Weekly Washington Healthcare Update
The election is over.... Back to implementing the Affordable Care Act.... States start thinking about whether to run their own exchanges.... Thoughts turn to the Sequester, Deficit Reduction and Expiring Tax Cuts.... Rep. Pete Stark (D-CA) is defeated.November 12, 2012
House of Representatives
Health and Human Services (HHS)
Centers for Medicare and Medicaid Services (CMS)
Food and Drug Administration (FDA)
3. State Activities
4. Regulations Open for Comment
Congressional Budget Office (CBO)
House of Representatives
House Energy and Commerce Committee Chairman Fred Upton issued a subpoena Tuesday to the co-owner of the New England Compounding Center -- the facility linked to the meningitis outbreak. The subpoena requires Barry Cadden to testify at the Oversight and Investigations Subcommittee hearing on the outbreak Nov. 14. Upton and ranking Democrat Henry Waxman said in a joint statement, "Since Mr. Cadden has indicated he will not appear voluntarily, we are left with no choice but to issue a subpoena."
While there will be some new members in both the House and Senate in the next Congress, one legendary health player was defeated. Rep. Pete Stark (D-CA) lost after serving in Congress for 40 years. The top Democrat on the Ways and Means Health Subcommittee since 1985, he may be best remembered for a body of law frequently referred to as "the Stark law." This collection of laws, passed in 1989 and 1994, was designed to prevent physicians from referring medical tests to centers in which they have a financial interest. It is expected that Rep. Jim McDermott (D-WA) will replace him in the next Congress as the ranking member of the Ways and Means Health Subcommittee. Rep. McDermott is a psychiatrist.
States needed to declare their intentions to run a state-based exchange by Nov. 16. However, Secretary Sibelius sent governors a letter stating that "in order to continue to provide you with appropriate technical support if you are pursuing a State-based Exchange, HHS is extending the deadline for State-based Exchange Blueprint application submissions to Friday, December 14, 2012." embed letter States likely to declare that they would run their own exchanges are thought to be Alabama, Arizona, Mississippi, Nebraska, Nevada and New Mexico. In addition, Sebelius announced that for states electing a state partnership exchange, in which the federal government would assist with exchange operations, applications would be accepted on a rolling basis, with a final exchange blueprint application due by Feb. 15.
For the first time, during this open enrollment season, Medicare officials are attempting to encourage approximately half a million beneficiaries to switch from 26 private drug and medical plans that have performed poorly over the past three years. In addition to the letters, Medicare is making it harder for people to sign up for one of the 26 plans. If they search for plans on Medicare's plan finder website, they can access and join other, better performing plans electronically but to join one of the 26, they must contact that insurance company directly. Those plans also have a special warning symbol next to their names to highlight their low ratings.
Public Citizen issued a statement on Tuesday calling the FDA "unconscionable" for denying a petition to ban Aricept 23, an Alzheimer's drug from manufacturer Eisai. According to Sidney Wolfe, the director of Public Citizen's Health Research Group, studies have failed to show the drug to be more effective than lower-dose drugs, but the drug did cause more vomiting, which can lead to pneumonia, gastrointestinal bleeding, esophageal rupture or death. Wolfe questioned whether the agency was "protecting the public health or, in effect, colluding with the drug industry when it denied a petition to ban Aricept 23, deciding to leave the dangerous drug on the market."
The Medicare Payment Advisory Commission met to continue work on issues including ambulance add-ons, geographic variations, home health and therapy caps, and other issues. To read a summary, click here.
3. State Activities
Missouri -- Voters approved a ballot measure that prevents the governor or a state agency from setting up an exchange without legislative or voter approval.
Florida -- Florida voters rejected a proposal that would have banned government mandates for obtaining insurance such as required by the Affordable Care Act. The proposed state constitutional amendment required 60 percent approval but didn't even have a majority with most of the vote counted Tuesday. It was favored by 48 percent and opposed by 52 percent.
Alabama -- Voters chose to prohibit individuals and businesses from being compelled to participate in any health care system. The initiative is considered largely symbolic.
Wyoming -- The ballot initiative passed to amend the state constitution to declare that the citizens of Wyoming have the right to make their own health care decisions and allow the state to act to "preserve these rights from undue government influence." The vote is considered largely symbolic.
Vermont -- The state issued a formal RFP late last week for health plans and stand-alone dental plans to sell on the exchange, known as Vermont Health Connect. The exchange is looking to make the final plan selections by mid-July.
New Mexico -- The planning group is looking to piggyback an exchange on an existing state health insurance program launched almost 20 years ago. The Health Insurance Alliance was created in the state to expand voluntary insurance coverage for small employer groups and individuals, but currently covers just about 4,000 people. A legislative workgroup has been studying whether the HIA would satisfy exchange governance requirements.
Virginia and Kansas Opt to Not Run an Exchange -- Governor Bob McDonnell of Virginia and Governor Sam Brownback of Kansas, both Republicans, announced that they would not pursue a State-based exchange. This means that the Federal Government would run the exchanges in those states.
4. Regulations Open for Comment
The Centers for Medicare & Medicaid Services (CMS) issued two final regulations updating Medicare payment rates and policies in calendar year (CY) 2013 for services furnished by physicians and other practitioners, as well as the rule for hospital outpatient departments and ambulatory surgical centers. Both rules were issued as final rules with a comment period until Dec. 31, 2012. The rules will take effect Jan. 1, 2013.
To read the final CY 2013 Medicare Physician Fee Schedule (MPFS) rule with comment period, and the final CY 2013 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rule with comment period, please visit the Office of the Federal Register.
As lawmakers prepare for intense deficit-reduction negotiations in Washington, the CBO released an analysis that details the consequences of not addressing the fiscal cliff, which describes a series of looming tax increases and spending cuts designed to reduce the nation's federal budget deficit. The report also describes various options for bringing spending and taxes into closer alignment, and criteria that lawmakers and the public might use to evaluate different approaches to deficit reduction. CBO's latest figures confirm what Republicans and Democrats acknowledge -- only selectively -- that health care is a large part of what is driving federal spending and debt. Health care programs are eating up an ever-increasing share of the economy, while tax revenues and other domestic spending are holding relatively steady. CBO also projects that maintaining the Medicare program's current payment rates to physicians and eliminating the expected automatic cuts to nondefense spending early next year would increase federal spending by about $40 billion in 2013 and by $61 billion the following year.
If you have any questions, please contact Stephanie Kennan, Senior Vice President, or Brian Looser, Assistant Vice President, at McGuireWoods Consulting. Founded in 1998, McGuireWoods Consulting LLC (MWC) is a full-service public affairs firm offering state and federal government relations, national/multistate strategies, infrastructure and economic development, strategic communications and grassroots issue management services. McGuireWoods Consulting is a subsidiary of the McGuireWoods LLP law firm and in 2010 was ranked in the Top 20 of The National Law Journal's "The Influence 50," an annual report of the top public affairs firms in Washington, D.C.
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