Washington Watch

Carter L. Alleman, J.D.

Affordable Care Act Repeal Fails to Garner Vote

House Republicans have ended consideration of their bill to repeal and replace the Affordable Care Act (ACA) because it lacked enough support for passage. The House floor vote on the American Health Care Act (H.R. 1628) was cancelled only shortly before it was scheduled to take place on Friday afternoon. Republicans had intended to repeal President Obama’s signature accomplishment on the seventh anniversary of its signing into law. GOP leadership had struggled to garner the votes necessary to pass the proposal since unveiling the plan. Negotiations attempted to appease two factions of the Republican Party: the conservative Freedom Caucus, which wanted to address the cost of health insurance through complete repeal of the ACA, and more moderate members, who were concerned about an increase in the uninsured rate and constituents losing health care coverage.

The Congressional Budget Office (CBO) found that recent changes to the ACA, like immediate repeal of Obamacare taxes and providing states the options of receiving Medicaid block grants and using work requirements in Medicaid, would result in less deficit reduction than the original ACA draft but would lead to the same levels of coverage losses and premium increases. Other late-breaking revisions to the bill include the elimination of essential health benefit requirements and the addition of $15 billion to the Patient and State Stability Fund, paid for by keeping the ACA’s Medicare tax on high earners for an additional six years.

The Freedom Caucus pushed for the elimination of the insurer ban from denying coverage to people with preexisting conditions, which would have resulted in a reduction in premium costs. The White House, however, was not willing to negotiate on the issue of preexisting conditions. In an attempt to pressure conservative Republicans to support the bill, President Trump issued an ultimatum, saying that he would leave the ACA in place unless lawmakers passed the White House backed legislation to repeal and replace the law.

CMS Allocates Funds to Help Small Practices Succeed in QPP

The Centers for Medicare & Medicaid Services (CMS) on February 17 granted approximately $20 million to 11 community-based organizations (CBOs) for the first year of a five-year program to educate and provide training on the Quality Payment Program (QPP) to health care practitioners in individual or small group practices with up to 15 clinicians. CMS will invest up to an additional $80 million over the next four years.

CBOs will provide these educational resources free of charge to numerous small practices, particularly those health care professionals who practice in historically disadvantaged and under-resourced areas, including rural areas, health professional shortage areas, and medically underserved areas. The CBOs will help practitioners successfully participate in the QPP by providing assistance with tasks such as selecting and reporting quality measures. A list of the 11 CBOs is included in the CMS press release.

To further assist practitioners in the transition to QPP, CMS has introduced a helpline that can be accessed at 866-288-8292.

Register Now for CMS Call on Global Codes Postoperative Care Data Reporting

The American College of Osteopathic Surgeons (ACOS) encourages members who are subject to the Centers for Medicare & Medicaid Services (CMS) reporting requirements for 10- and 90-day global services to participate in a CMS teleconference, 1:30−3:00 pm EST, Tuesday, April 25. This call will provide information regarding the new reporting requirements, along with reporting resources and tools.

The rule takes effect July 1 and applies to practitioners who furnish 10- and 90-day global services on a CMS list of 293 codes and who are in practices with 10 or more other practitioners in any of nine select states—Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island. These practitioners will be required to report Current Procedural Terminology (CPT) code 99024 for each postoperative visit related to the specified codes for services that they provide to a Medicare beneficiary.

The call will include a question-and-answer period. Coders, billers, and practice managers in the nine select states are encouraged to participate as well. Details about the call, including registration information, are posted on the CMS website.

Insurance Reforms Move Ahead

The House passed two bills that were intended to be a part of the GOP health care reform plan to enhance the American Health Care Act (AHCA). H.R. 372, the Competitive Health Insurance Reform Act, would end the exemption for health insurers from federal antitrust laws, and was passed by a vote of 416-7. The 1945 McCarran-Ferguson Act exempted insurers from federal antitrust laws to the extent it is regulated by a state. Republicans supported the bill as a means to increase competition in the health insurance market, while Democrats are in favor of enforcing antitrust regulations should insurers collude to raise rates or engage in other anti-competitive practices. The House also passed legislation that would remove some of the regulations on small businesses providing health insurance to their employees through association health plans (AHPs).

Trump's First Speech to Congress

In his first address to a joint session of Congress, the President voiced support for both the use of tax credits and an expansion of health savings accounts (HSAs) in repealing and replacing the Affordable Care Act (ACA). He also backed maintaining the law’s provision that requires insurance carriers to cover individuals with pre-existing conditions, as well as the provision of additional state flexibility to administer the Medicaid program. The President also mentioned support for medical liability reform, addressing the rising cost of prescription drugs, and expanding the ability to sell health insurance across state lines. President Trump had again suggested that his Administration may have plans to release their own plan to replace the 2010 health care law, separate from the work being done by congressional GOP leadership to overhaul the health care system.

Trump's Plan for Drug Pricing

While the GOP’s American Health Care Act (AHCA) does not contain any provisions that would address drug pricing, Rep. Elijah Cummings (D-Md.) said that the President is willing to work with Democrats on the issue. President Trump and Rep. Cummings met on the subject, and the President signaled he was open to granting the government more power to negotiate drug prices. Congressional Republicans have been historically opposed to such a policy. Rep. Cummings intends to introduce legislation on the subject in the coming weeks with Rep. Peter Welch (D-Vt.).

Continuing with Phase Two and Three

Phase one of GOP health care law repeal and replacement action has been deferred, but phases two and three continue. The administration can change regulatory requirements of the law and Congress can begin work on new legislative measures on health coverage options. Health and Human Services Secretary Tom Price was asked in a hearing last week about his ability to make regulatory changes to lower the cost of insurance coverage. Price responded: “Fourteen hundred and forty-two times the ACA said, the secretary shall or the secretary may.” Price precisely counted the opportunities for regulatory adjustments to the law.

Phase three of the GOP plan for health care law action calls for new legislation on health insurance market changes and proposals to entice lower health care costs. However, the new legislation is not covered by budgetary reconciliation rule and will require some Democratic support in the Senate along with unified Republican support in the House. Another test of phase three legislation begins this week with a planned vote on a bill addressing employer-sponsored health plan use of stop-loss coverage (HR 1304, view bill text). Self-insured health plans may purchase stop-loss coverage to cover costs after claims reach a specified level. The measure seeks to protect the special coverage by omitting stop-loss insurance from health plan regulations. More than half of all individuals with health insurance coverage in the U.S. are covered through employer plans.