery system and several states are aiding them by loosening some regulatory burdens. However, the pharmacists are still primarily restricted to distributing prescriptions and are not recognized in the Medicare program as a provider of other services similar to nurse practitioners and chiropractors. Carolyn Phenicie in CQ’s State Report describes how some states are allowing increased collaboration between physicians and pharmacists for medication management programs.

Separately, pharmacists have gained a voice in Congress. Georgia Republican Rep. Earl L. “Buddy” Carter is believed to be the first pharmacist, who has owned his own drug store, to ever serve in Congress. CQ Roll Call’s Melissa Attias reports (subscription) that Carter will seek to allow pharmacy care coordination services under the Medicare program.

Keeping Up on Unauthorized Appropriations

Every January, the Congressional Budget Office provides congressional committee’s with a sort-of advance warning notice. The CBO report lists the various unauthorized appropriations and expiring authorizations which may need some legislative attention. Most legislation that streams through Congress largely updates, revises and renews various existing laws. Often, for budgetary reasons, program spending is given a discrete time frame and a specific expiration date. As a result programs are often face authorization renewals.

The CBO report, sorted by House committee jurisdictions, can be a useful guide on possible legislative action this year. Included in the mix of expired programs is a wide range of very prominent health programs and laws, including the National Institutes of Health and the Affordable Care Act. A Senate committee on Tuesday already scheduled early action on a re-authorization bill for senior citizen nutrition programs.


SOTU: 21st Century Cures Effort Gains Support

President Obama, in his State of the Union address on Tuesday evening urged a “precision medicine initiative” that would advance efforts to address cures for diseases like cancer and diabetes. While the president offered no specific details on the initiative, congressional reaction to the speech interpreted a likely intersection with ongoing development in the House Energy and Commerce Committee of a medical research and drug product approval process overhaul package.

Committee chairman, Michigan Republican Fred Upton touted the work on a looming legislative measure, dubbed “21st Century Cures“, which seeks to speed the discovery, development, and delivery cycle of medical advances. Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander of Tennessee immediately tied the president’s initiative suggestion with the looming “21st Century Cures” effort.

State of the Union excerpt (view transcript):

21st century businesses will rely on American science and technology, research and development. I want the country that eliminated polio and mapped the human genome to lead a new era of medicine: one that delivers the right treatment at the right time.

In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable. Tonight, I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes and to give all of us access to the personalized information we need to keep ourselves and our families healthier.

January 20, 2015

IRS Sets 2015 Coverage Mandate Tax Penalty Levels

The IRS on Friday weighed in with one data point some taxpayers will need to know when planning their tax returns for the 2015 tax year. A taxpayer who is without minimum insurance coverage and is not eligible for an exemption,  is liable for a tax penalty — dubbed an individual shared responsibility payment. Part of the calculation of the penalty hinges on the national average charge for bronze plans offered under the various state health insurance exchanges.

The overall tax penalty is primarily calculated on a percentage of income or a minimum set penalty amount but it is capped by the sum of the monthly national average bronze plan premium. The IRS has calculated the average monthly bronze premium rate for the 2015 tax year at $207 for an individual and $1,035 for a family of five or more. The calculation of the average premium ignores allowed premium differences for age and tobacco use and is based upon the 21-year old, non-smoker premium level. This year’s amount is slightly higher than the rate set for the 2014 tax year of $204 for individuals and $1,020 for families.





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