H.R.5659 Would Open Medicare Advantage to End-Stage Renal Patients

Dialysis Patient Citizens (DPC) hailed the introduction of H.R. 5659 as the latest milestone toward opening Medicare Advantage enrollment to end-stage renal disease (ESRD) patients. Stephen Anderson, a patient advocate from Indianapolis said, “As a dialysis patient of five years, I am fortunate to have secondary insurance to cover what Medicare does not. However, I know many patients in my facility don’t have that luxury. Providing dialysis patients access to Medicare Advantage will greatly help to reduce our out-of-pocket costs while improving our health with care coordination measures,” said. A study comparing outcomes of dialysis patients grandfathered into Medicare Advantage plans found that they have lower mortality rates than id their peers in fee-for-service plans. For more information, visit dialysispatients.org.

Groups Call on Congress to Pass Medicare Virtual Colonoscopy Coverage

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The National Medical Association and the American College of Radiology are calling on Congress to pass the CT Colonography Screening for Colorectal Cancer Act (H.R. 4632), which was. Introduced in the House by Reps. Brad Wenstrup (R-OH) and Danny Davis (D-IL), H.R. 4632. It would provide Medicare coverage for seniors who choose to be screened with a virtual colonoscopy (CT colonography). This would remove a financial barrier to care widely covered by private insurance. The American Cancer Society recommends Virtual colonoscopy as a screening exam because it has been shown to increase screening rates. Less invasive than optical colonoscopy, it does not require sedation. After the procedure, patients may return to daily activities.

“Medicare coverage of virtual colonoscopy would increase African-American and other minority access to this test that can overcome many cultural stigmas and attract more people to be screened. This would prevent many cancers, find more cancers before they progress and save thousands of people who might otherwise die from a disease that is often preventable,” said Edith Peterson Mitchell, MD, President of the National Medical Association.

CIGNA, UnitedHealthcare, Anthem Blue Cross, Blue Shield, and other major insurers cover screening virtual colonoscopy. More than 20 states require insurers to cover these exams. Yet, Medicare does not cover beneficiaries for CT colonography. Virtual colonoscopy has been proven comparably accurate to colonoscopy in most people of screening — including those ages 65 and older. President Obama chose a virtual colonoscopy in his first checkup as Commander-in-Chief.

The Cadillac Tax Gets Delayed Until 2018

Congress passed a $1.5 trillion omnibus spending bill and $680 billion tax-extenders package, which funds the government through September 2016. President Obama signed the legislation on Friday. Included in the bill is a provision that will delay the Cadillac tax. The Affordable Care Act (ACA) imposes a 40% non-deductible excise tax on health plans with values exceeding $10,200 in coverage for singles and $27,500 for families beginning in 2018. The provision is indexed to inflation and will rise automatically over time, potentially affecting all employer-sponsored plans. If the tax goes into effect, employers could shift the cost of the tax to employees by raising deductibles and increasing other out-of-pocket costs. The omnibus bill delays the tax for two years, until 2020.

Sen. Sherrod Brown (D-OH) said, “A delay of the Cadillac tax is welcome relief for middle-class workers who shouldn’t be stuck with higher out-of-pocket costs or lower quality health care. Brown sponsored the American Worker Health Care Tax Relief Act of 2015, which would repeal the tax. The bill demands that repeal is accompanied by a proposal to offset lost tax revenue to prevent an increase in the federal deficit and protect the integrity of the health law. He added, “While I plan to continue working with my colleagues toward a full repeal of this tax, a two-year delay of the implementation date of this harmful tax will temporarily ensure that the cost of care isn’t shifted to workers in the short term.”

Terry O’Sullivan, general president of the Laborers’ International Union of North America (LIUNA) said, “LIUNA is just one of many labor, employer, health policy, and other groups opposed to this indefensible, misguided, and regressive 40% middle-class excise tax. Congressional action, while not the hoped-for outright repeal, is a big step in the right direction, and signals a recognition that the tax is deeply flawed. We hope that in the additional two years provided by this delay, Congress and the next President will, once and for all, repeal the deceptively named ‘Cadillac Tax.’”

Judge Says that the House GOP Can Sue the President

The Los Angeles Times reports that House Republicans won the opening round in a lawsuit against President Obama over their claim that his administration spent money for health insurers under the Affordable Care Act without receiving needed approval by Congress. U.S. District Judge Rosemary Collyer ruled Wednesday that the lawmakers have the legal standing to sue. The Constitution “could not be more clear: ‘No Money shall be drawn from the Treasury but in consequence of Appropriations made by Law’,” she said, quoting a key provision. “Neither the president nor his officers can authorize appropriations; the assent of the House of Representatives is required before any public monies are spent.”

The judge rejected pleas by Obama’s lawyers to dismiss the House lawsuit on the grounds it involved a political dispute, not a legal one. Collyer said that the House claimed it would suffer an “institutional injury” if the president and his aides could spend money on their own authority. Her ruling is only the first step, however. She told lawyers she would hear arguments in the fall on whether the administration’s action violated the Constitution. If Collyer, a judicial appointee of President George W. Bush, were to decide in favor of the House on the merits, Obama’s lawyers would appeal to the U.S. Court of Appeals for the District of Columbia Circuit, where Democratic appointees are in the majority. From there, the case could move to the Supreme Court. Unless the dispute moves with unusual speed, a final decision might not come until after Obama has left office. Nonetheless, Collyer’s initial ruling is a victory for House Speaker John A. Boehner, and it is likely to be seen as endorsing the GOP’s view that Obama overstepped his authority. In a statement, Boehner said he was “grateful to the court for ruling that this historic overreach can be challenged by the coequal branch of government with the sole power to create or change the law. The president’s unilateral change to Obamacare was unprecedented and outside the powers granted to his office under our Constitution.”

The White House said it would seek an immediate appeal. “The law is clear that Congress cannot try to settle garden variety disputes with the executive branch in court,” said Deputy Press Secretary Jen Friedman. “This case is just another partisan attack — this one, paid for by the taxpayers — and we believe the courts will ultimately dismiss it.” Many lawyers saw the House suit as unprecedented. In the past, courts have regularly said lawmakers do not have standing to turn their political fights into legal battles. Last summer, when the House voted to sue Obama, many legal experts predicted the suit would be tossed at the first stage. Boehner had first alleged that Obama’s aides had violated the law when they waived several deadlines under the Affordable Care Act.

But more recently, the lawyers for the House focused on a little-known dispute over how to reimburse health insurers who take on more low-income policyholders. The Affordable Care Act said these insurers would be reimbursed for waiving copayments and other costs for these new policyholders, but it did not make clear whether this money would be provided automatically or instead would require an annual appropriation from Congress. So far, the administration has spent $4 billion, and the total spending is expected to reach $175 billion over a decade. After the Republican-led House refused to appropriate money, Health and Human Services Secretary Sylvia Mathews Burwell decided the reimbursements were mandatory under the law and could be provided despite the lack of an appropriation.

Law professor Jonathan Turley, the lead counsel for the House, said the judge’s ruling means the court will decide “an issue that drives to the very heart of our constitutional system: the control of the legislative branch over the power of the purse.” Despite the setback, health law experts do not see this case as posing a major challenge to the future of Obama’s healthcare law. If spending for the reimbursements were cut off, insurers might have to raise premiums somewhat. Other experts say the insurance companies could turn to a federal claims court to seek reimbursements. For the full article, visit latimes.com.

Bill Would Expand Access to Home Healthcare Services

The Partnership for Quality Home Healthcare is urging Congress to advance the Home Health Care Planning Improvement Act (S.578). Under the bill, nurse practitioners could certify home health services for Medicare beneficiaries without getting physician approval. Nurse practitioners are already certified to perform such evaluations for hospice services. Eric Berger, CEO of the Partnership said, “Allowing nurse practitioners to certify patients for Medicare’s home health services would remove barriers to care that restrict access to patient-preferred healthcare for homebound beneficiaries. The Partnership commends Senator Susan Collins and her colleagues in the U.S. Senate for sponsoring this legislation, which would improve access to skilled home healthcare for Medicare’s most vulnerable patient population, particularly those patients living in underserved and rural parts of the country.

Mental Health Bill Reintroduced

Chairman Tim Murphy (R-PA) and Rep. Eddie Bernice Johnson (D-TX) reintroduced the Helping Families in Mental Health Crisis Act, H.R. 2646. The revamped bill builds upon the previous bipartisan version. H.R. 2646. It breaks down federal barriers to care, clarifies privacy standards, expands parity accountability, invests in services for the most difficult to treat cases, and drives evidence-based care. Rep. Murphy said, “We are moving mental health care from crisis response to recovery, and from tragedy to triumph.”

The Helping Families in Mental Health Crisis Act was first introduced in December 2013, following a yearlong investigation led by Oversight Chairman Murphy into the nation’s broken mental health system. The investigation revealed that the federal government’s approach to mental health is a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies.

As documented in a recent Government Accountability Office (GAO) report, 112 federal programs intended to address mental illness aren’t connecting for effective service delivery. Also, there is a lack of inter-agency coordination for programs supporting people with serious mental illness.

While the federal government dedicates $130 billion towards mental health each year, the mental health system is best described by its deficits. To name just a few:

  • There is a nationwide shortage of nearly 100,000 needed psychiatric beds.
  • Three of the largest mental health hospitals are criminal incarceration facilities.
  • Privacy rules frustrate physicians and family members and generate nearly 8,000 official complaints a year.
  • Only one child psychiatrist is available for every 2,000 children with a mental health disorder.
  • The leading federal mental health agency does not employ any psychiatrists.

The Helping Families in Mental Health Crisis Act of 2015, H.R. 2646 would do the following:

  • Create an Assistant Secretary for Mental Health and Substance Use Disorders with mental health credentials within HHS. The assistant secretary would elevate the importance of mental health in the nation’s leading health agency, coordinate programs across different agencies, and promote effective evidence-based programs.
  • Require the Assistant Secretary for Mental Health and Substance Use Disorders to make public all federal investigations into compliance with the parity law so that families and consumers know what treatment they have rights to access.
  • Establish a National Mental Health Policy Laboratory to drive innovative models of care and develop evidence-based and peer-review standards for grant programs.
  • Dedicate funding for the Brain Research Through Advancing Innovative Neurotechnologies Initiative.
  • Require psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to appropriate post-hospital care and services.
  • Provides additional psychiatric hospital beds for those with an acute mental health crisis who need short term (less than 30 days) immediate inpatient care.
  • Support advances in tele-psychiatry to link pediatricians and primary care doctors with psychiatrists and psychologists in areas where patients don’t have access to care.
  • Require the Assistant Secretary for Mental Health and Substance Use Disorders to study and recommend a national strategy to increase the number of psychiatrists, child and adolescent psychiatrists, psychologists, psychiatric nurse practitioners, clinical social workers, and mental health peer-support specialists.
  • Include child and adolescent psychiatrists in the National Health Service Corps.
  • Authorize the Minority Fellowship Program.
  • Authorize, for the first time in federal law, the Recovery After Initial Schizophrenia Episode (RAISE), an evidence-based early intervention program.
  • Reauthorize the National Child Traumatic Stress Network.
  • Launch an early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.
  • Provide incentives to states to offer community-based alternatives to institutionalization.
  • Reauthorizes the Garrett Lee Smith Suicide Prevention Program, invest in research on self-directed violence, and authorize, for the first time in the statute, the Suicide Prevention Hotline.
  • Extend health information technology for mental health providers to coordinate care with primary care doctors using electronic medical records.
  • Establishe an inter-agency Serious Mental Illness Coordinating Committee to organize, integrate, and coordinate the research, treatment, housing and services for people with substance use disorders and mental illness.
  • Ends the decades-old prohibition on physicians volunteering at community mental health clinics and federally qualified health centers.

Congressman Murphy, a psychologist with nearly three decades experience, has been a champion for reforming the broken mental health system. He yearly introduces the bipartisan congressional resolution declaring May as Mental Health Month, to end the stigma associated with mental illness and promote public awareness of mental health. He will soon advance a similar resolution recognizing the month of June as PTSD Awareness Month. A provision in the previous version of his Helping Families in Mental Health Crisis Act was recently adopted on the House floor. Murphy offered a bipartisan amendment with Rep. Michelle Lujan Grisham (D-NM) and Rep. Earl Blumenauer (D-Ore.) to the Commerce, Justice, Science and Related Agencies Appropriations Act of 2016, to advance and expand Mental Health Courts, a successful model of collaboration between criminal justice and mental health systems for those with serious mental illness.

Bringing Marketplace Competition to the ACA

As Congress debates health care reform, the Committee for Economic Development of the Conference Board (CED) offers the following prescription for bringing market-based competition to the post-Affordable Care Act (ACA) health care system:

  • Replace the ACA’s income-conditioned premium subsidies with a fixed-dollar refundable tax credit. With those credits available to all, eliminate the unnecessary individual and employer mandates.
  • Allow private exchanges and insurance sellers to compete with public exchanges to serve all people who choose to use them – not just the ACA’s restricted populations.
  • Establish alternative national regulatory approval to allow plans to market across state lines.
  • Risk-adjust premium revenue. Plans would not be permitted to refuse consumers or to charge higher premiums for pre-existing conditions. Plans that care for more-costly risks, on average, should be rewarded for doing so.
  • Increase the flexibility of the employer role. Firms may offer plans to their employees, in competition with the other options available. Alternatively, firms may serve as exchanges to their employees, or join private multi-employer exchanges, or merely provide advice to their employees.
  • Reorient the ACA’s Independent Payment Advisory Board (IPAB) to provide information for, rather than inject remote government judgment into, the physician-patient relationship. Expand data gathering and research.
  • Encourage innovative health care delivery models that range from highly specialized care to preventive services.
  • Create specialized expert courts and a safe harbor of standards of sound practice based on new data and analysis to facilitate more-timely and less-costly malpractice decisions.

Ron Williams, Co-Chair of CED’s Health Care Reform Subcommittee and former CEO of Aetna said, “Health care is a very personal issue, which is why having a fixed tax credit decoupled from the state or federal exchange will provide the consumer with significantly broader choice.

Millions Would Drop Coverage If Subsidies Were Eliminated

Eliminating government subsidies for low- and moderate-income people through federally run health insurance marketplaces would reduce enrollment in the individual market by more than 9.6 million, according to a new RAND study. If the Republican controlled Congress strikes down the subsidies, enrollment in the ACA-compliant individual market would drop to 4.1 million in 34 states. Individual market enrollment would drop 70% among people buying policies that comply with the Affordable Care Act.Christine Eibner, the study’s senior author and a senior economist at RAND said, “The disruption would cause significant instability and threaten the viability of the individual health insurance market in the states involved. Our analysis confirms just how much the subsidies are an essential component to the functioning of the ACA-compliant individual market.”

Premium costs for a 40-year-old nonsmoker purchasing a silver plan would rise from $3,450 annually to $5,060.  In addition, unsubsidized individual market premiums would rise 47% in those states. The hike would correspond to a $1,610 annual increase for a 40-year-old nonsmoker with a silver-level plan.

The Supreme Court has agreed to hear a court case (King v. Burwell) that challenges the use of government subsidies to help low- and moderate-income people buy health insurance in marketplaces operated by the federal government. Ending federal subsidies would have a bigger effect in states with federally run marketplaces than in states that run their own marketplaces. States with federally run marketplaces generally have more low-income participants who are more likely to drop insurance without subsidies. Those states also had higher uninsurance rates prior to adoption of the Affordable Care Act

HSAs Provide Financial Flexibility

Fifty-two percent of HSA account holders spent more than 80% of their HSA funds for health care expenses during 2012, according to a survey by America’s Health Insurance Plans (AHIP) and the American Bankers Assn. Since Congress authorized HSA plans in 2004, AHIP has conducted three surveys on HSA banking activity. This latest report measuring the financial activity of more than 1.4 million HSAs, shows consumers taking an active role in managing their health care dollars. Fifty-five percent of HSAs received personal contributions during 2012. While end of the year account balances varied, roughly 80% of accounts had a positive balance that could be carried over to the next year to help pay for future expenses. Fifty-eight percent of accounts had withdrawals during the year. Of those accounts, the average withdrawal during 2012 was $2,081. For more information, visit http://www.hsaalliance.org.

No ACA mandate delay or enrollment extension, HHS secretary tells Congress

HHS will neither delay the requirement for the majority of Americans to have health insurance nor extend the enrollment deadline past March 31, HHS Secretary Kathleen Sebelius told a House panel. Reuters (3/12), The New York Times (tiered subscription model) (3/13)

Last Updated 01/19/2022

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