Health Care Reform Implementation Update - April 14, 2014

Last Thursday Kathleen Sebelius resigned from her post as Secretary of Health and Human Services (HHS). On Friday President Obama nominated Sylvia Matthews Burwell, the Office of Management and Budget (OMB) Director.  As March came to a close, the first official open enrollment period since the individual mandate went into effect and the health insurance exchanges began operating came to a close, and the Obama administration met its goal of 7 million people signing up for health insurance. The Congress passed and President Obama signed into law a one-year “doc fix,” the Protecting Access to Medicare Act, which prevents payment cuts to doctors who provide care to Medicare beneficiaries that were slated to go into effect on April 1. Though Congress spent considerable effort to achieve a permanent fix to the formula used to determine Medicare payments to doctors, it ultimately was unable to find a way to pay for the permanent fix before April 1 and instead passed a temporary patch. The Centers for Medicare and Medicaid Services (CMS) released its final Medicare Advantage (MA) payment announcement, which increases MA rates by .4 percent.  And finally, in a historic move, CMS released data on payments to Medicare doctors.

ON THE HILL

On April 1, President Obama signed the “Protecting Access to Medicare Act,” which delays Medicare payment cuts to physicians under the sustainable growth rate formula (SGR), the formula on which doctors who see Medicare patients' payments are based, for another year. This latest “doc fix” passed the House by a controversial voice vote on March 27 and passed the Senate on March 31, the day before the previous doc fix was set to expire. There was significant pushback from many congressional members who would have preferred to see a permanent repeal of the SGR formula. Senate Finance Committee Chairman Ron Wyden (D-Ore.) was perhaps the most vocal opponent of this temporary “patch” and still plans to move forward with his bill that would permanently repeal the SGR. Chairman Wyden received strong support for his bill from numerous senators but ultimately no agreement could be reached on how to pay the $140-180 billion price tag for permanent repeal of the SGR.

Although the temporary doc fix is the main component of the Protecting Access to Medicare Act, other elements of the law will affect various areas of the health care industry as well. Of particular note is a provision that would delay ICD-10 implementation (a revision of the medical classification list by the World Health Organization) for another year despite CMS Administrator Marilyn Tavenner’s definitive statement in February that such a delay would not occur. The law also includes provisions that will create a value-based purchasing program for skilled nursing facilities, delay the enforcement of CMS’s two-midnight rule, create a framework for ordering diagnostic imaging scans, and provide relief to dialysis providers who received a payment cut last year. 

On April 3, the House passed the Save American Workers Act, which would change the definition of full-time work under the Affordable Care Act (ACA) from 30 hours to 40 hours per week. Congressional members that led the charge say that the 30-hour week definition incentivizes companies to cut work hours to 29 per week, resulting in smaller paychecks for individuals who previously worked more than 29 hours a week as well as a less productive economy. The Senate is not expected to take up the bill, and the president has already stated that he would veto it if it came to his desk.

House Budget Committee Chairman Paul Ryan (R-Wis.) released his FY2015 budget blueprint, which aims to balance the federal budget by cutting $5 trillion in spending over the next decade. The plan, called “The Path to Prosperity: A Responsible, Balanced Budget” would cut $5.1 trillion in spending, balance the budget by 2024, repeal the Affordable Care Act, reform Medicaid, SNAP (Supplemental Nutrition Assistance Program) and Medicare, and adopt parts of Ways and Means Chairman Dave Camp’s tax reform proposal. Given the proposal’s repeal of the ACA as well as its substantial reforms to entitlement programs, the plan has no chance of passing in the Senate but nonetheless serves as a vehicle for Republicans to define their priorities. On April 10, the House passed the budget measure. 

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program, met on April 3 and 4. The commissioners discussed the Health and Human Services (HHS) secretary’s required report on the impact on home health payment rebasing on beneficiary access to and quality of care, team-based primary care, per-beneficiary payment for primary care, measuring quality of care in Medicare, and measuring the effects of medication adherence for the Medicare population.

The Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC), the non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, met on April 10 and 11.  The commissioners discussed: improving delivery and payment: state perspectives on the Medicaid health homes initiative, managed care payment, the Children’s Health Insurance Program, administrative capacity, Medicaid and population health, long-term services and supports, Medicaid managed care encounter data and Children's Health Insurance Program Reauthorization Act (CHIPRA).

AT THE AGENCIES

Last Thursday Kathleen Sebelius resigned from her post as Secretary of Health and Human Services (HHS). On Friday President Obama nominated Sylvia Matthews Burwell, the Office of Management and Budget (OMB) Director. Burwell has a business background, which many have said is a key distinction the drivers of the ACA’s implementation should have. 

The Obama administration has extended the ACA enrollment period to April 15 for certain individuals who had begun filling out paperwork but had yet to complete the process, as well as for other individuals in particular circumstances. On March 26, the Center for Consumer Information and Insurance Oversight (CCIIO), released guidance for these extensions. CCIIO released a second guidance document that details additional grounds for extensions such as natural disasters, medical emergencies, planned system outages that occur near plan selection deadlines, display errors on the marketplace website, or enrollment errors where insurance companies do not receive a consumer’s information due to technical problems 

On April 3, HHS announced that the Social Security Administration has begun processing Medicare requests for same-sex spouses. This announcement served to clarify the effect that the Supreme Court ruling last year against portions of the Defense Against Marriage Act would have on evaluating the eligibility of same-sex couples for Medicare benefits. 

On April 7, the Centers for Medicare and Medicaid Services (CMS) announced that there would be a 0.4 percent increase in payment rates for Medicare Advantage in 2015. In February CMS had proposed a cut of 1.9 percent. The payment increase was announced after significant pushback from congressional members who expressed concern that the cuts would cause undue harm to seniors and specific concerns from Democrats who were worried that the proposed cuts would further harm their mid-term election prospects.

 On April 9, CMS released a detailed accounting of Medicare payments to 880,000 doctors. This is first time in over 35 years for this level of disclosure. The disclosure of these payments is intended to provide better transparency on the kinds of procedures performed by individual doctors and the amount of money physicians receive from the government through Medicare. Physician groups had resisted this move as a privacy violation. An injunction by the American Medical Association that had been in place since 1979 was overturned by a federal judge in May 2013, prompting the release of this data. So far, the data has revealed that a small proportion of doctors receive over a quarter of the $77 billion in Medicare payments to providers.

On April 10, then Secretary Sebelius testified before the Senate Finance Committee on the president’s budget with respect to HHS. Secretary Sebelius said that at least 7.5 million Americans have signed up for health coverage through the ACA exchanges. In response to questions, Sebelius said that she does not know how many of those who signed up for coverage previously had insurance or how many lost their plans because of the ACA's requirements. Additionally, Secretary Sebelius said that the decision to begin the next open enrollment period on November 15 instead of October 1 was not made for political reasons and separately said that the federal commitment to Medicaid expansion (the 100 percent match rate) was solid for the next 10 years so long as funding is not repealed by Congress. 

IN THE WHITE HOUSE

On April 1, the Obama administration announced that more than 7 million individuals had signed up for health insurance through the ACA exchanges. Supporters of the ACA touted the achievement as a huge victory for health reform, especially given the early and continuing technological issues the exchanges face. Opponents of the law are calling the figure misleading, as it does not detail how many of those who signed up were individuals who already had health insurance prior to the ACA, nor does it provide information on how many of these individuals have paid the premiums associated with the plans. According to a report by the Blue Cross and Blue Shield Association, the trade association for all Blue Cross and Blue Shield plans, 80-85 percent of individuals who have signed up for their plans under the ACA have paid their premiums. The Obama administration has yet to release actual payment data for all of the individuals across all plans that have enrolled in ACA exchanges.

Robert Gibbs, former White House press secretary, recently called into question whether or not the employer mandate under the ACA will actually be implemented, saying, “It’s a small part of the law. I think it will be one of the first things to go” at an event in Colorado. In an appearance on CNN’s “Face the Nation” on April 6, House Minority Leader Nancy Pelosi pushed back on Gibbs’ statement by assuring the public that the employer mandate would not be eliminated.

IN THE STATES

On March 25, New Hampshire lawmakers voted to become the 26th state to expand Medicaid under the ACA.

DC Health Link, the District of Columbia’s health insurance exchange, announced that it would allow residents to apply for individual or family coverage under the ACA until April 15.

On April 2, Louisiana Governor Bobby Jindal (R) introduced his replacement health care plan to the Affordable Care Act. Main features of Governor Jindal’s plan include full repeal of the Affordable Care Act, allowing the states to develop their own plans for covering individuals with preexisting conditions, a tax deduction for individuals who purchase their own insurance plans, and giving seniors funds to purchase private health insurance outside of the Medicare and Medicaid programs. Governor Jindal’s plan is a plan intended not just for Louisiana, but for the country, that you can expect to see as a primary component of his presidential campaign platform should he run. 

IN THE COURTS

While substantial attention has been paid to the case before the Supreme Court of Sebelius v. Hobby Lobby, in which Hobby Lobby as well as Conestoga Wood challenge the ACA’s requirement that private companies provide particular types of contraceptives through their health insurance plans contrary to the owner’s religious beliefs, there is another case that would be more damaging to the ACA were it to be decided in favor of the law’s challengers. On March 25, the Court of Appeals for the D.C. Circuit heard oral arguments in Halbig v. Sebelius. The case turns on a question of statutory interpretation. The ACA, as written, seems to only provide for subsidies for low-income individuals who are on state exchanges. Thirty-six states, however, are not operating state exchanges but rather are using the federal exchange. Were the courts to find that subsidies could only be given to individuals using state-run exchanges, many fewer people would be able to afford coverage through the federal exchanges. Supporters of the Affordable Care Act say that this case is a long shot for the challengers.

To view our compilation of recent health care reform implementation news, click here.

To view and search our library of Health Care Reform Implementation Updates, visit our Affordable Care Act Databook

Health Care Reform Implementation Update - March 26, 2014

On Sunday, the Affordable Care Act (ACA) turned four. Unsurprisingly, Democrats celebrated the law’s birthday by touting its many successes and Republicans used it to highlight the problems the law has faced, as well as caused. The Department of Health and Human Services (HHS) extended the ACA’s hardship exemption until 2016; an Office of Management and Budget (OMB) report effectively exempted exchange subsidies from sequestration; and the White House announced that it will continue the federally run Pre-Existing Condition Insurance Plan (PCIP) program for one extra month. Additionally, though significant work has been done over the past few weeks and months to find a way to permanently repeal the Sustainable Growth Rate (SGR), on March 25 the Senate Finance Committee and House Ways and Means Committee advanced a bill that would provide a short-term fix to Medicare provider payment rates through March of 2015, which will prevent doctors who treat Medicare patients from having their payments cut as scheduled for Tuesday April 1, 2014.

ON THE HILL

On March 26, following negotiations between House Speaker John Boehner and Senate Majority Leader Harry Reid, the House advanced a bill that would temporarily fix the SGR cuts to Medicare providers. Importantly, the bill prevents the 24% cut in reimbursement that would have gone into effect for doctors who treat Medicare patients this coming Tuesday. Congressional leaders say they will continue to work towards a permanent fix for the SGR.

On March 18, leaders of the House Ways and Means and Senate Finance committees released a bipartisan discussion draft that seeks to improve Medicare payments to providers caring for Medicare enrollees who are recovering from injuries and acute illnesses. The "Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014" would require standardized data allowing Medicare to compare the quality of care among different settings and use that information to reform the payment system and specifically would affect long-term care hospitals, skilled nursing facilities, home health agencies and rehabilitation services.

The House passed a few other bills last week that would make certain changes to the Affordable Care Act. TheEquitable Access to Care and Health (EACH) Act, championed by Rep. Aaron Schock (R-Ill.), passed the House. The bill would expand the ACA’s religious conscience exemption, excusing individuals from the individual mandate if they affirm on their tax returns that “sincerely held religious beliefs” would cause them to object to medical health care that would be covered under such coverage.

The House also passed the Hire More Heroes Act of 2013, which was offered by Rep. Rodney Davis (R-Ill.). The legislation would ensure that veterans who already receive medical care through the TRICARE program, the health care program of the U.S. Department of Defense Military Health System, would not be counted towards the 50-person threshold for requiring an employer to provide health insurance to his or her employees.

Finally Rep. Lou Barletta (R-Pa.) introduced the Protecting Volunteer Firefighters and Emergency Responders Act of 2014, which passed unanimously in the House. In an effort to avoid placing an undue cost burden on organizations like volunteer fire departments, the bill would exempt emergency service volunteers from being counted as employees for purposes of the ACA.

The House Ways and Means Committee held a hearing on the president’s FY 2015 budget for HHS. In his opening statement, Chairman Dave Camp (R-Mich.) questioned Secretary Kathleen Sebelius on the cost of the ACA overall, the cost incurred by the inefficient roll-out of the ACA exchange websites, and the number of individuals that have actually made payment towards their ACA exchange health coverage. Secretary Sebelius reported that health care premiums are likely to go up, but she expects that they will be “smaller than we’ve seen prior to the passage of the Affordable Care Act.”

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program, released one of its biannual reports to Congress. The Commission made specific recommendations on payments for hospital inpatient and outpatient services, ambulatory surgical center services, outpatient dialysis services, post-acute care providers, skilled nursing facilities, home health care services, inpatient rehabilitation facility services, long-term care hospital services, hospice services and the Medicare Advantage program.

The Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC), the non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, also released one of its biannual reports to Congress. The commission made specific recommendations on pregnancy coverage under the ACA, children’s coverage under CHIP and exchange plans, and Medicaid non-disproportionate share hospital supplemental payments.

AT THE AGENCIES

On March 5, HHS released a technical bulletin, buried at the end of which was a further delay to the individual mandate’s hardship exemption. There is a paragraph within the bulletin that notes that a delay in enforcement of the individual mandate included in a separate December 2013 bulletin would be extended for two additional years until 2016. The rule allows Americans whose coverage was cancelled to opt out of the individual mandate until 2016.

On March 11, CMS released a final rule, the HHS Notice of Benefit and Payment Parameters for 2015, in which it says: “We intended to propose standardized methodologies to take into account the special circumstances of issuers associated with the initial open enrollment and other changes to the market in 2014, including incurred costs due to technical problems during the launch of the state and federal exchanges.” Though not much more detail was provided on the topic, many have interpreted the rule to signal that the ACA’s Medical Loss Ratio (MLR) provisions will be relaxed. The MLR provision of the ACA required health plans to spend at least 80 percent of premiums on providing medical care. The change in this rule is likely due to insurance company concerns that they have faced and will continue to face increased administrative costs for 2014 due to technological problems and last-minute administrative changes.

On March 14, CMS published a proposed rule, the Exchange Insurance Market Standards rule, which addresses several mostly unrelated issues that involve the exchanges or the ACA’s insurance market reforms. More specifically, the rule proposes standards related to quality reporting, non-discrimination, minimum certification and responsibilities of qualified health plan (QHP) issuers, the Small Business health Options Program, and enforcement remedies in federally facilitated exchanges.

On March 7, CMS released a final rule on the ACA’s Basic Health Program (Section 1331 of the ACA) as well as its methodology for funding it for 2015. The Basic Health Program provides a bridge between the ACA’s expanded Medicaid program and exchange coverage by giving states the option of establishing a Medicaid-like choice for people with incomes too high for the Medicaid expansion but in the lowest income bracket of those on the exchanges. The rule finalizes a proposal to provide funding for states that want to take up the program in 2015.

On March 10, in response to pressure from Congress and various stakeholders, CMS announced that it will not be making some proposed changes to Medicare Advantage and the Medicare Part D program (the Medicare drug benefit program) that the department was considering. CMS had proposed eliminating three drug classes from protected class status (antidepressant, antipsychotic and immunosuppressant). There was widespread concern that eliminating this protected class status could force providers to alter their treatment regimens. The rollback of these changes means that Medicare will continue to require insurers to cover nearly all medications in six classes of drugs and quickly produced praise from many health care groups.

HHS reported that ACA insurance plans have now enrolled about 5 million people. The rate of enrollment in February was not significantly stronger than the January enrollment rate and the administration’s new goal of 6 million enrollees by March 31 will be hard to obtain with only two weeks to go. The administration stated they had “no plans” to extend the enrollment period. First Lady Michelle Obama is working on an initiative to reach out to mothers and encourage them to put pressure on their young adult children to sign up under the exchanges. Healthy young adult enrollees are a key demographic for the successful implementation of the ACA.

Though CMS has named Hewlett-Packard Co. as the replacement for the current host of HealthCare.gov, Terremark, on March 7 CMS announced that it would extend Terremark’s contract to ensure a smooth transition through the end of open enrollment.

IN THE WHITE HOUSE

On March 25, the Obama administration said it will extend the open enrollment deadline of March 31 for those who tried to sign up for health insurance but had trouble completing the enrollment process.

Among the items included in a report from the Office of Management and Budget (OMB) detailing the impact on sequestration (the across-the board cuts that arose from the Budget Control Act of 2011), was an exemption from sequestration for 2015 for the ACA’s exchange subsidies. These subsidies reduce the maximum costs that ACA enrollees with household income levels below 250 percent of the federal poverty level pay out-of-pocket for insurance co-payments. The change adds about $560 million to the cost of administering the exchanges.

The Obama administration announced that it will continue the federally run Pre-Existing Condition Insurance Plan (PCIP) (a type of health insurance offered to those who are uninsured and who have been unable to obtain coverage due to a pre-existing health condition) for one extra month, allowing individuals who have not yet found new health insurance through the exchanges to be enrolled in the PCIP through April 30, 2014.

IN THE COURTS

On March 25, the Supreme Court heard oral arguments on the ACA’s requirement that most employers provide contraception in their company health plans. Hobby Lobby and Conestoga Wood argued that providing certain contraceptives required by the ACA violate their religious beliefs and argued further that for-profit businesses can exercise religious rights. The Obama administration is challenging these claims. Though we do not yet know how the justices will rule on the matter, the questions they asked yesterday indicate to many that there is a real possibility that the Supreme Court may decide businesses cannot be required to provide birth control if doing so violates their strongly held religious beliefs.

IN THE STATES

Florida’s special election race for Florida’s 13th District involved campaigning from both sides on the Affordable Care Act. Republican David Jolly’s win over Democrat Alex Sink was seen by many as a victory for those who oppose the Affordable Care Act. As a result, many Democrats are increasingly worried about their own races in this year’s upcoming elections and are reevaluating how much support or opposition to express for the Affordable Care Act.

California is still the lead in enrollee numbers for Obamacare and has enrolled twice as many people as the next closest state for a total of 868,000. Massachusetts and Nevada, which both had trouble with their initial state run exchange roll-outs, also saw enrollment rates increase for the month of February.

To view our compilation of recent health care reform implementation news, click here.

To view and search our library of Health Care Reform Implementation Updates, visit our Affordable Care Act Databook

Infrastructure Alert - March 25, 2014

On March 20, a proposed shipping alliance of three major shippers was approved by the Federal Maritime Commission. The P3 Network Vessel Sharing Agreement, consisting of Maersk Line, Mediterranean Shipping Company and CMA CGM, authorizes these three ocean carriers, the largest containership operators in the world, to share space on vessels deployed in the three major east-west trades. European and Chinese regulators must approve the agreement before it can go into effect.

The Department of Transportation has updated its Highway Trust Fund ticker to reflect that the trust fund could dip below a $4 billion balance, a threshold under which the Department of Transportation will have to slow disbursements, in late July. The current authorization for surface transportation programs expires at the end of September.

ON THE HILL

On March 14, the Senate passed H.R. 4076, the Home Heating Emergency Assistance Through Transportation (HHEATT) Act of 2014. The bill, introduced by House Transportation and Infrastructure Chairman Bill Shuster on February 25, grants the Secretary of Transportation the authority to extend short-term emergency declarations from theFMCSA to allow tank truck operators delivering propane and other home heating fuels to drive for longer hours in order to speed up deliveries. President Obama signed the bill into law on March 21. The bill expires after May 31, 2014, unless the Secretary of Transportation makes a determination that a winter emergency persists past this date.

Hearings in the House and Senate highlighted some Members’ frustration with the surface transportation reauthorization funding mechanism supported by the Administration, to use revenues from corporate tax reforms to supplement Highway Trust Fund revenues to bridge the projected shortfall.

On March 13, several Senators expressed skepticism of the President’s budget plan to use corporate tax reform to prop up diminishing Highway Trust Fund revenues. During the Appropriations Transportation Subcommittee hearing on the FY2015 budget request for the Department of Transportation, Subcommittee Ranking Member Susan Collins (R-Maine) remarked that the proposal was controversial and stated her disapproval, adding that she did not think it was realistic to believe Congress will be able to reform the tax code this year.

On March 12, during the House Transportation and Infrastructure Committee hearing on MAP-21 implementation and the FY2015 surface transportation budget request, Rep. Peter DeFazio (D-Ore.) asked Department of Transportation Acting Under Secretary for Policy Peter Rogoff if the Administration had a backup plan other than the corporate tax reform. Rep. DeFazio rebuffed Rogoff’s answers, adding that he considers the notion that such tax reform could happen this Congress to be “illusory” and “fake.” Rogoff testified that the Department of Transportation could be unable to meet all of its obligations out of the Highway Trust Fund prior to August.

On March 11, Sens. John Boozman (R-Ark.), Pat Roberts (R-Kan.), and Jerry Moran (R-Kan.) introduced S. 2103, the General Aviation Pilot Protection Act of 2014. If enacted, the bill would require the FAA to reform its general aviation medical standards. A companion bill, H.R. 3708, was introduced in December 2013 by Rep. Todd Rokita (R-Ind.) and has 74 co-sponsors.

Tomorrow, the House Appropriations Subcommittee on Energy and Water Development will hold a hearing on Appropriations for the U.S. Army Corps of Engineers. Jo Ellen Darcy, Assistant Secretary of the Army for Civil Works, and Lt. Gen. Thomas P. Bostick, Chief of Engineers, will testify.

Also tomorrow, the House Transportation and Infrastructure Subcommittee on Coast Guard and Maritime Transportation will hold a hearing on the proposed FY2015 budget request for the U.S. Coast Guard and related marine transportation programs. Witness testimony will be provided by Admiral Robert J. PappJr., Commandant, U.S. Coast Guard; Master Chief Michael P. Leavitt, Master Chief Petty Officer of the Coast Guard, U.S. Coast Guard; Paul “Chip” Jaenichen, Sr., Acting Administrator, Maritime Administration; and Mario Cordero, Chairman, Federal Maritime Commission. Written testimony and a webcast of the hearing will be available here.

The Senate Committee on Homeland Security and Governmental Affairs will hold a hearing titled “Strengthening Public-Private Partnerships to Reduce Cyber Risks to Our Nation’s Critical Infrastructure” tomorrow. Witness testimony will be provided by Phyllis A. Schneck, Ph.D, Deputy Under Secretary for Cybersecurity, National Protection and Programs Directorate, U.S. Department of Homeland Security; Donna Dodson, Chief Cybersecurity Advisor, National Institute of Standards and Technology, U.S. Department of Commerce; Stephen L. Caldwell, Director, Homeland Security and Justice Issues, U.S. Government Accountability Office; Elayne Starkey, Chief Security Officer, Delaware Department of Technology and Information; David M. Velazquez, Executive Vice President for Power Delivery, Pepco Holdings, Inc.; Doug Johnson, Vice Chairman, Financial Services Sector Coordinating Council; and Steven R. Chabinsky, Chief Risk Officer, CrowdStrike, Inc. (testifying in his personal capacity). Written testimony and a webcast of the hearing will be available here.

On Thursday, the Senate Committee on Environment and Public Works will hold a hearing titled “MAP-21 Reauthorization: State and Local Perspectives on Transportation Priorities and Funding.” Witness testimony will be provided by Michael Lewis, Secretary, Rhode Island Department of Transportation; Sue Minter, Deputy Secretary, Vermont Agency of Transportation; Greg Ballard, Mayor, City of Indianapolis; Mick Cornett, Mayor, Oklahoma City; BillFontenot, President, St. Landry's Parish, Louisiana; Jim Willox, Chairman, Converse County Commission, Wyoming; and Dave Gula, Principal Planner, Wilmington Area Planning Council, Delaware. Written testimony and a webcast of the hearing will be available here.

AT THE AGENCIES

Yesterday, the U.S. Maritime Administration announced that its second symposium to help develop a National Maritime Strategy will be held on May 6, 2014. The deadline to submit domestic maritime proposals and agenda topics for inclusion is April 25. The agenda for the symposium, which will be held as part of a meeting of the Marine Transportation System National Advisory Council, will be released on April 28.

On March 19, the FAA published its final report on the safety of the Dreamliner. The Boeing 787-8 Design, Certification, and Manufacturing Systems Review concludes that the Dreamliner “meets its intended level of safety,” and that while “design issues have occurred,” the Boeing 787-8 Critical Systems Review Team “found their cause tended to represent individual escapes in the design or manufacture of the airplane.”

The National Transportation Safety Board released a highway accident brief on the July 19, 2013 Chesapeake Bay Bridge accident.

This month, the Federal Transit Administration has announced $30 million in competitive funds to 42 Native American tribes in 19 states for projects to improve transit service. Tribes and projects receiving funding can be found here.

On March 18, Amtrak released its FY2015 budget request. The request describes Amtrak’s reorganization into three rail-related business lines: Northeast Corridor (NEC) Operations, State-Supported Services and Long Distance Services. Amtrak requests no federal operating support for the NEC for FY2015, but requests $445 million in federal capital investment. Amtrak also requests $83 million of federal operating support for state-supported services, and the totality of the $618 million of FY2015 operating costs needed for long distance services. Amtrak requested $295 million in capital investment for long distance services, including $50 million for ADA compliance at stations, $130 million for the purchase of new rolling stock to replace Heritage cars, and $115 million for overhauls to its fleet. Amtrak’s total FY2015 budget request is $1.62 billion, up from $1.39 billion last fiscal year.

On March 13, the FMCSA announced a proposed rulemaking to require interstate commercial truck and bus companies to use electronic logging devices to ensure compliance with rules that limit how many hours drivers can work.

On March 13, the FAA released its annual Aerospace Forecasts. Among many of the forecasts made, the FAA predicts that ridership on U.S. airlines will grow steadily to over 1 billion prior to 2034. Last year, U.S. airlines carried over 740 million passengers, an increase of nearly 1 percent from the year prior.

At the end of April, Deborah Hersman, Chairwoman of the NTSB, will step down to become the President and CEO of the National Safety Council. Hersman has chaired the NTSB since 2009 and joined in 2004.

IN THE STATES

California: Yesterday, the Assembly Transportation Committee rejected a bill to prohibit using federal grant money on the California High-Speed Rail project until the state has secured matching funds. The committee voted down the bill, A.B. 1501, on a vote of 8-4. While the state is required to match the $3 billion in grant money that the Federal Railroad Administration has approved for the project, the FRA has allowed California to spend federal money until it can come up with its matching funds. Raising matching funds from the sale of bonds, authorized by referendum, is currently entangled in legal challenges. On March 14, the California High-Speed Rail Authority was granted permission tobegin eminent domain proceedings against eight properties in Fresno.

Michigan: On March 18, 40 organizations, including construction and labor groups, wrote a letter to President Obama to requesting that the Administration provide Customs and Border Patrol funding for the U.S. Federal Plaza associated with the New International Trade Crossing bridge from Detroit to Windsor, Ontario.

New Hampshire: The New Hampshire Senate advanced a bill that would raise the state gasoline tax by 4.2¢, but removed a provision from the bill that would have tied future increases to the tax to inflation. The bill advanced on a 14-9 vote and was then approved by the Senate Finance Committee on a vote of 4-2. Were the House to approve the bill, the current 18¢ per gallon tax would increase to about 22¢ per gallon in July. The gasoline tax has not been raised since 1991 and is currently the lowest in New England. The proposed increase is estimated to raise about $32 million annually for road improvements. Governor Maggie Hassan has stated that she would sign a tax increase if a consensus is reached.

Texas: The Coast Guard will re-evaluate whether vessel traffic can resume along the Houston Ship Channel today. Following a spill of about 168,000 gallons of bunker fuel oil into Galveston Bay, 54 deep-draft ships are in queue to enter the channel toward Houston and 47 are waiting to leave as of this morning.

 

Infrastructure Alert - March 24, 2014

On March 20, a proposed shipping alliance of three major shippers was approved by the Federal Maritime Commission. The P3 Network Vessel Sharing Agreement, consisting of Maersk Line, Mediterranean Shipping Company and CMA CGM, authorizes these three ocean carriers, the largest containership operators in the world, to share space on vessels deployed in the three major east-west trades. European and Chinese regulators must approve the agreement before it can go into effect.

The Department of Transportation has updated its Highway Trust Fund ticker to reflect that the trust fund could dip below a $4 billion balance, a threshold under which the Department of Transportation will have to slow disbursements, in late July. The current authorization for surface transportation programs expires at the end of September.

ON THE HILL

On March 14, the Senate passed H.R. 4076, the Home Heating Emergency Assistance Through Transportation (HHEATT) Act of 2014. The bill, introduced by House Transportation and Infrastructure Chairman Bill Shuster on February 25, grants the Secretary of Transportation the authority to extend short-term emergency declarations from theFMCSA to allow tank truck operators delivering propane and other home heating fuels to drive for longer hours in order to speed up deliveries. President Obama signed the bill into law on March 21. The bill expires after May 31, 2014, unless the Secretary of Transportation makes a determination that a winter emergency persists past this date.

Hearings in the House and Senate highlighted some Members’ frustration with the surface transportation reauthorization funding mechanism supported by the Administration, to use revenues from corporate tax reforms to supplement Highway Trust Fund revenues to bridge the projected shortfall.

On March 13, several Senators expressed skepticism of the President’s budget plan to use corporate tax reform to prop up diminishing Highway Trust Fund revenues. During the Appropriations Transportation Subcommittee hearing on the FY2015 budget request for the Department of Transportation, Subcommittee Ranking Member Susan Collins (R-Maine) remarked that the proposal was controversial and stated her disapproval, adding that she did not think it was realistic to believe Congress will be able to reform the tax code this year.

On March 12, during the House Transportation and Infrastructure Committee hearing on MAP-21 implementation and the FY2015 surface transportation budget request, Rep. Peter DeFazio (D-Ore.) asked Department of Transportation Acting Under Secretary for Policy Peter Rogoff if the Administration had a backup plan other than the corporate tax reform. Rep. DeFazio rebuffed Rogoff’s answers, adding that he considers the notion that such tax reform could happen this Congress to be “illusory” and “fake.” Rogoff testified that the Department of Transportation could be unable to meet all of its obligations out of the Highway Trust Fund prior to August.

On March 11, Sens. John Boozman (R-Ark.), Pat Roberts (R-Kan.), and Jerry Moran (R-Kan.) introduced S. 2103, the General Aviation Pilot Protection Act of 2014. If enacted, the bill would require the FAA to reform its general aviation medical standards. A companion bill, H.R. 3708, was introduced in December 2013 by Rep. Todd Rokita (R-Ind.) and has 74 co-sponsors.

Tomorrow, the House Appropriations Subcommittee on Energy and Water Development will hold a hearing on Appropriations for the U.S. Army Corps of Engineers. Jo Ellen Darcy, Assistant Secretary of the Army for Civil Works, and Lt. Gen. Thomas P. Bostick, Chief of Engineers, will testify.

Also tomorrow, the House Transportation and Infrastructure Subcommittee on Coast Guard and Maritime Transportation will hold a hearing on the proposed FY2015 budget request for the U.S. Coast Guard and related marine transportation programs. Witness testimony will be provided by Admiral Robert J. PappJr., Commandant, U.S. Coast Guard; Master Chief Michael P. Leavitt, Master Chief Petty Officer of the Coast Guard, U.S. Coast Guard; Paul “Chip” Jaenichen, Sr., Acting Administrator, Maritime Administration; and Mario Cordero, Chairman, Federal Maritime Commission. Written testimony and a webcast of the hearing will be available here.

The Senate Committee on Homeland Security and Governmental Affairs will hold a hearing titled “Strengthening Public-Private Partnerships to Reduce Cyber Risks to Our Nation’s Critical Infrastructure” tomorrow. Witness testimony will be provided by Phyllis A. Schneck, Ph.D, Deputy Under Secretary for Cybersecurity, National Protection and Programs Directorate, U.S. Department of Homeland Security; Donna Dodson, Chief Cybersecurity Advisor, National Institute of Standards and Technology, U.S. Department of Commerce; Stephen L. Caldwell, Director, Homeland Security and Justice Issues, U.S. Government Accountability Office; Elayne Starkey, Chief Security Officer, Delaware Department of Technology and Information; David M. Velazquez, Executive Vice President for Power Delivery, Pepco Holdings, Inc.; Doug Johnson, Vice Chairman, Financial Services Sector Coordinating Council; and Steven R. Chabinsky, Chief Risk Officer, CrowdStrike, Inc. (testifying in his personal capacity). Written testimony and a webcast of the hearing will be available here.

On Thursday, the Senate Committee on Environment and Public Works will hold a hearing titled “MAP-21 Reauthorization: State and Local Perspectives on Transportation Priorities and Funding.” Witness testimony will be provided by Michael Lewis, Secretary, Rhode Island Department of Transportation; Sue Minter, Deputy Secretary, Vermont Agency of Transportation; Greg Ballard, Mayor, City of Indianapolis; Mick Cornett, Mayor, Oklahoma City; BillFontenot, President, St. Landry's Parish, Louisiana; Jim Willox, Chairman, Converse County Commission, Wyoming; and Dave Gula, Principal Planner, Wilmington Area Planning Council, Delaware. Written testimony and a webcast of the hearing will be available here.

AT THE AGENCIES

Yesterday, the U.S. Maritime Administration announced that its second symposium to help develop a National Maritime Strategy will be held on May 6, 2014. The deadline to submit domestic maritime proposals and agenda topics for inclusion is April 25. The agenda for the symposium, which will be held as part of a meeting of the Marine Transportation System National Advisory Council, will be released on April 28.

On March 19, the FAA published its final report on the safety of the Dreamliner. The Boeing 787-8 Design, Certification, and Manufacturing Systems Review concludes that the Dreamliner “meets its intended level of safety,” and that while “design issues have occurred,” the Boeing 787-8 Critical Systems Review Team “found their cause tended to represent individual escapes in the design or manufacture of the airplane.”

The National Transportation Safety Board released a highway accident brief on the July 19, 2013 Chesapeake Bay Bridge accident.

This month, the Federal Transit Administration has announced $30 million in competitive funds to 42 Native American tribes in 19 states for projects to improve transit service. Tribes and projects receiving funding can be found here.

On March 18, Amtrak released its FY2015 budget request. The request describes Amtrak’s reorganization into three rail-related business lines: Northeast Corridor (NEC) Operations, State-Supported Services and Long Distance Services. Amtrak requests no federal operating support for the NEC for FY2015, but requests $445 million in federal capital investment. Amtrak also requests $83 million of federal operating support for state-supported services, and the totality of the $618 million of FY2015 operating costs needed for long distance services. Amtrak requested $295 million in capital investment for long distance services, including $50 million for ADA compliance at stations, $130 million for the purchase of new rolling stock to replace Heritage cars, and $115 million for overhauls to its fleet. Amtrak’s total FY2015 budget request is $1.62 billion, up from $1.39 billion last fiscal year.

On March 13, the FMCSA announced a proposed rulemaking to require interstate commercial truck and bus companies to use electronic logging devices to ensure compliance with rules that limit how many hours drivers can work.

On March 13, the FAA released its annual Aerospace Forecasts. Among many of the forecasts made, the FAA predicts that ridership on U.S. airlines will grow steadily to over 1 billion prior to 2034. Last year, U.S. airlines carried over 740 million passengers, an increase of nearly 1 percent from the year prior.

At the end of April, Deborah Hersman, Chairwoman of the NTSB, will step down to become the President and CEO of the National Safety Council. Hersman has chaired the NTSB since 2009 and joined in 2004.

IN THE STATES

California: Yesterday, the Assembly Transportation Committee rejected a bill to prohibit using federal grant money on the California High-Speed Rail project until the state has secured matching funds. The committee voted down the bill, A.B. 1501, on a vote of 8-4. While the state is required to match the $3 billion in grant money that the Federal Railroad Administration has approved for the project, the FRA has allowed California to spend federal money until it can come up with its matching funds. Raising matching funds from the sale of bonds, authorized by referendum, is currently entangled in legal challenges. On March 14, the California High-Speed Rail Authority was granted permission tobegin eminent domain proceedings against eight properties in Fresno.

Michigan: On March 18, 40 organizations, including construction and labor groups, wrote a letter to President Obama to requesting that the Administration provide Customs and Border Patrol funding for the U.S. Federal Plaza associated with the New International Trade Crossing bridge from Detroit to Windsor, Ontario.

New Hampshire: The New Hampshire Senate advanced a bill that would raise the state gasoline tax by 4.2¢, but removed a provision from the bill that would have tied future increases to the tax to inflation. The bill advanced on a 14-9 vote and was then approved by the Senate Finance Committee on a vote of 4-2. Were the House to approve the bill, the current 18¢ per gallon tax would increase to about 22¢ per gallon in July. The gasoline tax has not been raised since 1991 and is currently the lowest in New England. The proposed increase is estimated to raise about $32 million annually for road improvements. Governor Maggie Hassan has stated that she would sign a tax increase if a consensus is reached.

Texas: The Coast Guard will re-evaluate whether vessel traffic can resume along the Houston Ship Channel today. Following a spill of about 168,000 gallons of bunker fuel oil into Galveston Bay, 54 deep-draft ships are in queue to enter the channel toward Houston and 47 are waiting to leave as of this morning.

Health Care Reform Implementation Update - March 7, 2014

This week President Obama released his Fiscal Year 2015 Budget Proposal, which provides useful information on his priorities for the year but, as is normally the case, is not likely to gain much traction; the administration announced a two-year extension for individuals whose health insurance plans would have been canceled due to the Affordable Care Act (ACA); Ways and Means Chairman Dave Camp released a comprehensive tax reform plan, which also is more an indicator of his party’s priorities than of policies that will become law this year; the Obama administration announced a new delay for insurance plans that are not compliant with the ACA; and lawmakers and congressional staffers continue to work to prevent the upcoming cut to Medicare providers that results from the Sustainable Growth Rate (SGR) formula.

IN THE WHITE HOUSE

On March 4, President Obama released his Fiscal Year (FY) 2015 Budget Proposal (the Budget).  The Budget proposes $77.1 billion in discretionary funding to support the Department of Health and Human Services (HHS). This is a decrease in discretionary funding to HHS by $0.8 billion from the enacted FY 2014 funding level. Additionally, the Budget includes $402 billion in health savings over 10 years, more than $353 billion of which comes in the form of Medicare provider cuts. The Budget also includes $1.44 billion in funding for the Center for Medicare and Medicaid Innovation (CMMI) in FY 2015, an increase of $390 million above FY 2014. CMMI is tasked with improving and updating current payment and service delivery models.

Of particular note for providers is the Budget’s reduction of Medicare “bad debt” payments. Medicare currently reimburses hospitals, physicians and other providers 65 percent of bad debts. Bad debts are debts that result from Medicare patients failing to pay deductibles or coinsurance. President Obama’s Budget proposes decreasing the percentage paid to providers from 65 to 25 over a three-year period. This change was also proposed in the FY 2014 Budget but was never put into effect. 

Another provision of the Budget that would affect providers were it to go into effect is its cut to teaching hospitals and graduate medical education payments, which would amount to a decrease of $960 million in Medicare payments in 2015 and $14.6 billion over the next decade.

The President’s Budget would affect the Independent Payment Advisory Board (IPAB) as well, the board created by the ACA charged with reducing Medicare spending if it exceeds a specified target rate. The Budget changes this target rate from Gross Domestic Product (GDP) + 1 percent to GDP + .5 percent, which in simpler terms means it would reduce the extent to which Medicare spending can grow before the IPAB may step in to make changes to reduce costs. This proposed change has the potential to affect all providers depending on the types of recommendations the IPAB ultimately would make.

On March 5, the Obama administration announced another delay of the ACA. Under this new extension, those whose health insurance plans were supposed to be canceled this year will now have until 2017 to keep them. This further extends the administration’s earlier extension of these plans by an additional two years and avoids plan cancellations around this year’s mid-term elections, which vulnerable Democrats were concerned would hurt them.

AT THE AGENCIES

Gary Cohen is leaving his position at CMS as the Director of the Center for Consumer Information and Insurance Oversight (CCIIO).  In this position, Cohen led the development of the ACA insurance exchanges. Mandy Cohen (who is not related to Gary) will become the acting Director.

The Food and Drug Administration issued proposed rules to update Nutrition Facts labels for conventional foods and dietary supplements. The regulations would make calorie counts, serving sizes and percent daily value more prominent on the labels, and the serving sizes listed would be updated to reflect the amounts of food people actually consume, which tend to be larger than those listed on nutrition labels.

On February 25, the Internal Revenue Services (IRS) released a series of educational health care tax tips to help individuals understand how the ACA may affect their taxes. In the rules, the IRS guidance provides information on premium tax credits, the health care law for individuals and the health insurance marketplaces.

A new actuarial report from the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary predicts that 65 percent of small businesses will see premiums increase under the ACA. The report evaluated employers with 50 or fewer full-time employees buying outside insurance policies for their employees.

CMS posted a notice titled “Medicaid Program; Preliminary Disproportionate Share Hospital Allotments (DSH) for Fiscal Year (FY) 2014 and the Preliminary Institutions for Mental Diseases Disproportionate Share Hospital Limits for FY 2014.” Disproportionate Share Hospital Allotments (DSH) payments refer to the federal law that requires state Medicaid programs to make payments to qualifying hospitals serving a large number of Medicaid and uninsured individuals. Under the ACA, DSH funds were to be cut this year; however, those cuts were delayed in December (2013) for two years. The preliminary allotments, which vary by state, total $11.7 billion.

ON THE HILL

Though congressional leaders have nearly dismissed the possibility of tax reform in 2014, House Ways and Means Chairman Dave Camp (R-Mich.), who put significant work into advancing tax reform with Former Senate Finance Chair Max Baucus last year, released a draft tax reform proposal this week. The plan would reduce the number of tax brackets from seven to two and lower the corporate income tax rate from 35 to 25 percent. With respect to the ACA, the plan would repeal: 1. the ACA’s tax on medical devices; 2. the law’s prohibition on using health spending accounts to buy over-the-counter medicine; 3. the ACA tax credit for small employers, which allows small businesses to claim a credit for up to two years if it pays at least half of employees’ health insurance premiums and purchases coverage through a state exchange; and 4. the ACA’s tax exemption for Consumer Operated and Oriented Plans (CO-OPs), which are entities that compete as nonprofits in the health insurance market.

On March 5, the House voted 250-160 to delay the individual mandate until 2015. Twenty-seven Democrats joined Republicans to vote for the delay.

On February 25, Sens. Mitch McConnell (R-Ky.), John Cornyn (R-Texas), John Thune (R-S.D.), John Barrasso (R-Wyo.), Jerry Moran (R-Kan.) and Roy Blunt (R-Mo.) sent a letter to HHS Secretary Sebelius expressing their concerns over the changes to Medicare Advantage and the Medicare Part D program (the Medicare drug benefit program) the Department is considering.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program, is meeting on March 6 and 7. The meeting is broken into the following sessions: Site-neutral payments for select conditions treated in inpatient rehabilitation facilities and skilled nursing facilities, next steps in measuring quality across Medicare’s delivery systems, developing payment policy to promote use of services based on clinical evidence, per-beneficiary payment for primary care, synchronizing Medicare benchmarks across payment models, and improving risk-adjustment in the Medicare program.

The Medicaid and CHIP Payment and Access Commission (MACPAC), the non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, is next scheduled to meet on April 10 and 11. We will provide further information on the agenda as it becomes available.

IN THE STATES

Pennsylvania Governor Tom Corbett agreed in a letter to Secretary Sebelius that he would back off the component of his Medicaid expansion proposal that would require able-bodied beneficiaries without full-time work to participate in an employment program as a condition of their health coverage. The Governor instead proposed a pilot program to encourage those who are able to work to participate in job training and work opportunities without making this a condition for eligibility. Participation in this voluntary program would lower participants’ premiums and cost sharing.

On March 4, the Arkansas state House voted to continue allowing the state to use Medicaid dollars to buy private health care insurance for poorer residents. This was the state House’s fifth attempt to pass such legislation, which as a spending bill requires a 75 percent supermajority to pass in Arkansas. The state Senate voted 27-8 last month approve the measure.

To view our compilation of recent health care reform implementation news, click here.

To view and search our library of Health Care Reform Implementation Updates, visit our Affordable Care Act Databook.

Health Care Reform Implementation Update - February 26, 2014

Though Congress was in recess this past week, congressional staff was hard at work continuing to consider ways to prevent a cut to Medicare providers’ payment rates that will be triggered by the sustainable growth rate formula on March 31, the Department of Health and Human Services (HHS) in conjunction with the Employee Benefits Security Administration and Internal Revenue Service, released proposed rules on the 90-day waiting period limitation, and the Centers for Medicare and Medicaid Services (CMS) released its annual notice on Medicare Advantage Rates and changes in payment methodology for Medicare Part D benefits for 2015.

AT THE AGENCIES

On February 21, CMS released its annual notice announcing Medicare Advantage rates and changes in payment methodology for Medicare Part D benefits for 2015.  Medicare Advantage currently covers one third of all Medicare beneficiaries.  In advance of the announcement, 40 senators including some Democrats sent a letter to the administration cautioning against large cuts to Medicare Advantage. Last year’s rate announcement received significant attention when the administration proposed 2.2 percent cuts to Medicare Advantage plans but changed course after an intense lobbying campaign by stakeholders ultimately resulting in a 3.3 increase in the rate. You can expect to see similar advocacy efforts this time around. Comments and questions may be submitted to CMS by 6:00 PM on March 7, 2014.

On February 20, the U.S. Departments of Labor, Health and Human Services and Treasury published a final rule implementing a 90-day limit on waiting periods for health coverage. A waiting period refers to the period that must pass before coverage for an individual who is eligible to enroll in a group health plan becomes effective. The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage to be offered to any particular individual or class of individuals.

CMS is seeking comments on methodology it would use to adjust payment amounts for durable medical equipment, prosthetics, orthotics and supplies. Durable medical equipment is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions or illness. The proposed rule will be published in the Federal Register on February 26. 

ON THE HILL

Republicans from the House Committee on Energy and Commerce sent a letter to Treasury Secretary Jack Lew requesting  information on the recent delay of the Affordable Care Act’s (ACA's) employer mandate. The employer mandate refers to the provision of the ACA that requires employers with 50 or more full-time employees to provide these employees with health insurance. The information the lawmakers request includes all memoranda or analyses of the constitutional or statutory authority of Treasury to delay the ACA requirements that were considered or relied upon by Treasury when deciding to move forward with the second delay.

In response to the regulations published by CMS in January that would empower the agency to participate in Medicare Part D (the part of Medicare under which prescription drug coverage falls), negotiations between insurance companies and pharmacies, an alliance of drug companies, patient advocates, and Democrats and Republicans in Congress has waged a campaign against a policy that would allow insurers to limit Medicare coverage for certain classes of drugs.

Representative John Dingell (D-Mich.) announced this week that he would retire this year, marking the end of the longest congressional career in history. Dingell played a part in expanding access to health care through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA) in the 50-plus years he served in Congress.

The Medicaid and CHIP Payment and Access Commission (MACPAC), the non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, met on February 20. The commissioners discussed eligibility and enrollment strategies, the use of the emergency department by Medicaid enrollees, the future of the Children’s Health Insurance Program, the need for long-term services and supports, and Medicaid and population health.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program, is next scheduled to meet in March. We will provide further information on the agenda as it becomes available.  

IN THE STATES

On February 19, Governor Corbett submitted Pennsylvania’s state waiver request to implement the healthy Pennsylvania initiative, an alternative to the ACA’s Medicaid expansion provisions that were made optional for states by the Supreme Court. Based on comments received by the Department of Public Welfare (DPW), the final proposal Gov. Corbett submitted contained several modifications including local funding for federally qualified health centers in the private coverage option networks, cost sharing criteria, and coverage between presumptive eligibility application date and the date the private option coverage is effective. If HHS accepts Pennsylvania’s proposal, providers in the state can expect to see more patients through this new channel.

The Arkansas legislature has been considering the future of its Medicaid program over the past week. The state Senate voted 27-8 to renew funding for the state’s Medicaid expansion for another year. The House, however, so far has failed to get the necessary three-fourths majority required in Arkansas to pass spending bills. Republican leaders in the Arkansas state House have pledged to continue to bring up the measure in the chamber until it passes.

IN THE COURTS

On February 21, the U.S. 7th Circuit Court of Appeals in Chicago ruled against the University of Notre Dame in its case arguing that it should not be required to provide health insurance for students and employees that covers contraceptives given that it is a Catholic university.  The administration made a compromise last year that attempted to create a buffer for religiously affiliated hospitals, universities and social service groups that oppose birth control under which insurers or the health plan’s outside administrator would pay for birth control, and the religiously affiliated organization itself would not be involved. Notre Dame contended that even with the buffer, this part of the law violates their constitutional rights.

To view our compilation of recent health care reform implementation news, click here.

To view and search our library of Health Care Reform Implementation Updates, visit our Affordable Care Act Databook.

Infrastructure Alert - February 26, 2014

President Obama will announce his support for a four-year, $302 billion transportation funding bill to repair and rebuild bridges, tunnels, roads and transit. About $150 billion of the bill would be paid for through corporate tax reform. More details on the proposal are expected to be included in the President’s budget. He is in St. Paul today to announce a new, $600 million round of TIGER grants.

Panama Canal expansion work has resumed after a deal was reached between the construction consortium and canal authorities regarding how cost overruns will be paid. The Panama Canal Authority has agreed to pay the consortium, Grupo Unidos por el Canal, $36.8 million towards outstanding invoices, and the estimated $1.6 billion in cost overruns will be addressed via arbitration.

President Obama has directed the Department of Transportation and the Environmental Protection Agency to issue a new rule promoting energy efficiency for heavy-duty trucks by March 31, 2015 to be implemented a year after. The new standards would apply to vehicles of model years 2018 and later.

ON THE HILL

On February 12, the Senate Committee on Environment and Public Works held a hearing  titled, “MAP-21 Reauthorization: The Economic Importance of Maintaining Federal Investments in our Transportation Infrastructure.” During the hearing, Chairwoman Barbara Boxer (D-Calif.) said she intends to introduce a surface transportation reauthorization bill in April. She also stated that the Committee on Finance, and not the Committee on Environment and Public Works, would address the funding mechanisms, though she expressed her confidence that the bill would be long-term and sustainable. Ranking Member David Vitter (R-La.) stated he would not support a bill that includes a net tax increase. Sen. Jeff Sessions (R-Ala.) was very critical of raising the federal gasoline tax during the hearing and criticized Chamber of Commerce CEO Thomas Donohue for advocating for a tax increase as a solution to the Highway Trust Fund projected shortfall. Sen. Sessions asked if Donohue would support other measures instead of raising the gasoline tax, such as cutting spending elsewhere to fund the bill, and Donohue stated he would support such a proposal but was skeptical that it was realistic. The Moving Ahead for Progress in the 21st Century Act, the current surface transportation authorization, expires in September. Chairwoman Boxer and House Transportation and Infrastructure Chairman Bill Shuster (R-Pa.) have both stated that they will push for at least a five-year bill.

On February 11, Rep. Gary Peters (D-Mich.) introduced H.R. 4057, the Customs Plaza Construction Act of 2014. The bill would create a new customs plaza for the $2.1 billion North American International Trade Crossing bridge that the Canadian government is funding.

On February 21, Rep. Jeff Denham (R-Calif.), Chairman of the House Transportation and Infrastructure Subcommittee on Rail and leading critic of California High-Speed Rail, issued a press release criticizing the Federal Railroad Administration’s decision to delay the date by which the California High Speed Rail Authority was to provide $180 million according to its grant agreement. Chairman Denham introduced H.R. 3893, the Responsible Rail and Deterring Deficiency Act, on January 16. The bill would suspend federal funding to the project.

Sen. Chuck Grassley (R-Iowa) and Sen. Maria Cantwell (D-Wash.) have introduced S. 2021, the Biodiesel Tax Incentive Reform and Extension Act of 2014. The bill that would extend the $1 per-gallon tax credit for biodiesel producers through 2017. The provision expired at the end of 2013. Senate Finance Chairman Ron Wyden (D-Ore.) has indicated his support for renewing this and other extenders.

This afternoon, the House Transportation and Infrastructure Subcommittee on Railroads, Pipelines, and Hazardous Materials will hold a hearing titled “Oversight of Passenger and Freight Rail Safety,” which was postponed from February 26. Jospeh Szabo, Administrator of the Federal Railroad Administration, Cynthia Quarterman, Administrator of the Pipeline and Hazardous Materials Safety Administration, Robert Sumwalt, Member of the National Transportation Safety Board, John Tolman, Vice President and National Legislative Representative of the Brotherhood of Locomotive Engineers and Trainmen, Jack Gerard, President and Chief Executive Officer of the American Petroleum Institute, Edward Hamberger, President and Chief Executive Officer of the Association of American Railroads, and Michael Melaniphy, President of the American Public Transportation Association will testify. Witness testimony and hearing streaming will be available here.

Tomorrow, the House Transportation and Infrastructure Subcommittee on Highways and Transit will hold a hearing titled “Improving the Nation’s Highway Freight Network.” Mark Gottlieb, Secretary of the Wisconsin Department of Transportation, will testify on behalf of the American Association of State Highway and Transportation Officials, and Gerald Bennett, the Mayor of Palos Hills, Ill., will testify on behalf of the Chicago Metropolitan Agency for Planning. Henry Maier, the President and Chief Executive Officer of FedEx Ground, and Susan Alt, the Senior Vice President of Public Affairs at Volvo Group North America, will testify as well. Witness testimony and hearing streaming will be available here .

On March 4, the House Transportation and Infrastructure Subcommittee on Coast Guard and Maritime Transportation will hold a hearing titled “Maritime Regulations: Impacts on Safety, Security, Jobs and the Environment.” More information, witness identities and testimony as they become available, and streaming will be available here.

AT THE AGENCIES

Yesterday, the Department of Transportation issued an emergency order requiring stricter standards for shippers transporting crude oil by rail. Shippers will now be required to test crude oil coming from the Bakken region and classify it according to federal safety regulations.

On February 21, the Department of Transportation and the Association of American Railroads (AAR) announced anagreement for more track inspections and a lower speed limit for freight trains carrying crude oil. The agreement states that any member freight rail company of the AAR will comply with most of the new regulations by July 1, 2014. The agreement will also have industry install wheel alignment detectors every 40 miles of track.

According to a February 20 article in The Oregonian , the U.S. has 76,000 railroad bridges and the Federal Railroad Administration has only five inspectors to inspect all of them. The article details that one inspector inspects all of Oregon’s 1,263 bridges, as well as all the bridges in Washington, Montana, Idaho, North Dakota, South Dakota, Wyoming and Alaska.

On February 12, the Government Accountability Office released a report titled “Maritime Administration: Ship Disposal Program Needs Improved Communications and Updated Strategic Plan.” The report details contractors’ confusion with MARAD’s source-selection process. The report also concludes that although MARAD is required to provide regular reports to Congress on the backlog of obsolete ships, these reports do not include strategic short- and long-term direction for the program. GAO suggests that MARAD create and updated strategic plan.

On February 21, the Office of Inspector General of the Department of Transportation initiated an audit of the FAA’s implementation of a pilots record database . The audit was requested by the Rep. Frank LoBiondo (R-N.J.) and Rep. Rick Larsen (D-Wash.), Chairman and Ranking Member respectively of the House Transportation and Infrastructure Subcommittee on Aviation. The Office of Inspector General has also initiated an audit of the FAA’s oversight in the use of flight deck automation by air carrier pilots, requested by “the current and former Ranking Members of the House Transportation and Infrastructure Committee and its Subcommittee on Aviation.” On February 20, the Office of Inspector General initiated an audit of the productivity of FAA air traffic control towers, requested by House Transportation and Infrastructure Chairman Bill Shuster (R-Pa.) and Aviation Subcommittee Chairman LoBiondo.

IN THE STATES

At the recent National Governors Association meeting, Republican Governors Jan Brewer of Arizona and Dave Heineman of Nebraska both suggested a devolution of the gas taxes and transportation funding solely to the states.

California: In addition to Rep. Denham’s press release, the California High-Speed Rail project continues to be plagued by criticism. On February 14, Lieutenant Governor Gavin Newsom advocated for reallocating the high-speed rail bond funding , approved by voters, towards other projects. Newsom was formerly very supportive of the project, and Gov. Jerry Brown is one of its largest supporters. A Probolsky Research poll last month indicated that 42.8 percent of voters would vote to stop the project , compared with only 23.6 percent who would vote to continue it.

Michigan: The Canadian government has granted an environmental approval for the proposed twin span, six-lane expansion of the privately owned Ambassador bridge between Windsor and Detroit. Several other assessment and approvals are still required before construction can begin. Representatives from Gov. Rick Snyder’s office stated that the expansion will have no effect on the proposed, Canadian-funded, Detroit River International Crossing bridge construction.

Virginia: On February 13, the Virginia Senate voted 37-1 to repeal the $64 annual fee on hybrid vehicles. The fee was part of Gov. Bob McDonnell’s transportation funding package passed in 2013. The House of Delegates has already passed the measure, and Gov. Terry McAuliffe has indicated that he will sign it.

Health Care Reform Implementation Update - February 14, 2014

This week the Obama administration announced that it would delay the employer mandate, which requires that businesses with more than 50 full-time employees provide full-time employees with health insurance or pay a penalty, for some businesses until 2015, marking the second time the mandate has been delayed.  The House and Senate passed a measure to raise the country’s debt limit, averting the Treasury Department’s projected February 27 deadline.  Though House Republicans had considered attaching a 9-month sustainable growth rate patch (“doc fix”) to the bill, it was ultimately passed with no attached conditions.  Also, Senator Ron Wydenwas confirmed as the new Senate Finance Chairman, a position that will put him at the helm of one of the most important health policy committees in Congress.

ON THE HILL

On February 12, Senator Ron Wyden (D-Oregon) was confirmed to lead the Senate Finance Committee, taking over the chairmanship from the new ambassador to China, Max Baucus.  The Senate Finance Committee is one of the primary committees with jurisdiction over healthcare issues.

The House Ways and Means Committee advanced legislation that would change the workweek under the ACAfrom 30 hours to 40 hours.  Currently the ACA requires employers (with more than 50 employees) to provide health insurance to all full-time employees, where an employee qualifies as full-time by working 30 hours a week.  Republicans in the House and some Democrats are working to change the definition of full-time under the ACA to 40 hours a week.  This initiative is in part inspired by the significant number of employer cutbacks in employer hours to just under 30.  While a requirement that employees who work 40 hours be provided health insurance by their employers may result in similar hour reductions, hour reductions to just under 40 allow employees to work more hours than hour reductions to just under 30.  Further, a 40-hour definition fits what many believe is a more traditional full-time workweek.  This week, Rep. Dan Lipinski (D-Illinois) signed on to a Republican-led bill sponsored by Rep. Todd Young (R-Indiana), which would increase the number of hours an employee has to work to be eligible for health benefits from his or her employee from 30 to 40 hours.

The House and Senate passed legislation on February 12 to undo prior cuts to military pensions and pay for the change by extending sequestration for another year, which results in significant cuts to Medicare providers in 2024 and raises concerns among Medicare providers that sequestration-level reimbursement will eventually become the new norm.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program, is next scheduled to meet in March.  We will provide further information on the agenda as it becomes available.

The Medicaid and CHIP Payment and Access Commission (MACPAC), the non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, is next scheduled to meet on February 20.  We will provide further information on the agenda as it becomes available.

AT THE AGENCIES

On February 10, the Treasury department announced that it would delay the ACA’s employer mandate until 2016 for businesses with between 50 and 99 employees. Additionally, employers are not permitted to cut their workers to meet the threshold. This provision of the ACA was already delayed once from January 2014 to January of 2015.  Employers with 50 or fewer employees will not have to provide insurance to their employees, as was already the case.  Additionally, the regulation gives businesses with more than 100 workers additional time to prepare to provide coverage for their employees.  House and Senate Republicans responded to the additional time given to employers before they must comply with the mandates or face a penalty by renewing calls for the same treatment for the individual mandate.  Several Senate Republicans are also reaching out to the Internal Revenue Service requesting further information on how the individual mandate and its penalties will be enforced.

The regulations also detail some specific ways the employer mandate will affect school employees, saying that they may not be considered part-time (and thus an employee who does not require health insurance under theACA’s employer mandate, which only applies to full-time employees), even though schools are closed for part of the year.

Parts of HealthCare.gov will be down over President’s Day weekend for maintenance.  The deadline to sign up for coverage for March, however, is this Saturday.  In light of the upcoming deadline, the Obama administration announced a special enrollment period for people who have difficulty applying for March 1 coverage.  From 3pmSaturday through 5am Tuesday, customers will be able to access HealthCare.gov, even though they will not be able to verify their identities by the Social Security Administration.

The Department of Health and Human Services announced that about 1.1 million people signed up for health insurance through the ACA exchanges in January, bringing the total enrollment through exchanges to 3.3 million.  The administration says that 25 percent of the enrolled population is made up of the “young invincibles” it is hoping to attract, the population between 18 and 34 years old who are likely to be healthier and less expensive to the system.

On February 7, CMS announced that providers would have an extra month to demonstrate that they meet requirements for meaningful use of electronic health records.  The deadline, originally February 28, has been extended to March 31.

IN THE STATES

New York's state health agency said over 412,000 people in the state had enrolled in ACA since open enrollment began in October.  Two-thirds of these enrollees were previously uninsured.

New York Gov. Andrew Cuomo announced that New York and HHS had reached an “agreement in principle” on an $8 billion Medicaid waiver to help struggling hospitals throughout the state that otherwise would have closed, particularly those in Brooklyn.  New York had requested a $10 billion waiver.

CMS is giving the Massachusetts Health Connector (Massachusetts’ insurance exchange) a three-month extension, until June 30, for subsidized insurance programs that were set to expire to provide Massachusetts with extra time to make its troubled insurance exchange function.  CMS’ extension is in acknowledgment that the state’s exchange is not functioning.

IN THIRD PARTIES

The American Medical Association (AMA) has been lobbying forcefully in favor of the SGR repeal and replace legislation offered last week.  The AMA will not, however, speak to how this legislation should be paid for, which is the biggest obstacle to the legislation’s passing.

The Senate has been considering a proposal to extend unemployment insurance that would extend the 2% Medicare sequester cut that kicked in last year by one more year until 2024. On February 10, several of the nation's largest hospital groups joined together to send a letter that urges senators to oppose extending Medicare sequester (which refers to the automatic spending cuts to federal government spending) cuts to restore unemployment benefits.

To view our compilation of recent health care reform implementation news, click here.

Infrastructure Alert - February 11, 2014

The Panama Canal Authority and the GPUC, the construction consortium working on its expansion, have been deadlocked over whether the Canal will pay for $1.6 billion in cost overruns. Construction halted on February 5 due to the disagreement. The construction consortium’s winning bid was $1 billion lower than its nearest competitor. The project is 70 percent completed and is expected to be completed by 2015.

ON THE HILL

This morning, the House Transportation and Infrastructure marked up and approved several bills, most notably H.R. 4005, the Howard Coble Coast Guard and Maritime Transportation Act of 2014. Rep. Duncan Hunter (R-Calif.), Chairman of the Subcommittee on Coast Guard and Maritime Transportation, introduced the bill on February 6. Full committee Chairman Bill Shuster (R-Pa.) and Ranking Member Nick Rahall (D-W.Va.) are the two co-sponsors of the bill. H.R. 3676, the Prohibiting In-Flight Voice Communications on Mobile Wireless Devices Act of 2013, and 17 resolutions concerning General Services Administration Capital Investment and Leasing Program were also approved. More information on the markup and bills will be available on the committee website.

H.R. 4005 authorizes the Coast Guard for FY 2015-2016, requires the Coast Guard to submit an annual authorization request to Congress, requires the Coast Guard to take an inventory of its real property and determine which property can be divested or consolidated, requires MARAD to develop a National Maritime Strategy, places prohibitions and exemptions on certain regulations, reauthorizes the Federal Maritime Commission at its current funding level, and imposes term limits on the FMC Commissioner.

For H.R. 4005, two amendments were approved. The first, offered by Rep. Hunter, was a manager’s amendment and was approved by voice vote. The amendment included technical amendments, language to reform and strengthen cargo preference laws, language to respond to extreme debris events, language regarding the Merchant Marine program and maritime academies, amendments to the section of the bill regarding icebreakers, and language to direct the Government Accountability Office to conduct an economic study of the potential effects of requiring all LNG exports to be carried by U.S. flagged and U.S. built tankers, among other provisions. The only other amendment to be approved was an amendment offered by Chairman Shuster to rename the bill after retiring Rep. Howard Coble (R-N.C.). Rep. Coble has served 15 terms in the House, and is the only active Member of Congress to have served in the Coast Guard.

Nearing its third month, the conference to reconcile the water resources reauthorization bills continues. The conference committee first met on November 20, 2013. H.R. 3080, the Water Resources Reform and Development Act of 2013, passed the House by a vote of 417-3 on October 23, 2013. S. 601, the Water Resources Development Act of 2013, passed the Senate by a vote of 83-14 on May 5, 2013.

On February 6, Sen. Mark Begich (D-Ark.) and Sen. Brian Schatz (D-Hawaii) introduced S. 2004, the Safe Streets Act of 2014. The bill is the Senate version of H.R. 2468, the Safe Streets Act of 2013, introduced by Rep. David Joyce (R-Ohio) and Rep. Doris Matsui (D-Calif.) in June. The bill would institute “Complete Streets” policies that would create protocols for how federally funded roadways and bridges are constructed with consideration of pedestrian and bicyclist use. If enacted, the Secretary of Transportation would evaluate how these policies would be evaluated and implemented within one year.

On February 5, the House Transportation and Infrastructure Subcommittee on Aviation held a hearing titled “The FAA Modernization and Reform Act of 2012: Two Years Later.” Department of Transportation Inspector General Calvin Scovel testified that he thinks “two to three times” the $40 billion that has been invested by public and private sources will be needed to complete the NextGen transition. He also estimated that NextGen implementation may not be completed until 10 years after its original 2025 goal. The FAA is also lagging behind the deadlines the law put in place for integrating unmanned aerial vehicles (UAVs) into the national airspace, and Scovel testified that the FAA will not meet the statutory deadline of September 30, 2015 for the integration of UAVs. The FAA has completed only eight of the 17 drone-related provisions of the law, and of those eight, several were past their deadlines. FAA Administrator Michael Huerta testified that UAVs will have a “staged integration.” The FAA Modernization and Reform Act of 2012 expires after September 25, 2015.

At a recent Bloomberg Government sponsored event, House Transportation and Infrastructure Chairman Bill Shuster stated that he would not support raising the gasoline tax in the upcoming surface transportation reauthorization. He also stated that he prefers a five- or six-year bill, as opposed to a two-year reauthorization like the current Moving Ahead in Progress for the 21st Century Act. Chairman Shuster added that there are other ways to raise the revenue necessary to fund the bill, mentioning cutting federal spending and programs several times as well as remarking that user fees such as a vehicle miles traveled (VMT) tax should be considered. He mentioned that the Ways and Means Committee was working on some funding mechanism ideas.

Sen. Max Baucus (D-Mont.) has been confirmed as U.S. Ambassador to China. His confirmation will leave a vacancy for the chairmanship of the Senate Environment and Public Work Subcommittee on Transportation and Infrastructure. Sen. Baucus also leaves a vacancy for the chairmanship of the Senate Finance Committee, which will be the committee of jurisdiction for funding the upcoming surface transportation reauthorization.

Tomorrow, the Senate Environment and Public Works Committee will hold a hearing titled “MAP-21 Reauthorization: The Economic Importance of Maintaining Federal Investments in our Transportation Infrastructure.” Witnesses include Thomas Donohue, President and CEO of the U.S. Chamber of Commerce; Richard Trumka, President of the AFL-CIO; Mike Hancock, President of the American Association of State Highway and Transportation Officials and Secretary of the Kentucky Transportation Cabinet; and Jay Timmons, President and CEO of the National Association of Manufacturers. More information, witness testimony as it becomes available, and streaming will be available here.

Thursday, the Senate Commerce, Science, and Transportation Subcommittee on Surface Transportation and Merchant Marine Infrastructure, Safety, and Security will hold a hearing titled “Enhancing our Rail Safety: Current Challenges for Passenger and Freight Rail.” Witnesses include Cynthia Quartermain, Administrator of the Pipeline and Hazardous Materials Safety Administration; Deborah Hersman, Chairman of the National Transportation Safety Board; Geoffrey Blackwell, Chief of the Office of Native Affairs and Policy of the Federal Communications Commission; Jack Gerard, President and CEO of the American Petroleum Institute; and Ed Hamberger, President and CEO of the Association of American Railroads. More information, witness testimony as it becomes available, and streaming is available here.

On February 26, the House Transportation and Infrastructure Subcommittee on Railroads, Pipelines, and Hazardous Materials will hold a hearing titled “Oversight of Passenger and Freight Rail Safety.” More information, witness identities and testimony as they become available, and streaming will be available here.

On February 27, the House Transportation and Infrastructure Subcommittee on Highways and Transit will hold a hearing titled “Improving the Nation’s Highway Freight Network.” More information, witness identities and testimony as they become available, and streaming will be available here.

On March 4, the House Transportation and Infrastructure Subcommittee on Coast Guard and Maritime Transportation will hold a hearing tiled “Maritime Regulations: Impacts on Safety, Security, Jobs and the Environment.” More information, witness identities and testimony as they become available, and streaming will be available here.

AT THE AGENCIES

The Congressional Budget Office has released a10-year projection of highway trust fund accounts. The CBO estimates that “the highway and transit accounts of the Highway Trust Fund will have insufficient revenues to meet obligations starting in fiscal year 2015” under CBO’s February 2014 baseline.

On February 3, the National Highway Transportation Safety Administration announced that it plans to mandate vehicle-to-vehicle (V2V) communication technology for light vehicles. In August 2012, the Department of Transportation conducted a pilot program of 3,000 vehicles in Ann Arbor, Mich., to test the technology. V2V will allow vehicles to detect other vehicles and provide warning to the drivers of the automobile, but would not facilitate automatic operations, track drivers or use personally identifiable information in its communications. NHTSA will release a report of its findings and analysis from the pilot program “in the coming weeks” and “will then begin working on a regulatory proposal that would require V2V devices in new vehicles in a future year, consistent with applicable legal requirements, Executive Orders, and guidance.”

The Federal Motor Carrier Safety Administration released its “Field Study on the Efficacy of the New Restart Provision for Hours of Service.” The study, which analyzes the efficacy of the FMCSA’s 34-hour restart provision, “included 106 participants, 1,260 days of data and nearly 415,000 miles of driving that were recorded by the truck-based data acquisition systems” and its analysis shows that the rule “will prevent approximately 1,400 crashes and 560 injuries, and save 19 lives each year.”

On February 4, the National Highway Traffic Safety Administration issued a notice of public listening session and request for comment for a February 24 public listening session on its 2014-2018 Strategic Plan.

On February 3, the Government Accountability Office released a report titled “Federal Motor Carrier Safety: Modifying the Compliance, Safety, Accountability Program Would Improve the Ability to Identify High Risk Carriers.”

On February 3, the Office of the Inspector General of the Department of Transportation announced a self-initiated audit of the Department of Transportation’s (DOT) practices for certifying and issuing warrants to Contracting Officers. The review will not include the FAA.

On January 30, President Obama announced his intention to re-nominate William P. Doyle as Commissioner of the Federal Maritime Commission until June 30, 2018. Commissioner Doyle was originally confirmed by the Senate on January 1, 2013.

IN THE STATES

California: On February 7, the California High-Speed Rail Authority has released its Draft 2014 Business Plan. The plan is an update of its 2012 Business Plan, and cuts capital costs by 1 percent. The plan now carries an estimated total cost of $67.6 billion, whereas the 2012 plan estimates its costs at $68.4 billion. The updated plan also includes forecasts thatriders will be taking shorter trips, bringing in less revenue, increasing operations and maintenance costs, but yet still not requiring a taxpayer subsidy. The draft plan is required by law to be published 60 days prior to its submittal to the state legislature for public review and comment. The updated plan comes after significant Congressional, state, and judicial concern for the feasibility of the prior business plan, as detailed in our last Infrastructure Alert.

New York: On February 7, Governor Andrew Cuomo announced that all 112 “NY Works” accelerated bridge programs have been completed. Of the 112 projects, 32 were contracted through the design-build process, and 77 bridges were rehabilitated and three were built through the traditional contract bid process. The 2012-13 Budget allotted $212 million for initiative, and $687 million was allocated for nine signature transportation projects of regional or statewide significance throughout the state that had been delayed due to resource constraints, some of which are still under construction.

Texas: On February 10, the U.S. Department of Transportation announced an $840 million TIFIA loan for the Grand Parkway Project in Houston. The loan will finance the design and construction of certain portions of the 55-mile toll road. The total project cost is $2.5 billion. 

Health Care Reform Implementation Update - February 10, 2014

Last week the Congressional Budget Office (CBO) released a report on the Affordable Care Act (ACA), in which it projected a decline in the number of full-time-equivalent hours worked; the Senate Finance, House Ways and Means, and House Energy and Commerce committees released a joint sustainable growth rate (SGR) repeal and replace proposal without offsets on the same day Finance Committee Chairman Max Baucus (D-Mont.) was confirmed to be the next U.S. Ambassador to China, setting off a chain reaction of committee leadership changes that will bring Oregon Democrat Ron Wyden to the chairmanship of that committee; some House and Senate Republicans continued to draw attention to the ACA’s risk corridor and reinsurance provisions, which they characterize as enabling insurance company bailouts; and New Hampshire moved closer to Medicaid expansion.

ON THE HILL

On February 6, congressional lawmakers from the Senate Finance Committee, House Ways and Means Committee, and House Energy and Commerce Committee unveiled a bicameral, bipartisan agreement to repeal Medicare’s Sustainable Growth Rate (SGR) formula, the formula used to determine physician Medicare payments. The bill would repeal the SGR and replace it with a system focused on quality, value and accountability according to a summary from the committees and give physicians a 0.5 percent pay increase each year for five years. The bill does not provide pay-fors for the $120-$150 billion proposal or include the extra policies, or extenders, that traditionally are attached to yearly fixes to the SGR.

According to a February 4 report from the CBO, the ACA will reduce workforce hours in the United States by the equivalent of 2 million full-time jobs in 2017. The report also revised CBO’s earlier projection that 7 million people would get covered through the state and federal marketplaces in 2014 down to 6 million. Further, CBO projected that if 6 million people were to enroll, 5 million of them would receive subsidized coverage.

In the wake of the House Committee on Ways and Means’ January 28 hearing on the definition of full-time employee as those who work at least 30-hours a week and a major announcement from the Congressional Budget Office that people would work fewer hours due to the ACA, the House Ways and Means Committee is working on a bill that would change the workweek under the ACA from 30 hours to 40 hours. Advocates of this change believe it would reduce the incentive for employers to cut workers’ weekly hours below 30.

On February 5, the House Oversight Committee examined the law’s Consumer Operated and Oriented Plan (CO-OP) Program, which funds nonprofit cooperative health insurers.  Before the hearing began, the committee set the tone by releasing a report drawing attention to HHS’ funding of companies with shaky finances and management and legal troubles.

The House Oversight Committee held a hearing on February 5 at which members discussed the ACA’s risk corridor program. Sen. Marco Rubio (R-Fla.) testified at the hearing about what some Republicans are calling insurance company bailout provisions. House Republicans have debated the possibility of attaching a cancellation of the risk corridor program to legislation to raise the debt ceiling.

Following Congressman Henry Waxman’s (D-Calif.) retirement announcement last week, Reps. Anna Eshoo (D-Calif.) and Frank Pallone Jr. (D-N.J.) are both eyeing, and campaigning with their peers for, his position as the top Democrat on the House Committee on Energy and Commerce. Another possible contender is John Dingell (D-Mich.).

House Majority Leader Eric Cantor (R-Va.) is saying that the House will vote in 2015 on an ACA replacement plan and is encouraging members to consider options for addressing the ACA and jobs.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program, is next scheduled to meet in March. We will provide further information on the agenda as it becomes available.

 The Medicaid and CHIP Payment and Access Commission (MACPAC), the non-partisan federal agency charged with providing policy and data analysis to Congress on Medicaid and CHIP, is next scheduled to meet on February 20. We will provide further information on the agenda as it becomes available.

AT THE AGENCIES

On January 31, the Centers for Medicare and Medicaid Services (CMS) announced that the Medicare Accountable Care Organizations (ACOs) program, the ACA development that encouraged providers to collaborate to provide cost-effective and high-quality care to patients, saved a total of $380 million in their first year. Close to half of the 114 hospital and doctor groups that began ACOs under the ACA managed to slow Medicare spending in their first year; however, only 29 saved enough money to qualify for bonus payments. Jonathan Blum, the Principal Deputy Administrator at CMS, said the ACO spending reductions were greater than were expected.

The Department of Health and Human Services (HHS) announced that with nearly 800,000 people signing up for health insurance coverage in January, more than 3 million people have now enrolled in private health plans sold through the ACA’s marketplaces. HHS’s stated goal is to have 7 million enrollees by the end of open enrollment, on March 31.

On January 30, CMS announced a temporary moratoria on the enrollment of home health agencies in Fort Lauderdale, Fla., Detroit, Dallas and Houston and on new ground ambulance suppliers in the Greater Philadelphia area. This second wave of moratoria follows a first wave of home health moratoria last year. CMS also extended for six-months the current enrollment moratoria of home health agencies in Chicago and Miami and for Houston ground ambulance supplier enrollments in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

The Senate held a confirmation hearing on February 4 for President's Obama’s pick for surgeon general, Vivek Murthy. Murthy is a physician at Brigham and Women’s Hospital in Boston, a software entrepreneur, and founder of Doctors for America (originally Doctors for Obama). There is some opposition from Republicans who are skeptical of Murthy’s ACA advocacy background.

On February 3, HHS issued a final rule that requires labs to provide patients with access to their own test results without going through a physician if requested.

On January 31, CMS extended by six months the partial enforcement delay of its two-midnight policy for inpatient admission and medical review criteria. The new policy was included in the 2014 Medicare inpatient payment rule and instituted a time-based presumption period for medically necessary inpatient care. The “two-midnight” rule assumes an admission is appropriate for a Medicare Part A payment if a physician expects a beneficiary's treatment to require a two-night hospital stay and admits the patient under the assumption.

IN THE WHITE HOUSE

On January 30, executives from ACA’s cooperative health insurers (CO-OPs) met with Obama administration health officials to provide an update on enrollment, as well as ideas for improving the program. The White House said many CO-OP leaders reported strong enrollment numbers.

IN THE STATES

On February 6, New Hampshire state senators said they had reached a bipartisan deal to expand Medicaid in the state, under which the state will use federal money to buy private insurance similar to the plan adopted in Arkansas. New Hampshire’s House had already voted in favor of a similar proposal.

Virginiamay be moving closer to expanding its Medicaid program. At Governor Terry McAuliffe’s first bill-signing on February 5, he made a pitch for Medicaid expansion and invited proposals from fellow state government officials. State Sen. John Watkins (R-Powhatan) offered a new proposal under which, instead of spending new federal Medicaid dollars directly on expanding the program, it would send the money into a “taxpayer recovery fund.” Early responses to Rep. Watkins’ proposal do not look overwhelmingly positive; however, we will continue to follow it and other legislative proposals in the state.

To view our compilation of recent health care reform implementation news, click here