Legislative Update: January 17, 2017

Marilyn Singleton, MD, JD is back with her first legislative update for the 115th Congress. 

The 115^th United States Congress has convened with the introduction of numerous health care bills. Most bills we looked at last year have “died in a previous Congress.” Bills are not carried forward from Congress to Congress. They have two years to make it into law.

Senate Sets Stage for Reconciliation Bill: First Step in Repealing ACA

On January 12, 2017, the Senate voted 51-48 along party lines (with a lone Republican “NAY” by Rand Paul) for the resolution – S.Con.Res. 3 –  that will start the reconciliation process. The House followed with its approval in a 227-198 vote on January 13. Reconciliation allows for expedited consideration of certain tax, spending, and debt limit legislation. A reconciliation measure cannot be filibustered and the Senate can pass such a bill with a simple majority. This is the same procedure used to pass the ACA. Under the resolution, the House and Senate committees must come up with repeal legislation by January 27^th.  Under this process, however, only certain taxing/spending-related provisions of the ACA would be repealed, but would not repeal the entire law. For example, pre-existing condition mandates for insurers would remain.

Additionally, House Speaker Paul Ryan said he would like a “concurrent” replace and repeal.

Another Step Toward Interstate Licensure

Jan 9, 2017, H.R. 302, the Sports Medicine Licensure Clarity Act of 2017, was introduced by Brett Guthrie (R-KY). This was a re-introduction of the same 2016 bill. On January 9, 2017, the bill passed the House and was referred to Senate Committee on January 10^th. The bill protects sports medicine professionals to who have malpractice insurance and provide services to an athlete in a Secondary State pursuant to a contract, the insurance shall cover the professional. If the professional is licensed in the Primary State, they are presumed to have satisfied licensure requirements for licensure in the Secondary State (where services were rendered). This bill’s language is another step in opening the door for interstate licensure.

Full text: https://www.govtrack.us/congress/bills/115/hr302/text.

Just What We Don’t Need: Another Commission

On January 5, H.R. 309, the National Clinical Care Commission Act, was introduced by Rep. Pete Olsen (R-TX).  On January 9, 2017, the House passed the bill.  This bill amends the Public Health Service Act to establish within the Department of Health and Human Services (HHS) a National Clinical Care Commission to evaluate and recommend solutions regarding better coordination and leveraging of federal programs that relate to supporting clinical care for individuals with complex metabolic or autoimmune disease, diabetes, or complications caused by such diseases.

The duties of the commission include: evaluating HHS programs regarding the utilization of preventive health benefits, identifying current activities and gaps in federal efforts to support clinicians in providing integrated care, making recommendations regarding the development and coordination of federally funded clinical practice support tools, recommending clinical pathways for new technologies and treatments, evaluating and expanding education and awareness activities provided to health care professionals, and reviewing and recommending methods for outreach and dissemination of educational resources. The commission must submit an operating plan to HHS and Congress within 90 days of its first meeting. The commission is terminated after it submits a final report, but not later than the end of FY2021.

Full text: https://www.govtrack.us/congress/bills/115/hr309/text.

On Jan 9, 2017, H.R. 315, the Improving Access to Maternity Care Act, was introduced by Rep. Michael Burgess (R-TX). On January 9, 2017, the bill passed the House and was referred to Senate Committee on January 10^th. This bill amends the Public Health Service Act to require the Health Resources and Services Administration (HRSA) to identify areas within health professional shortage areas that have a shortage of maternity care health professionals, for purposes of assigning maternity care health professionals to those areas.

Full text: https://www.govtrack.us/congress/bills/115/hr315/text.

A Batch of Health Care Related Bills: Awaiting the Text

Ted Cruz introduced a bill to repeal the ACA in its entirety. This may end up being the only relevant bill. Multiple bills were introduced that chipped away at the Affordable Care Act. These may be posturing for the congressperson’s constituency or they honestly believe the ACA will not be repealed.  Rand Paul has tweeted out the first page of “THE Obamacare Replacement Plan,” which he says will be released in full soon.  He shared some details in an interview with CNN.

Senate:

On January 4, 2017, S. 28, the Health Savings Account Expansion Act of 2017 was reintroduced by Sen. Jeff Flake. It is a bill “to amend the Internal Revenue Code of 1986 to expand the permissible use of health savings accounts to include health insurance payments and to increase the dollar limitation for contributions to health savings accounts, and for other purposes.”  The House companion bill is H.R. 247, introduced by Rep. Dave Brat.

On January 5, 2017, S. 41, A bill to amend part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate covered part D drug prices on behalf of Medicare beneficiaries was introduced by Sen. Amy Klobuchar (D-MN) and referred to the Senate Finance Committee.

On January 10, 2017, S. 85, a bill to amend the Internal Revenue Code of 1986 to repeal the amendments made by the Patient Protection and Affordable Care Act which disqualify expenses for over-the-counter drubs under health savings accounts and health flexible spending arrangements was introduced by Sen. Pat Roberts (R-KS) and referred to the Senate Finance Committee. The sister bill in the House, H.R. 394, was introduced on January 10^th by Rep. Lynn Jenkins (R-KS) and referred to the House Ways and Means Committee.

On January 10, 2017, S. 93, a bill to allow women greater access to safe and effective contraception was introduced by Sen. Joni Ernst (R-IA) and referred to the Senate Finance Committee. The sister bill, H. R. 421 was introduced by Rep. Mia Love (R-UT) and referred to the House Energy and Commerce and Ways and Means Committees.

On January 12, 2017, S. 106, a bill to repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 in its entirety was introduced by Sen. Ted Cruz (R-TX) and referred to the Senate Finance Committee.

On January 12, 2017, S. 109, a bill to amend title XVIII of the Social Security Act to provide for coverage under the Medicare program for pharmacist services was introduced by Sen. Charles Grassley (R-IA) and referred to the Senate Finance Committee.

House:

On January 6, 2017, H.R. 352, a bill to amend the Social Security Act to replace the Medicaid program and the Children’s Health Insurance program with a block grant to the States was introduced by Rep Todd Rokita (R-IN) and referred to the House Appropriations, House Committee on Education and the Workforce Committee, and 6 other committees.

On January 9, 2017, H.R. 370, a bill to repeal the patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation act of 2010, was introduced by Rep. Bill Flores (R-TX) and referred to the House Appropriations, House Committee on Education and the Workforce Committee, and 7 other committees.

On January 10, 2017, H.R. 407, a bill to amend the Internal Revenue Code of 1986 to allow a deduction for premiums for insurance which constitutes medical care, was introduced by Rep. Steve King (R-IA) and referred to the House Ways and Means Committee.

On January 10, 2017, H.R. 408, a bill to amend the Internal Revenue Code of 1986 to expand health savings accounts was introduced by Rep. Steve King (R-IA) and referred to the House Ways and Means Committee.

On January 10, 2017, H.R. 409, a bill to amend title XVIII of the Social Security Act to sunset certain penalties relating to meaningful electronic health records use by Medicare eligible professionals and hospitals was introduced by Rep. Steve King (R-IA) and referred to the House Energy and Commerce and Ways and Means Committees.

On January 10, 2017, H.R. 410, a bill to amend title XVIII of the Social Security Act to exclude coverage of advance care planning services under the Medicare program was introduced by Rep. Steve King (R-IA) and referred to the House Energy and Commerce and House Committee on Ways and Means Committees.

On January 12, 2017, H.R. 499, a bill to require members of Congress and congressional staff to abide by the Patient Protection and Affordable Care Act with respect to health insurance coverage was introduced by Rep. Ron DeSantis (R-FL) and referred to the House Energy and Commerce and House Administration Committees, and 2 other committees.

On January 12, 2017, H.R. 508, a bill to expand Medicare coverage to include eyeglasses, hearing aids, and dental care was introduced by Rep. Lucille Roybal-Allard (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees.

On January 13, 2017, H.R. 521, a bill to amend the Internal Revenue Code of 1986 to provide an exemption to the individual mandate to maintain health coverage for individuals residing in counties with fewer than two health insurance issuers offering plans on an Exchange was introduced by Rep. Mark Amodei (R-NV) and referred to the House Ways and Means Committee.

On January 13, 2017, H.R. 537, a bill to amend the Internal Revenue Code of 1986 to provide an exemption to the individual mandate to maintain health coverage for individuals residing in counties with fewer than two health insurance issuers offering plans on an Exchange; to require members of Congress and congressional staff to abide by the Patient Protection and Affordable Care Act with respect to health insurance coverage was introduced by Rep. Andy Biggs (R-AZ) and referred to the House Energy and Commerce and House Administration Committees, and 2 other committees.

On January 13, 2017, H.R. 562, a bill to amend the Internal Revenue Code of 1986 to flatline the individual mandate penalty was introduced by Rep. Luke Messer (R-IN) and referred to the House Ways and Means Committee.

On January 13, 2017, H.R. 563, a bill to amend the Internal Revenue Code of 1986 to exempt certain individuals from the individual health insurance mandate was introduced by Rep. Luke Messer (R-IN) and referred to the House Ways and Means Committee.

Only My Opinion

There a bill from the last Congress that I am glad is dead. Sen. Ron Wyden (D-OR) introduced Senate Resolution 590, a resolution commemorating 100 years of health care services provided by Planned Parenthood, “affirm[ing] that Planned Parenthood remains an essential thread in the fabric of society.” My objection is that Planned Parenthood’s founder, Margaret Sanger is quite controversial. She supported eugenics, noting, “Eugenics suggests the reestablishment of the balance between the fertility of the “fit” and the “unfit.” In The Pivot of Civilization (1922) she referred to immigrants and poor people as “reckless breeders,” “spawning…human beings who never should have been born.”  No matter what one’s views on today’s Planned Parenthood or abortion are, Planned Parenthood’s advocates should include a denunciation of its founder’s extreme views alongside its praise for the present-day organization.