Latest News | Congress

Gov. Jerry Brown’s administration wants health care change, with or without federal law

From: The Sacramento Bee – 3/30/12

Aricle Excerpt:

Gov. Jerry Brown’s administration vowed Thursday to continue pushing forward elements of the federal health care overhaul in California, even if the U.S. Supreme Court strikes it down.

If the court does rule the federal law unconstitutional, state Health and Human Services Secretary Diana Dooley said California should at least consider enacting its own universal health care legislation, including requiring every Californian to buy insurance.

“I think that we should be committed to making this system more rational than it is today, and improving the health of the people of California,” Dooley said in an interview. “If we ask the insurance plans to take everybody and insure everybody with no screens or pre-existing conditions, then we have to have everybody buying some level of health insurance to meet their responsibility to the system.”

She said whether the administration sponsors such legislation would depend on “where we are and what the conditions are at that particular time.”

Dooley’s remarks came a day after the Supreme Court finished three days of oral arguments over President Barack Obama’s signature health care law.

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Supreme Court has a wide range of options in ruling on Obama’s health care overhaul law

From: Chicago Tribune – 3/30/12

Article Excerpt:

WASHINGTON (AP) — The arguments are done and the case has been submitted, as Chief Justice John Roberts says at the end of every Supreme Court argument. Now the justices will wrestle with what to do with President Barack Obama’s health care overhaul. They have a range of options, from upholding the law to striking it down in its entirety. The court also could avoid deciding the law’s constitutionality at all, although that prospect seems remote after this week’s arguments.

A look at six potential outcomes, from the simplest to the most complicated possible rulings:

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Legal Challenges to the Affordable Care Act

From: HFMA – March 2012

Publication Excerpt:

The Supreme Court has granted review of four issues from challenges to the Affordable Care Act that have been pursued in the federal courts since passage of the act in March 2010. The court originally set aside 5 1/2 hours for oral argument (arguments at the court are typically restricted to one hour, with each side granted a half-hour of argument), but has expanded the total argument time to 6 hours, spread over three days (March 26, 27, and 28, 2012). The four issues on which the court has granted review are:

• Whether the Anti-Injunction Act prevents challenges to the Affordable Care Act at this time (90 minutes of argument on March 26)
• The constitutionality of the individual mandate, requiring most Americans to purchase health insurance by 2014 (2 hours of argument on March 27)
• Whether the individual mandate is severable if it is found to be unconstitutional, or whether the entire Act would have to fail (90 minutes of argument on March 28)
• Whether the Affordable Care Act’s expansion of the Medicaid program is constitutional (1 hour of argument on March 28)

The issues of the constitutionality and severability of the individual mandate have attracted the most attention in the federal district and appellate courts. The possibility that the Anti-Injunction Act might bar challenges to the Affordable Care Act has also emerged as a significant issue, hinging on the question of whether the penalty for failure to observe the individual mandate functions as a tax.

The argument that the act’s expansion of Medicaid is unconstitutional has not been successful in lower court challenges. This argument asserts that the act violates the Constitution’s Spending Clause (Article I, Sec. 8, Clause 1), based largely on speculation in preexisting Supreme Court case law that financial inducements offered by Congress to encourage state action could at some point pass a threshold and become coercive.

The discussion below summarizes district court rulings on the challenges to the Affordable Care Act, followed by a summary of reviews of the district courts’ rulings in the federal appellate courts.

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Could the health-care law work without the individual mandate?

From: Washington Post – 3/27/12

Article Excerpt:

If the Supreme Court were to invalidate the 2010 health-care law’s requirement that virtually all Americans obtain insurance, would the rest of the law become unworkable?

Even among supporters of the statute, opinions vary widely about the practical impact of a decision to strike down the mandate but leave everything else intact — one of several options available to the court.

“It’s probably the biggest area of uncertainty around all estimates about the law,” said Larry Levitt, a health insurance expert with the Kaiser Family Foundation.   The Obama administration argues that requiring individuals to get coverage is essential to the success of two of the most important — and popular — regulations that the law will impose starting in 2014: a rule that insurers can’t discriminate against people with preexisting conditions, and limitations on how much they can vary rates among customers.

Many of the law’s supporters insist that without the mandate, these rules would impose an unsustainable burden on insurers, ultimately causing the market to implode.

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Tentative ‘Doc Fix’ Deal Would Cut Health Law’s Prevention Fund by $5B

From: Kaiser Health News – 2/15/12

Article Excerpt

After wrangling for weeks over how to finance a Medicare “doc fix,” House and Senate conferees have a plan.  The proposal would cut Medicare payments to hospitals and other providers for “bad debt,” Medicare payments to clinical laboratories and Medicaid “disproportionate share” payments to hospitals that serve many poor patients, and divert $5 billion  from the health law’s $15 billion prevention fund.

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H.R. 3630 Conference Bill Health Offsets

From: H.R 3630 Conference Report – 2/13/12

The conference bill reveals the following Medicare cuts agreed to be made:

• Sec. 3201 – Reduction of Bad Debts treated as an allowable cost – Hospital/SNF allowable bad debts will  be reduced to 35% (currently 70%) amounts beginning in FFY 2013. (See Pages 92-93)
• Sec. 3201 – Reduction of Bad Debts treated as an allowable cost – CAH allowable bad debts will be reduced to 88% (currently 100%) in FFY 13, 76% in FFY 14 and 65% in subsequent FFYs. (See Pages 94-95)
• Sec. 3202 – Rebase Medicare Clinical Laboratory Payment Rates – Fee schedule will be reduced by 2% starting in FFY 2013 (See Page 96)
• Sec. 3203 – Rebasing State DSH Allotments for FY 2021 – Conference bill does not provide details of the specific impact (See Page 97).
• Sec. 3205 – Prevention and Public Health Fund – Made changes to the funds available from 2012 – 2022 (See Page 98-99).  $5 Billion diverted according to above article.

From: Washington Post – 12/15/11

Article Excerpt:

It was adopted by Congress in 1997 almost as an afterthought — a new formula to keep Medicare spending on doctors from growing faster than the economy as a whole.

But like a snowball that swells in size as it rolls down a mountain, the rate-setting formula has transformed into a budget-busting juggernaut that will hit doctors with a 27.4 percent pay cut for their Medicare patients in January unless legislators step in.

The cost of congressional intervention has ballooned just as formidably: Postponing the cuts — the solution Congress has turned to every year since 2003 — would cost $21 billion for a one-year delay and $38.6 billion for two years. Fully repealing the formula would add nearly $300 billion to the deficit, according to the Congressional Budget Office.

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Overnight Health: Republicans put together ‘doc fix’ offer

From: The Hill Healthcare blog – 12/8/11

Article Excerpt:

House Republicans seem to be coalescing around a two-year “doc fix” paid for with Medicare cuts — including cuts that could directly affect seniors. As expected, a two-year fix was included in the larger tax proposal GOP leaders pitched to their caucus on Thursday.

Doctors will face a nearly 30 percent cut in their Medicare payments if Congress doesn’t act by the end of the year. Republican lawmakers told The Hill after Thursday’s caucus meeting that leadership discussed a plan to avert that cut and give doctors a 1 percent pay increase in 2012 and 2013.

A two-year fix would cost roughly $38 billion, and Republicans might try to offset that cost by asking seniors to pay more for their Medicare benefits. Members said they’re looking at increased means-testing and other changes in Medicare’s premiums.

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House Dems look to exempt Medicare from automatic spending cuts

From: The Hill Healthwatch Blog – 12/1/11

Article Excerpts:

While some Republicans are taking heat for seeking to mitigate $600 billion in sequestration cuts to the Defense Department, a handful of House Democrats this week put forward their own proposal to spare Medicare from spending cuts triggered by the August debt deal.

Rep. Edolphus Towns (D-N.Y.) introduced H.R. 3519, along with six other House Democrats, in a bid to exempt Medicare. Towns said Wednesday that hospitals would not be able to cope with reduced Medicare reimbursements required under the sequestration cuts required under the Budget Control Act.

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Hospitals, Insurers Would Bear Brunt of Automatic Cuts

From: The Hill’s Healthwatch Blog – 11/22/11

Article Excerpt:

Automatic Medicare cuts triggered by the congressional super-committee’s failure would hit hospitals harder than any other health industry, according to an analysis from Avalere Health.

The report puts hard numbers to across-the-board cuts that stakeholders have mostly viewed in broad, general terms. But Avalere chief executive Dan Mendelson cautioned that the figures also assume the automatic cuts will actually happen — an assumption he’s not ready to make.

The super-committee’s cuts, if it had agreed on a deal, likely would have started next year. But sequestration isn’t scheduled to begin until 2013.

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