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

Support for #KeystoneXL Continues to Grow

Ken Salazar, President Obama's former Secretary of the Interior, today added his support with conditions to the construction of the proposed, $7 billion Keystone XL Pipeline. He called the pipeline a "win-win" but suggested that the operator fund environmental and conservation projects along its route. Earlier this week, Steven Chu, President Obama's former Secretary of Energy, said that the decision to build the pipeline was a "political one." 

Last week, the State Department released a long awaited report of the proposed pipeline in which it cited no major environmental objections to its construction. The Final Supplement Environmental Impact Statement (EIS) is being hailed by proponents of the pipeline as evidence that there is no longer a reason to delay construction. 

Congressional Republicans have pointed to the State Department review and former cabinet secretaries' remarks as they continue to request that the Administration approve the deadline.

 

 

 

Health Care Reform Implementation Update - January 31, 2014

This week the Congressional Budget Office (CBO) provided new scores for the three sustainable growth rate (SGR) repeal proposals from the Senate Finance, House Ways and Means, and Energy and Commerce Committees; a list of potential offsets for SGR legislation circulated Washington; the president discussed the already positive developments from the Affordable Care Act (ACA) in his State of the Union address; Utah announced its intention to expand Medicaid under the ACA tipping the balance of Medicaid-expansion and non-expansion states to more than half expanding, and 20-term congressman and long-time advocate of a health care reform Henry Waxman, announced his retirement. Additionally senator and doctor, Tom Coburn, who has spent 15 years in Congress, will retire at the end of this year.

ON THE HILL

On January 24, the Congressional Budget Office (CBO) said that the House Ways and Means SGR repeal bill would cost $121 billion over 10 years. Additionally, CBO reduced its estimate for the House Energy and Commerce SGR bill from $175 billion down to $146 billion. Then on January 25, the CBO announced the score of the Senate Finance Committee’s SGR repeal bill of $150.4 over 10 years. The higher-cost Senate Finance proposal includes close to $40 billion in Medicare extenders not included in the other two proposals.

A list of possible offsets for SGR formula repeal is being circulated around Washington. The list is extensive and is derived from policies developed by the Obama administration, the Congressional Budget Office and the Bipartisan Policy Center. All listed potential offset policies are merely options, not cuts or policy changes that will necessarily occur. Cozen O’Connor Public Strategies is happy to provide this list upon request.

On January 28, the House Ways and Means Committee held a hearing on the law’s employer mandate and its definition of a “full-time” worker. The ACA counts employees who work 30 hours a week to be full-time employees, and thus part of the group to whom employers must provide health insurance. At the hearing, retail, restaurant and other business groups argued that the ACA’s definition of full-time work is going to cause businesses to cut employee hours to avoid having to offer them health insurance. Ways and Means Ranking Member Rep. Sandy Levin (D-Mich.) argued in the hearing, “Why wouldn’t you want to cover them? Why wouldn’t you want to cover these people?” Republicans argued that the requirement will simply force employers to alter hours and employment opportunities.

The House Oversight and Government Reform Committee held a hearing titled “A Roadmap for Hackers? Documents Detailing HealthCare.gov Security Vulnerabilities,” in which the committee continued to examine the security concerns presented by the ACA.

On January 27, senior SensOrrin Hatch (R-Utah), Tom Coburn (R-Okla.) and Richard Burr (R-N.C.) released a legislative outline for a replacement plan to the ACA. The plan envisions issuing tax credits to those not working at a large company, allowing states to set up high-risk pools and significantly reshaping our Medicaid program. The plan would be paid for by capping the tax exclusion for employee health plans. It still needs legislative language and an official cost estimate, but it is unlikely to move through the Democrat-controlled Senate.

On January 28, the House voted 227-188 to pass the No Taxpayer Funding of Abortion Act, which would ban federal subsidies from going toward insurance plans that cover abortion and making the ban on federal spending on abortion permanent – something which is approved on an annual basis through the Hyde Amendment. The White House threatened to veto this bill.

Speaking in Texas on January 23, Rep. Paul Ryan said Republicans are discussing eliminating the ACA’s “insurance company bailouts” in negotiations to lift the nation's debt ceiling in February. Republicans have already introduced legislation to target the reinsurance fund and risk corridors to which Rep. Ryan alluded, which are designed to limit the risk insurers have to take and try to prevent premium spikes for consumers that result from ACA’s requirements that insurance companies accept all beneficiaries. Sen. Mike Lee also noted the “bailouts” in his official Tea Party response to the State of the Union address.

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 and 21. We will provide further information on the agenda as it becomes available.

Focused on initiatives like the faulty rollout of HealthCare.gov, Reps. Anna Eshoo (D-Calif.) and Gerry Connolly (D-Va.) are co-sponsoring a measure that calls for creating a U.S. Digital Government office, responsible for reviewing and guiding major IT projects of all federal agencies. The legislation would also make the role of U.S. chief technology officer a permanent position.

AT THE AGENCIES

The federal government is seeking a candidate to fill a new position as a CMS risk management officer. The position was inspired by the faulty rollout of HealthCare.gov.

According to an IRS notice released on January 23, Americans with limited health coverage under Medicaid and certain military health care programs will not be subject to the individual mandate penalty in 2014. 

HHS awarded nine states with a combined $201.2 million in new federal grants to support state-run and partnership exchanges. In order of grant amount received, the states receiving grants are Washington state, New Mexico, Mississippi, Arkansas, Delaware, Nevada, New Hampshire, Rhode Island and Utah.

On January 22 at the U.S. Conference of Mayors, HHS Secretary Sebelius encouraged mayors to urge their state legislatures to expand Medicaid under the ACA. Also on January 22, an HHS release said that more than 6.3 million people were determined eligible for either Medicaid or the Children’s Health Insurance Program (CHIP) between October and December.

The Federal Trade Commission (FTC) sued Kobeni Inc. due to spam emails it sent threatening federal prosecution unless the reader immediately clicked on a link to enroll in health insurance. The FTC accuses Kobeni and its president Yair Shalev of injuring consumers and deceptive representations, as well as violations of the FTC Act and the CAN-SPAM Act, failing to provide notice of opt out and failing to include a valid physical address in the spam mail.

IN THE WHITE HOUSE

On January 28, President Obama delivered his fifth State of the Union address. While health care and the ACA did not play as central a role in the speech as they have in years past, the president did note the strides that had been taken for those with pre-exiting conditions, those who are 26 and still able to remain on their parents’ health insurance plans, and that over nine million Americans had signed up for private health insurance or Medicaid coverage.

On January 23, Chris Jennings, a senior White House healthcare adviser, announced he would be stepping down from his post. An unnamed source told the Washington Post that Jennings' departure was due to health and family reasons.

IN THE STATES

On January 23, Utah Governor Gary Herbert expressed in a news conference that he backed his state’s expansion of Medicaid. Assuming the legislature is on board with Gov. Herbert, Utah would become the 26th state to agree to expand Medicaid, and a majority of states will be in this group.

IN THIRD PARTIES

On January 23, Moody’s downgraded the credit outlook for health insurance companies from “stable” to “negative.”  Some of the concerns prompting Moody’s downgrade were a rocky rollout of the exchanges, lower than expected enrollment numbers, uncertainty over who is enrolling, ever-changing regulations, troublesome back-end exchange issues and an underlying question of whether insurers are going to get paid sufficient premiums through the exchanges.

New research from the American Action Forum shows that young adults, defined as between 18 and 35 years old, may find it financially advantageous to pay the individual mandate penalty instead of purchasing insurance coverage, as long as they remain healthy.

A study from the Brookings Institution from January 27 says that the ACA will improve the “well-being and incomes of Americans in the bottom fifth of the income distribution.”  Brookings projects in its report that incomes in the bottom fifth of the distribution will increase close to 6 percent, and those in the bottom 10th of the distribution will increase over 7 percent.

Target is now planning to stop providing health insurance coverage for its part-time employees beginning in April, at which point these employees can join the ACA’s health insurance exchanges. Target's announcement follows those of Trader Joes and Home Depot among others. Target’s shift reflects the ACA requirement that employers provide health insurance to their full-time employees.

IN THE COURTS

The U.S. Court of Appeals for the D.C. Circuit granted an expedited appeal of Judge Paul Friedman's January 15 ruling. On January 15, Judge Friedman upheld the IRS rule to extend tax credits and cost-sharing subsidies for the purchase of qualifying health insurance plans in health insurance exchanges established by the federal government.

On January 24, the Supreme Court granted the Little Sisters of the Poor, a group of Catholic nuns, a temporary exemption from the birth control mandate of the ACA until the 10th U.S. Circuit Court of Appeals decides the case.

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

Infrastructure Alert - January 30, 2014

In Tuesday’s State of the Union address, President Obama urged Congress to pass a reauthorization for the Water Resources Development Act. President Obama also called for corporate tax reform as a method to finance infrastructure spending. He stated that his administration will “slash bureaucracy and streamline the permitting process for key projects” and said that he supports higher fuel efficiency standards for trucks.

ON THE HILL

Although the Water Resources Development Act conference began more than two months ago, House Transportation and Infrastructure Chairman Bill Shuster (R-Pa.) has recently stated that he is “confident” the bill will move out of conference.

On January 16, Sen. Michael Bennet (D-Colo.) and Sen. Roy Blunt (R-Mo.) introduced S. 1957, the Partnership to Build America Act of 2014. The bill would create a $50 billion infrastructure bank called the “American Infrastructure Fund” to fund transportation, energy, communications, water and education infrastructure projects. The other 10 co-sponsors of the bill are Sen. Mark Warner (D-Va.), Sen. Kelly Ayotte (R-N.H.), Sen. Mary Landrieu (D-La.), Sen. Angus King (I-Maine), Sen. Dan Coats (R-Ind.), Sen. Lindsey Graham (R-S.C.), Sen. John Hoeven (R-N.D.), Sen. Mark Begich (D-Ark.), and Sen. Mark Kirk (R-Ill.). The bill is a Senate companion to an infrastructure bill that Rep. John Delaney (D-Md.) introduced in May 2013 that also has bipartisan support.

On January 15, the House Transportation and Infrastructure Subcommittee on Railroads, Pipelines and Hazardous Materials held a hearing titled “A Review of the Challenges Facing California High-Speed Rail.” Karen Hedlund, Deputy Administrator of the Federal Railroad Administration, Dan Richard, the Chairman of the Board of the California High-Speed Rail Authority, and Alissa Dolan of the Congressional Research Service testified, as well as several Members of Congress from California. Chairman Jeff Denham (R-Calif.) was the most vocal critic of the progress shown by the California High-Speed Rail Committee, but also of the Federal Railroad Administration for continuing to reimburse California for the project even after a court ruling prevented the sale of bonds. Denham was frustrated that the FRA has been unable to provide him and his staff with invoices regarding the project for weeks. Richard assured the subcommittee that federal taxpayers are fully protected and that California will continue to match federal funds. Several members of the subcommittee criticized the reliance on the project for federal funding, and made comparisons to the private-partnerships that are financing high-speed rail in Florida and Texas.

The following day, Rep. Denham introduced H.R. 3893, the Responsible Rail and Deterring Deficiency Act. The bill would prevent federal funds from being used by the California High-Speed Rail Authority until it could verify that the matching state funds are fully funded. The bill has 14 co-sponsors, all of whom are Republicans from California.

The House Transportation and Infrastructure Committee has created a special panel on public-private partnerships. This is the second special panel the committee has created leading up to its work on the surface transportation reauthorization. The “Panel on Public-Private Partnerships” will be chaired by Committee Vice Chairman John Duncan, Jr. (R-Tenn.) and Rep. Michael Capuano (D-Mass.) will serve as its ranking member. The remaining panelists are Reps. Candice S. Miller (R-Mich.), Lou Barletta (R-Pa.), Tom Rice (R-S.C.), Mark Meadows (R-N.C.), Scott Perry (R-PA), Peter A. DeFazio (D-OR), Eleanor Holmes Norton (D-DC), Rick Larsen (D-WA), and Sean Patrick Maloney (D-N.Y.). The first panel, on intermodal freight, released its report to the committee in October. Rep. Duncan also chaired that panel.

On January 14, Rep. Richard Hanna (R-N.Y.) and Rep. Janice Hahn (D-Calif.) introduced H.R. 3872, the State Transportation and Infrastructure Financing Innovation Act (STIFIA). The bill would reauthorize the State Infrastructure Bank program, which permitted states to use up to 10 percent of existing federal transportation funding to create a state infrastructure bank. The program was created in 2005, its authorization expired in 2009, and the program was not included in the Moving Ahead for Progress in the 21st Century Act (MAP-21) in 2012. The bill would amend MAP-21 to reauthorize the program, but allow states to use up to 15 percent of existing federal transportation funding to capitalize a state infrastructure bank. Rep. Albio Sires (D-N.J.) is also a co-sponsor.

The House Transportation and Infrastructure Committee held its first hearing to begin discussing the surface transportation reauthorization with stakeholders on January 14. Witnesses included Mary Fallin, Governor of Oklahoma; on behalf of the National Governors Association; Stuart Levenick, Group President, Caterpillar Inc.; KasimReed, Mayor of Atlanta; on behalf of the U.S. Conference of Mayors; and Lawrence Hanley, International President, Amalgamated Transit Union. The existing surface transportation authorization, Moving Ahead for Progress in the 21stCentury (MAP-21), expires at the end of September. In his opening statement, Chairman Shuster said that he wants the reauthorization bill on the House floor prior to the August recess. GovFallin testified that eliminating the federal tax code exemption for interest on municipal bonds would trigger higher interest rates, increase borrowing costs, and increase the total costs of projects in general. Levenick urged Congress to improve port facilities, stressing the need for a long-term, multimodal plan, adding that American transportation modes are not as aligned as they are in other countries.

During the hearing, Rep. Duncan asked how Congress should supplement the falling revenues from the Highway Trust Fund. Levenick remarked there are several options that are attractive, including increasing TIFIA funding or passing Rep. Delaney’s infrastructure bank bill. He said that Caterpillar is open to many options so long as they provide long-term certainty. Mayor Reed praised TIFIA, but said alternatives are needed as well. Hanley voiced his support for taxing financial transactions to fund infrastructure and criticized public-private partnerships as a “craze” that often hurts American workers. Rep. Grace Napolitano (D-Calif.) stated she wants an infrastructure bank to supplement Highway Trust Fund revenues and pay for surface transportation. Rep. Richard Hanna (R-N.Y.) and Rep. Larry Buchson (R-Ind.) floated the idea of a federal user fee on transit. Rep. Janice Hahn (D-Calif.) stated Congress needs to use Harbor Maintenance Tax Fund money for investing in dredging and the nation’s ports.

President Obama signed the $1.1 trillion omnibus appropriation bill on January 17. The bill passed the Senate by a 72-26 vote on January 16 and the House by a 359-67 vote on January 15.

The appropriations bill contains $17.8 billion in discretionary appropriations and $53.5 billion in non-discretionary funding for the Department of Transportation. Funding includes nearly $41 billion for the Federal Highway program (the same amount authorized by MAP-21), $12.4 million for the Federal Aviation Administration ($168 million below FY2013 enacted funding), $1.6 billion for the Federal Railroad Administration ($34.6 million below FY2013 enacted funding), $2.15 billion for the Federal Transit Administration ($100 million below FY2013 enacted funding), $819 million for the National Highway Traffic Safety Administration ($8.9 million above FY2013 enacted funding), and $585 million for the Federal Motor Carrier Safety Administration ($24 million above FY2013 enacted funding). The omnibus preserves funding for the FAA’s NextGen program and does not include funding for high-speed rail. The omnibus funds the Maritime Security Program at $186 million and the Title XI Federal Ship Financing Program at $38 million. The bill also appropriates $140 million for contract control towers, $600 million for TIGER grants, and a $12.8 million increase from 2013 for the Pipeline and Hazardous Materials Safety Administration.

Rep. Trey Radel (R-Fla.), formerly a member of the House Transportation and Infrastructure Committee, has resigned.

Senate Environment and Public Works Chairman David Vitter (R-La.) has announced he will run for Governor of Louisiana.

On February 4, the House Transportation and Infrastructure Subcommittee on Coast Guard and Maritime Transportation will hold a hearing titled “Finding Your Way: The Future of Federal Aids to Navigation.” When witnesses are announced, their names and testimony will be available here.

On February 5, the House Transportation and Infrastructure Subcommittee on Aviation will hold a hearing titled “The FAA Modernization and Reform Act of 2012: Two Years Later.” When witnesses are announced, their names and testimony 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 Transportation Regulations: Impacts on Safety, Security, Jobs and the Environment, Part II.” When witnesses are announced, their names and testimony will be available here.

AT THE AGENCIES

Federal Transit Administrator Peter Rogoff is now the Department of Transportation acting undersecretary of policy, following Polly Trottenberg’s appointment to Commissioner of the New York City Department of Transportation.

On Tuesday, Amtrak issued a press release titled “Amtrak: Framework Needed for Surface Transportation Investment Program.” The press release cited recent remarks made by Amtrak President and CEO Joe Boardman that Amtrak should be included in the upcoming surface transportation reauthorization. Boardman also criticizes the Highway Trust Fund as “based on an outmoded vision for mobility in the United States and is financially unviable.”

On January 23, the National Transportation Safety Board released three recommendations regarding rail cars that carry crude oil to the Federal Railroad Administration and the Pipeline and Hazardous Materials Safety Administration. The NTSB recommends: requiring expanded hazardous materials route planning for railroads to avoid populated and other sensitive areas, developing an audit program to ensure rail carriers that carry petroleum products have adequate response capabilities to address worst-case discharges of the entire quantity of product carried on a train, and auditing shippers and rail carriers to ensure they are properly classifying hazardous materials in transportation and that they have adequate safety and security plans in place.

On January 22, the Federal Motor Carrier Safety Administration issued a final rule for “Patterns of Safety Violations by Motor Carrier Management.” The rule will allow the FMCSA to more easily suspend or revoke registration of for-hire motor carriers that have poor safety or compliance records. The rule goes into effect on February 21.

On January 17, the National Transportation Safety Board released its 2014 “Most Wanted List” of advocacy priorities.

On January 16, the Government Accountability Office released a report titled “Federal-Aid Highways: Federal Highway Administration Could Further Mitigate Locally Administered Project Risks.”

On January 15, The Office of Inspector General of the Department of Transportation released a report titled “DOT's Efforts to Reduce Spending on Management Support Services Contracts Have Been Delayed.”

The FAA Management Advisory Council has 10 new members: Steve Alterman, President of Cargo Airline Association; Bill Ayer, former Chairman of the Alaska Air Group; Montie Brewer, former President and CEO of Air Canada; Ray Conner, President and CEO of Boeing Commercial Airplanes; Craig Fuller, President of the Fuller Co.; Jane Garvey, former FAA Administrator; Michael Hancock, Mayor of Denver; Lee Moak, President of the Air Line Pilots Association; John Potter, President and CEO of the Metropolitan Washington Airports Authority; and Gwynne Shotwell, President and COO, Space X.

The Department of Transportation Bureau of Transportation Statistics has published its “Pocket Guide to Transportation 2014.”

IN THE STATES

California: Republican Assemblyman Jeff Gorell has proposed a ballot measure to prevent bond sales to fund high-speed rail in the state. The sale of $10 billion in state general obligation bonds was originally approved by a 2008 ballot measure. Since that vote, however, the project’s projected costs have risen and the project has suffered several setbacks in court rulings, including a ruling in November that deemed that the California High-Speed Rail Authority had provided too little information to move forward with the sale of over $8 billion in bonds. In order to qualify for the ballot, the proposed referendum must collect 504,760 signatures.

New York: On January 24, the federal Department of Transportation and the Federal Transit Administration announced $886 million in funding for the New York Metropolitan Transportation Authority for projects to repair Hurricane Sandy damage and protect against future natural disasters. MTA has announced it will use the funding in the following manner: $535 million for critical repairs primarily to the damaged under-river Greenpoint, Montague and Steinway tunnels, $138.9 million to restore damaged substations and power infrastructure for the Long Island Rail Road (LIRR) and Metro-North Railroad, $88.1 million to repair essential communications and signal equipment for Metro-North (system-wide) and LIRR’s Long Beach Branch and Westside storage yard, $91.5 million to restore damaged rights of way and to design services to make long-term repairs to damaged assets, and $32 million to repair stations, employee facilities, and fare collection equipment for both rail and bus facilities.

Minimum Wage Increase via Executive Order for Federal Contract Workers

In tonight's State of the Union address, President Obama is expected to announce an Executive Order to raise the minimum wage for federal contractors to $10.10 per hour. Raising the minimum wage has been a plank in the President's and Democratic Party's platform for years, but a bill to raise the minimum wage has not passed Congress. The current minimum wage is $7.25. 

The Executive Order is expected to apply only for new contracts. Many Republicans have warned that raising the minimum wage will lead to increased unemployment, particularly among young people. Democrats, particularly those in the Progressive Caucus, however, have argued that the minimum wage has been too low for years, and that its buying power has been eroded by inflation. 

Socially Responsible Procurement and Best Value

The New York Times had an article yesterday by Ian Urbina, The Shopping List as Policy Tool, that analyzes the possibility of using the government’s purchasing power to cure a range of social challenges, including limiting harsh working conditions and even mandating a new minimum wage.  Urbina cites the effectiveness of prior uses of such power, such as FDR’s mandate that defense contractors can’t engage in racial discrimination.  Urbina wraps his analysis in a discussion regarding the tension between low bid and socially responsible procurement.  Urbina missed an opportunity, however, to use two words that can go a long way towards reconciling that tension.  Best value.
Responsible contractors favor best value procurements because they eliminate bottom feeder competition by enabling the government to award contracts based on a combination of technical qualifications and price, rather than simply price alone.
 
Government agencies often favor a best value approach because it gives them discretion.  As government budgets have tightened, however, low bid procurements have proliferated, inviting in — not surprisingly — low-budget behavior.  More best value procurements will not by themselves cure societies ills, and they certainly don’t make for the significant press that would come from issuing an executive order mandating, for example, a higher minimum wage in government contracts.  But best value procurements will raise the procurement bar and result in awards to better qualified, more responsible bidders that treat (and often pay) their workers better.
 
Howard
(cross-posted from The Business of Government)

Health Care Reform Implementation Update - January 24, 2014

In a high-stake but relatively uneventful series of negotiations, the House and Senate passed a continuing resolution to fund the government through September, averting another government shutdown. Also over the past week, the Director of the Center for Consumer Information and Insurance Oversight (CCIIO) Gary Cohen testified before the House Committee on Energy and Commerce subcommittee on oversight that he was confident HealthCare.gov was secure; a federal judge ruled that the Affordable Care Act’s (ACA’s) insurance subsidies are lawful in those states that did not create their own marketplaces, the Medicare Payment Advisory Commission (MedPAC) held its monthly meeting; the Department of Health and Human Services (HHS) extended the Pre-Existing Condition Insurance Plan (PCIP) by two months; and the administration released data showing that to date less than a quarter of those who have signed up for health insurance through the ACA are between the ages of 18 and 34.

ON THE HILL

Avoiding another government shutdown, and funding the government through September, the $1.1 trillion omnibus spending bill passed the House with a vote of 359-67 on January 15 and passed the Senate with a vote of 72-26 on January 16. The final omnibus spending bill will ease some of the cuts imposed by budget sequestration. Additionally, the bill includes a section that requires HHS in the president’s fiscal year 2015 budget proposal to detail all spending by the Centers for Medicare and Medicaid Services (CMS) on the exchanges since the ACA was enacted, as well as proposed uses for such funding for fiscal year 2015. The bill also reduces funding for the Independent Payment Advisory Board (IPAB) by $10 million.

On January 16, CMS’s Director of the Center for Consumer Information and Insurance Oversight (CCIIO), Gary Cohen testified before the House Committee on Energy and Commerce subcommittee on oversight that: full end-to-end testing of Healthcare.gov was completed on December 18, that he was fully confident that the site is secure, and that a temporary system was in place to allow insurers to calculate what they are owed.

House Majority Leader John Boehner (R-Ohio) predicted on January 16 that House Republicans would unveil and potentially vote on a replacement for the ACA this year.

The effort to extend emergency unemployment compensation stalled in the Senate, with Democrats and Republicans disagreeing over the amendments process. We expect lawmakers to resume consideration of this legislation, which may involve payment cuts to Medicare providers, in late January or early February.

On January 16, the House passed ACA exchange disclosure legislation, which would require weekly reports on enrollment and operation of the insurance exchanges. Among the data that must be included in these reports are the number of unique visitors to the site, new account registrations and enrollees in private exchange plans and Medicaid. The bill was sponsored by Reps. Lee Terry (R-Neb.) and Bill Cassidy (R-La.). On January 9, the Office of Management and Budget said the Obama administration is opposed to this bill.

On January 15, the likely replacement for Senate Finance Chairman Max Baucus (D-Mont.), Ron Wyden (D-Ore.), along with Sen. Jonny Isakson (R-Ga.), Rep. Peter Welch (D-Vt.) and Rep. Erik Paulsen (R-Minn.) unveiled The Better Care, Lower Cost Act of 2014, a proposal to revamp Medicare to focus care on the chronically ill and rein in program costs, under which Medicare providers would have the option of receiving new risk adjustments and capitated payments and to be rewarded for better outcomes.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program met on January 16 and 17. The topics covered were: assessing payment adequacy and updating payments: hospital inpatient and outpatient services, and reforming Medicare’s prospective payment system for long-term care hospitals; the Medicare Advantage program: status report, and employer group plan and hospice policies; Medicare Accountable Care Organizations (ACOs): policy options; assessing payment adequacy and updating payments: home health care services; and steps toward broad post-acute care payment reforms; assessing payment adequacy and updating payments: ambulatory surgical centers, hospice, inpatient rehabilitation facilities, and long-term care hospitals status report on part D, and financial assistance for low-income Medicare beneficiaries.

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 meeting today, January 23 to discuss the following: Administrative Capacity of State Medicaid Programs; New Studies Focused on CHIP Benefits; Characteristics of Medicaid Managed Care Programs; Paying for Value in Medicaid: Lessons Gleaned from Advanced Payment Models in Four States; Medicaid and Population Health; and Early Insights into ACA Enrollment: Focus Group Highlights.

AT THE AGENCIES

On January 14, HHS announced that the approximately 85,000 people currently enrolled in the Pre-Existing Condition Insurance Plan, the high-risk insurance pools created by the ACA, will have an extra two months – until March 31 – before they lose coverage. The program was originally slated to end at the end of 2013. Given the widespread technical difficulties with HealthCare.gov, the administration decided to give people more time to enroll in insurance exchanges.

According to theNew York Times, the Obama administration has announced another ACA provision delay to the provision of the law that would fine employers who provide top executives with better health coverage than the coverage offered to other employees. Though a similar policy has long been in place for employers serving as their own insurers, the ACA extends these protections to employers who buy insurance for their workers through a third party. The report says that the Internal Revenue Service has not yet been able to issue regulations that would clarify which individuals qualify as “highly compensated.”

Under the ACA, starting in 2015 employers with 50 or more employees must offer health coverage to all employees who work 30 hours or more per week. Up until last week, “employees” included volunteer firefighters and other emergency personnel – even if they were not paid or paid only a nominal amount. Many were concerned that these requirements would have devastated some of the 50-plus-employee volunteer fire companies and other similar organizations. Last week, the Treasury Department said it would not count volunteer emergency responders as full-time equivalent employees.

The administration released new enrollment data, which shows that of the 2.2 million who have enrolled in new coverage under the ACA, only 24 percent are between the ages of 18 and 34. This concerns some watching the makeup of the risk pools, since those who are older tend to be more expensive beneficiaries to cover. The administration said the demographics of those who have signed up to date are promising, and it expects the younger individuals to sign up closer to the deadline.

IN THE STATES

According to the latest update from New York’s state Health Department, close to 330,000 people have signed up for health insurance coverage through the state’s health insurance exchange, putting the state on track to meet its goal of enrolling 1.1 million by the end of 2016, according to health officials from New York.

IN THIRD PARTIES

Douglas Holtz-Eakin, the former Congressional Budget Office (CBO) director, opened The Center for Health and Economy, a new health care-focused think tank. The think tank will score proposals introduced by lawmakers and other think tanks.

IN THE COURTS

On January 15, in the case of Halbig v. Sebelius, a federal judge ruled that the ACA’s insurance subsidies are lawful in those states that did not create their own marketplaces. The U.S. District Court Judge wrote in his decision that, “The plain text of the statute, the statutory structure, and the statutory purpose make clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges.”

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

Congress Sounds Off On President's #NSAspeech

Today, President Obama delivered an address announcing reforms to the NSA's domestic surveillance programs. Following a deluge of leaks concerning the NSA's domestic operations, President Obama created an advisory panel to review the NSA programs and submit policy reforms. With those recommendations in mind, the President has issued a policy directive that ends the bulk metadata collection program.

While the presidential policy directive addresses bulk metadata collection that operates under Section 215 of the Patriot Act, it does not address other programs that operate under Section 215 or programs such as PRISM that operate under the authority of other laws. One of the most notable policy recommendations from the advisory panel that the President did not accept was the prohibition of demanding information on individuals from companies, such as telecoms, through national security letters without first acquiring court approval.

For more on the #NSAspeech, see the below reactions from Twitter, and this New York Times article.

 

 

Every Word Matters 1/14/14 - #NetNeutrality

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #NetNeutrality - the idea that data flowing through internet service providers and telecoms not be discriminated for or against depending on the content or from where the content originates. Today, a U.S. Appeals Court ruled that the FCC acted outside of its legal authority in attempting to prohibit broadband providers from blocking or throttling web traffic from specific sites.

This ruling is a blow to proponents of net neutrality. The Democrats below who tweeted about it decried the court ruling, whereas the Republicans praised the ruling as one that allows broadband providers to innovate without the burdensome regulation. Net neutrality is not traditionally a party-line issue, and there is support and opposition for net neutrality in both parties.


 

Health Care Reform Implementation Update - January 13, 2014

With only a few days remaining before the current Continuing Resolution (CR) expires, House and Senate Appropriations Committee leaders are trying to quickly negotiate remaining issues in the omnibus spending bill; however, they may have to buy themselves more time to finalize it by extending the current CR by a few days. Also on Capitol Hill, Republicans advanced two new Affordable Care Act (ACA) bills, one which would require the Department of Health and Human Services (HHS) to notify those whose personal data has been compromised through the health insurance exchange within two days and another that would require the secretary of HHS to provide a weekly report until March 2015 on health exchange updates. This week, Gary Cohen, director of the Center for Consumer Information and Insurance Oversight (CCIIO) is scheduled to testify before the Energy and Commerce oversight subcommittee. In the agencies, the Centers for Medicare and Medicaid Services (CMS) created the Office of Hearings and Inquiries, which will now handle complaints and appeals under the ACA insurance exchange as well as assist with Medicare complaints, inquiries and grievances; and CMS released a proposed rule that includes changes to Medicare Advantage and Part D for Contract Year 2015. Finally, CMS officially appointed Tim Love to replace Michelle Snyder as chief operating officer of CMS, and Dave Nelson to replace Tony Trenkle as chief information officer; and the administration has decided to replace CGI Federal, which created the faulty online exchange, with Accenture.

ON THE HILL

House and Senate negotiators met on January 6 to hammer out the remaining issues in their omnibus spending bill in advance of the January 15 deadline. While the two chambers came to an agreement last month on a budget bill, and the president signed it, the appropriations bill is necessary to allocate the authorized funds. Concerned they may not meet this deadline, leaders of the Appropriations Committee are considering extending the current CR by three days to buy themselves more time to finalize negotiations.

On January 6, Chairman of the Energy and Commerce health subcommittee Rep. Joe Pitts (R-Pa.) unveiled The Health Exchange Security and Transparency Act, a bill addressing the security of data on HealthCare.gov by requiring HHS to notify people within two days if their personal data has been compromised through the health insurance exchanges. On January 10, the bill passed the House with a vote of 291-122 with 67 Democrats voting with Republicans. 

On January 9, Sens. Mike Johanns (R-Neb.) and John Barasso (R-Wyo.) introduced a bill in the Senate that would require HHS to notify users within two business days if a security breach in the health insurance exchange compromises their personal information.

The House is expected to vote this week on a second bill sponsored by Rep. Lee Terry (R-Neb.), the Exchange Information Disclosure Act, which addresses Republican complaints about the lack of transparency from the administration on how HealthCare.gov is working. It would require HHS to provide a weekly report every Monday until March 2015 on how many individuals have enrolled in health insurance through the site, specified other consumer interactions with the website, as well as details on problems that occur with the website and associated health care exchanges. On January 9, the Office of Management and Budget said the Obama administration is opposed to this bill. 

On January 6, Sen. Ron Johnson (R-Wis.) announced that he is filing a lawsuit against the Office of Personnel Management arguing that the office’s policy that allows legislators and Hill staff to receive employer payments for their health plans is not authorized by the ACA.

Senate Minority Leader Mitch McConnell (R-Ky.) proposed paying for an extension of unemployment benefits by delaying the individual mandate for one year, and Sen. John Thune (R-S.D.) said he will propose an amendment to replace the Senate plan with new tax breaks and an ACA exemption. Majority Leader Harry Reid (D-Nev.) blocked Sen. McConnell from offering this amendment. Under the package offered by Sen. Reid, the unemployment benefits would be paid for largely by extending a 2 percent cut to Medicare health providers in 2024.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the Medicare program, is scheduled to meet on January 16 and 17. The agenda includes sessions on assessing payment adequacy and updating payments for hospital inpatient and outpatient services and reforming Medicare’s prospective payment system for long-term care hospitals, the Medicare Advantage program and employer group plan and hospice policies, Medicare Accountable Care Organizations (ACOs), assessing payment adequacy and updating payment for home health care services as well as broad post-acute care payment reforms, assessing payment adequacy and updating payments for ambulatory surgical centers, hospice, inpatient rehabilitation facilities and long-term care hospitals, a status report on Medicare Part D, and financial assistance for low-income Medicare beneficiaries.

The Medicaid and CHIP Payment and Access Commission (MACPAC) a non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, is next scheduled to meet on January 23. We will provide further information on the agenda when it becomes available.

AT THE AGENCIES

Tim Love was appointed to replace Michelle Snyder as chief operating officer of CMS. Additionally, Dave Nelson was appointed to replace Tony Trenkle, who left in November, to be the chief information officer.

CMS created the Offices of Hearings and Inquires (OHI), a new office tasked with handling complaints and appeals under the ACA insurance exchanges and assisting Medicare beneficiaries with “complaints, inquiries and grievances, and in gathering information necessary to file Medicare appeals.” The office will be led by the former Medicaid Program Integrity Group Director Angela Brice-Smith. To consolidate all complaints within a single office, CMS eliminated the Office of Public Engagement and is moving the functions of that office to OHI.

On January 6, CMS released a proposed rule that includes changes to Medicare Advantage and Part D for Contract Year 2015. Among the changes, this rule proposes new criteria for identifying protected classes of drugs in Part D, changes related to the use preferred pharmacy networks, limits on the number of plans that a sponsor may offer in the same service area, and requiring Part D prescribers to enroll in Medicare. CMS states that the proposed rule would save $1.3 billion over the five years 2015-2019 if finalized. 

On January 3, as part of its more general effort to “keep guns out of potentially dangerous hands,” the Department of Justice proposed a regulation to clarify prohibitions on possessing a firearm for mental health reasons. Additionally, HHS is proposing a regulation to relax legal barriers that may prevent states from submitting information on the mentally ill to the National Instant Criminal Background Check System. 

AT THE WHITE HOUSE

On January 7, the Office of the Actuary at CMS reported that in 2012 national health expenditures grew at an annual rate of 3.7 percent, marking the fourth consecutive year of low growth. Health spending as a share of gross domestic product fell slightly from 17.3 percent in 2011 to 17.2 percent in 2012. The White House said that the ACA was partially responsible for the slowdown in health care spending growth, noting, however, that its effect was only minimal. 

IN THE STATES

Cover Oregon’s executive director resigned after one month of being on medical leave, citing the "uncertainty of [his] health” as the reason.

On January 10, CMS and Maryland announced an agreement to reward state hospitals based on performance in a move away from fee-for-service.

IN THIRD PARTIES

A new study published in Science magazine examined a group of 10,000 low-income Oregon residents who recently obtained Medicaid coverage and found that they visited emergency rooms 40 percent more than those without insurance. The data is the product of five years of research in Oregon, where 10,000 randomly chosen residents received Medicaid coverage.

On January 8, at his annual State of American Business Address, U.S. Chamber of Commerce President Tom Donohue expressed that employers are concerned about the ACA’s negative impacts and that many smaller businesses expect to be hit even harder in 2014.

IN THE COURTS

The Supreme Court set the date of March 25 for oral arguments in the cases of Hobby Lobby and Conestoga Wood, two cases in which businesses are challenging the ACA’s contraception coverage requirements.

Action on the challenge by the Little Sisters of the Poor Home for the Aged, the organization of Catholic nuns in Denver that requested an emergency stay on the contraception mandate of the ACA and were temporarily granted relief from Justice Sotomayor, has not yet been announced.

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

Every Word Matters 1/10/14 - #JobsReport

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is the #JobsReport - the Bureau of Labor Statistics released its monthly job report this morning. While the national employment rate has decreased to 6.7%, there was only a net gain of only 74,000 jobs, indicating that many are no longer looking for employment and have left the workforce.

 

Infrastructure Alert - January 8, 2014

As 2014 begins, congressional appropriators are working on drafting and passing omnibus legislation (12 appropriations measures in one bill) to fund the government before the January 15 deadline. Meanwhile, the Water Resources Development Act/Water Resources Reform and Development Act conference continues. The current surface transportation authorization, Moving Ahead for Progress in the 21st Century Act (MAP-21), will expire in 2014, and the House Committee on Transportation and Infrastructure has already scheduled a hearing to discuss the upcoming reauthorization.  A new report from the Tax Foundation finds that states pay the majority of what is spent on transportation expenses, but that gasoline taxes and user fees pay for only half of state and local road spending. In 2011, only 50.4 percent of state and local expenses were funded through highway user fees and user taxes.

ON THE HILL

Appropriations for the federal government expire on January 15. Legislators are currently working on a $1.012 trillion omnibus funding bill, essentially containing the 12 traditional appropriations bills within it, to fund the government in FY2014.

The Heritage Foundation released a list of 10 programs that it would like to eliminate in the upcoming appropriations bill, two of which are infrastructure-related. Heritage suggests eliminating the Transportation Alternatives Program, which it estimates will save $800 million, and eliminating the Essential Air Service program, which it estimates will save $200 million. The Transportation Alternatives Program funds projects such as sidewalks, bike paths, and nature paths from the Highway Trust Fund. The Essential Air Service program subsidizes commercial flights to and from rural airports.

Water Resource (Reform) Development Act conferences continue, and while there have been no public developments as to what the final bill will include or eliminate from the House or Senate bills, a release of the conference report is expected soon.

On January 14, the House Transportation and Infrastructure Committee will hold a hearing titled, “Building the Foundation for Surface Transportation Reauthorization.” Witnesses will include Atlanta Mayor Kasim Reed, Oklahoma Governor Mary Fallin, Caterpillar President Stuart Levenick, and Amalgamated Transit Union International President Larry Hanley. Their testimony and a stream of the hearing will be available here. Issues that are expected to arise during the process of passing a surface transportation reauthorization are transit tax benefits, whether to increase the national weight limits on trucks for the interstate highway system, President Obama’s and various congressional proposals for an infrastructure bank, and FMCSA requirements regarding truckers required break hours.

At the beginning of the new year, the commuter tax benefits for transit dropped and commuter tax benefits for parking increased after the expiration of a provision that brought parity to commuter benefits passed in last year’s fiscal cliff deal. Pre-tax commuter benefits for transit decreased from $245 monthly to $130, and pre-tax commuter benefits for parking increase from $245 monthly to $250. Several proposals were introduced before the new year to prevent this issue, and Congress may pass legislation that reinstates the parity that could include a retroactive fix.

Prior to the December recess, the Senate confirmed Alejandro Mayorkas as Deputy Secretary for the Department of Homeland Security by a vote of 54 to 41.

AT THE AGENCIES

Since the beginning of FY2013, the Department of Transportation has announced about $3 billion in Transportation Infrastructure Finance and Innovation Act (TIFIA) loans and loan guarantees. The largest awards last year were a $1.6 billion agreement for the Tappan Zee Bridge in New York, a $474 million loan to the Port Authority of New York and New Jersey for the replacement of the Goethals Bridge, a $452 million loan for a bridge in Louisville, Ky., and a $275 million for reversible highway lanes for Atlanta.

The Federal Highway Administration has extended the application period for the Integrated Corridor Management Deployment Planning Grants, which was originally planned to end on December 31, 2013, to January 17. States, metropolitan planning organizations and local governments are intended to apply for deployment planning grants to promote the integrated management and operations of the transportation system and improve multimodal transportation system management and operations.

On December 30, the Federal Aviation Administration announced the six test sites for unmanned aircraft systems (UAS) research. The drone research will help the FAA integrate UAS into the national airspace safely and effectively. The sites chosen are the University of Alaska, the State of Nevada, New York’s GriffisInternational Airport, the North Dakota Department of Commerce, Texas A&M University – Corpus Christi, and Virginia Polytechnic Institute and State University (Virginia Tech).

The Government Accountability Office has released a new report titled “In-Car Location-Based Services: Companies Are Taking Steps to Protect Privacy, but Some Risks May Not Be Clear to Consumers.”

IN THE STATES

California: Following a recent court ruling that rescinded its funding plan and Members of Congress who have committed to block any future funding for the rail line without investigations of how funds will be matched by the state, the California High-Speed Rail Authority will be the subject of a California Senate hearing in February togauge the status of the project. The February 26 joint hearing, “California’s High-Speed Rail Project: How Should the State Safeguard the Public’s Interest?” will be examine the management and oversight of the project, as well as discuss the proper role should be for publicly employed inspectors of work completed by private contractors.

North Dakota: On December 30, a train crash and explosion occurred when a BNSF train hauling tankers of crude oil crashed into railcars pulling grain. The derailment was the fourth major derailment of 2013 involving a freight train transporting oil. On January 1, the Pipeline and Hazardous Materials Safety Administration issued a safety alert warning that the crude oil being transported from the Bakken region “may be more flammable than traditional heavy crude oil.” The PHMSA and the Federal Railroad Administration are currently investigating safety issues pertaining to the rail transportation of Bakken crude oil.

Texas: The Texas Department of Transportation has announced an $800 million plan to fund additions to I-10, US 281, and Loop 1604 in San Antonio region. The projects will include both non-tolled and tolled lanes, connectors and improvements to existing lanes. Construction is expected to begin in early 2015.

Every Word Matters 1/7/14 - #FixFlood

 Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #FixFlood (insurance). A bipartisan coalition of 28 senators held a press conference today urging the passage of S. 1846, the Homeowner Flood Insurance Affordability Act. The bill would prevent flood insurance rate hikes on primary residences under the National Flood Insurance Program for about four years. The Congressional Budget Office released a cost estimate of the bill today.

 

 

Health Care Reform Implementation Update - January 3, 2014

The new year kicked off this week with all eyes watching not only Winter Storm Hercules, but also how the new Affordable Care Act (ACA) coverage will work. According to the Centers for Medicare and Medicaid Services (CMS), more than a million people have signed up in the federal exchange. The president signed into law a two-year budget deal, that creates a three-month “doc fix” (a physician payment patch so that SGR payment rates do not kick in while lawmakers continue to work on a permanent repeal), extends for two years sequester cuts to Medicare, and decreases the likelihood of another government shutdown in January. Throughout the country, insurers spent the last week scrambling to finalize hundreds of thousands of last-minute ACA applications, given the administration’s extension of its extension of the deadline for applying to Christmas Eve. Key CMS official Michelle Snyder, who oversaw much of HealthCare.gov’s implementation, resigned effective January 3, temporarily replaced by her deputy, Tim Love. In another judicial twist, the contraception mandate was temporarily stayed on New Year’s Eve by JusticeSotomayor in response to a petition from a Catholic nun’s order in Colorado. The government is scheduled to reply this week to the temporary stay. Finally, the Obama administration announced late last month that individuals whose insurance plans had been canceled would be eligible for hardship exemptions from the individual mandate for 2014.

ON THE HILL

On December 18, with a vote of 64 to 36, the Senate passed a bipartisan budget deal. The legislation had already been passed by the House, with a vote of 332 to 94. The deal rolls back certain sequester cuts, includes a three-month SGR patch, and raises spending marginally above current levels through a combination of reforms and new, non-tax revenue. The deal does not address wider and more divisive issues of taxes and entitlement reforms. On December 26, President Obama signed the budget bill.

Senator Max Baucus, who helped author the ACA and who has served as the chairman of the Senate Finance Committee, which has jurisdiction of health issues, was nominated by the White House to be the Ambassador to China, signaling that he will likely leave his post as chairman before expected. Action on Senator Baucus’ nomination is expected this month. Sen. Jay Rockefeller (D-W.Va.) is next in line to be chair of the Senate Finance Committee; however, he is retiring at the end of next year and has told reporters he will cede the chairmanship to Senator RonWyden (D-Ore.).  Senator Wyden offered a comprehensive bipartisan Medicare reform proposal in 2011 along with Rep. Paul Ryan (R-Wis.), the latter of which is slated to take over the helm of the powerful House Ways and Means Committee next January, setting up a possible tax and entitlement reform environment in 2015 as both men lead the “A” committees that could propel such legislation forward. 

The Medicare Payment Advisory Commission, MedPAC, the independent body that advises Congress on issues affecting the Medicare program, is next scheduled to meet on January 16 and 17. We will provide further information on the agenda when it becomes available. 

The Medicaid and CHIP Payment and Access Commission, MACPAC, a non-partisan federal agency charged with providing policy and data analysis to Congress on Medicaid and CHIP, is next scheduled to meet on January 23. We will provide further information on the agenda when it becomes available.

AT THE AGENCIES

On December 18, the Centers for Medicare & Medicaid Services proposed payment rules for the Basic Health Insurance Program, which provides affordable coverage for individuals earning between 133 and 200 percent of the federal poverty level. The formula, detailed in the regulations, bases payment on an applicant’s age, income and where in the state he or she resides, with CMS covering 95 percent of premiums that would account for the tax credit they would receive if they purchased insurance on the exchange. This plan was supposed to be implemented in 2014, but the Department of Health and Human Services (HHS) delayed it until 2015.

On December 23, the Obama administration extended the deadline to sign up for health coverage by a day, until midnight on Christmas Eve, in acknowledgement that the site was still facing problems. This extension followsHHS’s December 12 interim final rule that formalized the administration’s earlier announcement that the deadline to sign up for health insurance coverage for January 1 would be moved from December 15 to December 23.

On December 29, CMS Administrator Tavenner announced that nearly 1 million people signed up for health insurance through the federal exchanges between December 1 and December 24. A few days later the administration announced that enrollment had topped 1 million.

On December 23, HHS Secretary Sebelius announced that doctors, hospitals and other health care providers had formed 123 new accountable care organizations (ACOs), providing about 1.5 million more Medicare beneficiaries withACO provided care.

On December 30, the IRS and Treasury Department proposed new ACA rules that would allow charitable hospitals to maintain their tax-exempt status if they fail to satisfy various requirements under the ACA

The Office of the National Coordinator for Health Information Technology named city of New Orleans Health Commissioner Dr. Karen DeSalvo to be the new National Coordinator for Health IT. 

On December 31, the Chief Operating Officer for the Centers for Medicare & Medicaid Services Michelle Snyder, whose duties included supervising the personnel who developed the federal health insurance marketplace, retired. Snyder had intended to retire a year ago but stayed in her position to assist with challenges CMS faced in 2013.

AT THE WHITE HOUSE

On December 17, the White House announced that Kurt DelBene, a former president of Microsoft’s Office division, will lead the administration’s efforts to repair the troubled health care site upon the departure of Jeff Zients to serve as chief economic adviser.

Late on December 19, the Obama administration announced that individuals whose insurance plans had been canceled would be eligible for “hardship exemptions” from the individual mandate for 2014.  In a letter to Senators Warner, King, LandrieuHeitkamp, and Kaine, Secretary Sebelius outlined the policy. Secretary Sebelius says in the letter that the policy President Obama announced in November, which allows states and insurers to renew their 2013 health plans for 2014, has already helped many consumers who faced plan cancellations and that over half the states had accepted the option.

On December 19, the White House released new a national report and state-by-state reports that show the cost of repealing the Affordable Care Act.

The White House announced on December 23 that President Obama had signed up through the D.C. exchange for a bronze plan under the ACA that will cost him about $400 a month. According to a statement distributed by an anonymous White House official to reporters, President Obama’s health care will continue to be provided by the military, making his enrollment in an exchange plan merely symbolic.

ACA supporters, including the White House, Democratic congressmen, and advocacy organizations launched a campaign this week to highlight ACA success stories. White House officials and congressional staffers say that they have been vetting success stories of Americans so they are ready for prime time.

IN THE STATES

On December 31, Michigan’s Medicaid expansion proposal, Healthy Michigan, was approved by the federal government. The program requires cost-sharing, which makes it unique from some other states’ Medicaid programs.

IN THIRD PARTIES

America’s Health Insurance Plans (AHIP) extended the deadline for consumers in most states to pay their premiums for coverage beginning January 1 until January 10, responding to the Obama administration’s request that insurers relax some coverage rules.

IN THE COURTS

On December 31, in response to a request from Little Sisters of the Poor Home for the Aged, an organization of Catholic nuns in Denver that requested an emergency stay, Supreme Court Justice Sonia Sotomayor temporarily blocked the ACA birth control mandate that would have forced some religion-affiliated organizations to provide employee health insurance that includes contraceptive coverage beginning on January 1, 2014. Sotomayor issued an order stating that the government is “temporarily enjoined from enforcing against applicants the contraceptive coverage requirements imposed by the Patient Protection and Affordable Care Act.” The White  House said that while it defers to the Department of Justice on litigation issues, it is confident that its final rules are constitutional.

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

Health Care Reform Implementation Update - December 19, 2013

The deadline to enroll in coverage for January 1 was officially extended by a week, but the new December 23 deadline is fast approaching, and premium payments are required to be paid by the last day of 2013 for January 2014 coverage. Last week, both the Senate Finance Committee and the House Ways and Means Committee advanced legislation to permanently repeal the sustainable growth rate (SGR) formula, which is used to determine Medicare reimbursement for physicians; however, the legislation was not offset or “paid for” and is not expected to be passed until next spring, when it could be wrapped up in a larger debt ceiling package. Also in the past week, the House and Senate passed a two-year budget deal, which creates a “doc fix” (a physician payment patch so that SGR payment rates do not kick in while lawmakers continue work on a permanent repeal), extends for two years sequester cuts to Medicare, and decreases the likelihood of another government shutdown in January. The president is expected to sign the deal as well. The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) both held their regular monthly meetings last week, the Department of Health and Human Services released an interim final rule formalizing the Obama administration’s delay of the enrollment deadline from December 15 to December 23, and the Centers for Medicare and Medicaid Services (CMS) announced an extension of the Pre-Existing Condition Insurance Plan of a month.

 ON THE HILL

On December 10, Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wis.) announced an $85 billion budget agreement to set new funding levels for the next two years, cut the deficit by $23 billion, and provide $63 billion of sequester relief. On December 12, the House passed the two-year budget deal with a vote of 332-94, and the Senate passed the budget deal on December 18th with a vote of 64-26. President Obama has indicated he will sign the legislation into law. The budget includes a three-month SGR patch. Once President Obama signs the bill, the doctor payment cut will be averted for three months.

On December 12, the House Ways and Means Committee unanimously approved a bill that would repeal and replace Medicare’s Sustainable Growth Rate formula. On December 11, Chairman Dave Camp (R-Mich.) changed the bill to avoid strong opposition by surgeon groups by including a 0.5 percent update to physician payments from 2014 to 2016, which adds between $8 and $9 billion to the cost of the bill.

The Senate Finance Committee held a markup of the SGR repeal legislation on December 12 and advanced the plan as well. The Senate Finance version of the bill did not include the 0.5 percent pay increase. It did, however, include seven amendments that: establish a five-year demonstration project allowing community behavioral health providers to be paid more under new criteria; permanently extend the Medicare Dependent Hospital program and Low-Volume Hospital program, which provide a bump to rural hospitals that treat higher numbers of Medicare patients; set a floor for the physician work index in the Medicare fee schedule; establish a demonstration project for remote patient monitoring; extend transitional medical assistance for five years; define podiatrist as a physician in Medicaid; and provide technical assistance to small rural providers in the value-based purchasing program.

The SGR-repeal bills moving through the Senate Finance and House Ways and Means Committees are not expected to be passed until next spring, when they could be wrapped up in a larger debt ceiling package.

On December 12, House Energy & Commerce Oversight Subcommittee Chairman Tim Murphy (R-Pa.), introduced the Helping Families in Mental Health Crisis Act, which focuses programs and resources on psychiatric care for patients and families most in need of services by increasing inpatient and outpatient treatment options; clarifying standards used to commit an individual to medical care; updating the existing legal framework to help families and physicians communicate during a crisis; and moving toward data-driven, evidence-based models of care so treatment is accessed not through the criminal justice system by the health care system.

On December 10, House Energy and Commerce Committee leaders sent letters to the Medicaid directors of all 50 states and the District of Columbia requesting information on the status of their Medicaid programs and current ability to provide care to the most vulnerable populations.

HHS Secretary Sebelius testified before the House Energy and Commerce Health Subcommittee on December 11 about the status and progress of the ACA rollout. Republicans on the committee grilled the secretary on those who are losing plans, the large number of pages of regulations, the total number of people who enrolled, and problems small businesses may face in the near future as a result of the ACA.

The Medicare Payment Advisory Commission, MedPAC, the independent body that advises Congress on issues affecting the Medicare program, met on December 12 and 13. The commission’s agenda included the following sessions: assessing payment adequacy and updating payments: physician, other health professional, and ambulatory surgical center services; assessing payment adequacy and updating payments: hospital inpatient and outpatient services; assessing payment adequacy and updating payments: long-term care hospital services; assessing payment adequacy and updating payments: outpatient dialysis services; skilled nursing facility services: assessing payment adequacy and updating payments; steps toward post-acute care payment reform; assessing payment adequacy and updating payments: home health care services; the Medicare Advantage program, status report, and employer bid and hospice policies; assessing payment adequacy and updating payments: hospice services; and assessing payment adequacy and updating payments: inpatient rehabilitation facility services.

The Medicaid and CHIP Payment and Access Commission, MACPAC, a non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, also met on December 12 and 13. The commission’s agenda included the following sessions: overview of March Report; review of draft chapter for March Report: Medicaid and CHIP in the context of the ACA; review of draft chapter for March Report: strategies to address churning; review of draft chapter for March Report: issues in pregnancy coverage under Medicaid and exchange plans; review of draft chapter for March Report: Medicaid eligibility changes: program integrity issues; review of draft chapter for March Report: Medicaid non-DSH supplemental payments; access measures for March MACStats; examining Medicaid managed care; review of draft chapter for March Report: selected issues in children’s coverage under CHIP and exchange plans; review of draft chapter for March Report: long-term services and supports.

AT THE AGENCIES

On December 12, HHS posted an interim final rule formalizing the administration’s earlier announcement that the deadline to sign up for health insurance coverage for January 1 would be moved from December 15 to December 23. The administration’s decision aims to avoid coverage gaps for consumers as they transition into new private health plans under the ACA. Additionally, the rule allows states to set their own deadline and gives individuals until December 31 to pay their premiums and still be covered by January 1. Comments are due by 5:00 p.m. on December 23, 2013. The interim rule also encourages insurers to be flexible in accepting premium payments later (through December 31) and to cover new members’ prescription drugs and to treat existing providers as in-network providers. America’s Health Insurance Plans (AHIP) announced that the changes could “exacerbate the challenges associated with helping consumers through the enrollment process.”

On December 18, CMS posted a proposed rule on the basic Health Program under the ACA.  The Basic Health program is an optional state coverage program for those earning between 133 and 200 percent of the federal poverty level and some immigrants who are not eligible for Medicaid but who cannot afford health plans on the insurance exchanges.

HHS began a “soft launch” of the ACA Spanish-language enrollment tool, which will allow the government to receive feedback and make updates along the way, CuidadoDeSalud.gov.

Due to the widespread difficulty enrolling in the online marketplaces, CMS announced a one-month extension of the temporary ACA high-risk pool program, known as the Pre-Existing Condition Insurance Plan. The Pre-Existing Condition Insurance Plan (PCIP) was established by the ACA to provide a bridge to the exchanges for those with pre-existing conditions. Though it was set to expire at the end of 2013, the administration extended it due to the continuing problems with HealthCare.gov by a month to assist the sickest people who may face a coverage gap. This program provides coverage to close to 135,000 people with high-need medical conditions.

On December 11, HHS released official data showing that about 260,000 people enrolled in ACA exchanges, bringing the total to about 365,000 in federal and state run exchanges. Though the Obama administration has advertised that this number is more than double the October sign-up rate, the number is still low due to HealthCare.gov technical issues.

AT THE WHITE HOUSE

On December 10, Vice President Joe Biden announced $100 million in new spending on mental health services to be allocated by the federal government for mental health services at community health centers and to improve mental health facilities.

IN THE STATES

On December 12, Iowa and the White House announced that they had come to an agreement on expanding the state’s Medicaid program under the ACA. Under the compromise with HHS, Iowa will be allowed to charge premiums to those earning between 100 and 133 percent of the federal poverty line but not to those who make less. The premiums may not exceed 2 percent of income, and enrollees have the ability to reduce these payments through involvement in a wellness program. The plan Iowa had proposed would have required Medicaid enrollees at 50 percent of the federal poverty level and above to pay premiums. Pennsylvania should take note of the outcome of Iowa’s proposal, since the draft plan Gov. Corbett posted last week also requires premiums for individuals and families earning at least 50 percent of the federal poverty level.

In response to widespread enrollment problems in signing up for health insurance through the District of Columbia'sonline health insurance exchange, House lawmakers and their staffs whose health insurance is set to terminate at the end of December will have their current plans extended to the end of January if they have not yet been able to enroll for new coverage.

Tennessee Gov. Bill Haslam sent a letter to HHS Secretary Sebelius alerting the department that the ongoing problems with ACA implementation are discouraging Tennessee from expanding its Medicaid program under theACA.

On December 12, the Michigan legislature overrode Gov. Rick Snyder's earlier veto and passed a law that bans private insurance plans in the state from covering abortion services unless individuals buy a separate rider for their coverage (if the insurance company offers the rider).

IN THIRD PARTIES

Pew survey released on December 10 showed that 54 percent of Americans disapprove of the ACA, and only 41 percent are currently in favor of it.

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

Every Word Matters - Military Veterans' COLAs

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is the cost-of-living-adjustment (COLA) for military veterans. A bipartisan effort is underway in the House to repeal cuts to veteran retirees' cost-of-living adjustment in the Bipartisan Budget Act.

 

Every Word Matters - Court Ruling on #NSA Surveillance

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is a ruling this afternoon from a federal judge stating that the NSA domestic surveillance program is likely unconstitutional, the first time such a ruling has been issued.

 

Every Word Matters 12/10/13 - #InvestInKids

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #InvestInKids - advocates for H.R. 3461 / S. 1697, the Strong Start for America's Children Act of 2013, were encouraging their colleagues and followers to support the bill.  The primary function of the bill is to provide funding for preschool programs that serve children in low- to moderate-income families.

 

Health Care Reform Implementation Update - December 9, 2013

 The Obama administration announced that it met the November 30 deadline for fixing HealthCare.gov’s problems; however, there are some concerns that information submitted by consumers is not properly transmitting to insurers, and many continue to question issues with the site’s security, as well as Affordable Care Act (ACA) concerns more generally, such as cancelled health policies and the inability to keep your doctor. Both the Senate Finance Committee and the House Ways and Means Committee are planning to hold markups on repealing the sustainable growth rate (SGR) formula proposal this week; however, there is speculation that a full repeal would not happen until next year given that Congress is expected to recess this Friday. Additionally, Secretary Sebelius is slated to testify before the House Committee on Energy and Commerce this week in her first appearance on the Hill since October, andMedPAC and MACPAC will hold their December meetings at the end of this week.

ON THE HILL

As we have noted over the past month, the Senate Finance Committee is planning to hold a markup to consider legislation to repeal the sustainable growth rate system and health care extenders on December 12. Additionally, on December 5, House Ways and Means Chairman Dave Camp (R-Mich.) said that Ways and Means will also mark up a bill to repeal and replace the SGR this week. If Congress does not act, Medicare pay cuts of 24.4 percent are set to take effect on January 1. Current speculation is building around a short term, three to six month SGR patch that can carry Congress over the debt ceiling debate this spring, with Congress continuing to work towards a longer-term deal. On December 6, the Congressional Budget Office reported that repealing the formula would cost $116.5 billion over 10 years. This cost is further reduced from the reduced rate the CBO reported earlier this year of $139 billion, and may serve as an additional push for swift Congressional action.

Secretary Sebelius is scheduled to testify before the House Energy and Commerce Health Subcommittee on December 11 about how the health law rollout is going. The last time Secretary Sebelius appeared before Congress was October 30.

The Medicare Payment Advisory Commission, MedPAC, the independent body that advises Congress on issues affecting the Medicare program, is scheduled to meet on December 12 and 13. The commission’s agenda includes the following sessions: Assessing payment adequacy and updating payments: physician, other health professional, and ambulatory surgical center services; Assessing payment adequacy and updating payments: hospital inpatient and outpatient services; Assessing payment adequacy and updating payments: long-term care hospital services; Assessing payment adequacy and updating payments: outpatient dialysis services; Skilled nursing facility services: assessing payment adequacy and updating payments; steps toward post-acute care payment reform; Assessing payment adequacy and updating payments: home health care services; The Medicare Advantage program, status report, and employer bid and hospice policies; Assessing payment adequacy and updating payments: hospice services; and Assessing payment adequacy and updating payments: inpatient rehabilitation facility services.

The Medicaid and CHIP Payment and Access Commission, MACPAC, a non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, is also scheduled to meet on December 12 and 13. The commission’s agenda includes the following sessions: Overview of March report; Review of draft chapter for March report: Medicaid and CHIP in the context of the ACA; Review of draft chapter for March report: Strategies to address churning; Review of draft chapter for March report: Issues in Pregnancy Coverage under Medicaid and Exchange Plans; Review of Draft Chapter for March Report: Medicaid Eligibility Changes: program integrity issues; Review of draft chapter for March report: Medicaid non-DSH supplemental payments; Access measures for March MACStats; Examining Medicaid managed care; Review of draft chapter for March report: Selected issues in children’s coverage under CHIP and exchange plans; Review of draft chapter for March report: Long-term services and supports.

After spending the lead-up to Thanksgiving messaging on the ACA’s failed promise that “If you like your plan, you can keep it,” Republicans this week are focusing on a new message: the ACA’s failed promise that “If you like your doctor, you can keep your doctor.”

AT THE AGENCIES

On December 1, the Obama administration announced that it had met its goal of having HealthCare.gov working smoothly for the vast majority of users by the end of November. Following the difficulties HealthCare.gov experienced in the first days of open enrollment, HHS set November as the deadline by which they would have the site functioning. On December 1, HHS held a briefing to discuss the website’s progress by the November 30 deadline. Jeff Zients, who is leading the charge to get HealthCare.gov running smoothly, said that the website was functioning at 42.9 percent for most of October but is now functioning at 90 percent. 

In the first two days of December, about 29,000 people signed up for health insurance through HealthCare.gov. This number exceeds the total number of people who signed up during the month of October. Notwithstanding these successes, some insurance industry officials are pointing out that they continue to receive garbled reports of who is enrolling on their end. This could mean that those who have completed the health insurance enrollment process may not actually be signed up on the insurer end.

A new Centers for Medicare and Medicaid Services (CMS) report finds that applications jumped 15.5 percent in states expanding Medicaid in October.

On November 27, the Obama administration announced that it will delay the small-business online enrollment under the ACA for one year. HHS announced that it was opening up direct enrollment for small businesses to sign up immediately through an insurer, agent or broker.

On November 26, the Internal Revenue Services (IRS) released three ACA rules: the Additional Medicare Tax Rule, which increases Medicare contributions from individuals who make more than $200,000 annually and married couples filing jointly making more than $250,000 by 0.9 percent on income above that amount; the Health Insurance Providers Fee Rule, which details which health insurers will be subject to these fees in 2014; and the Net Income Investment Tax Rules (also a product of the ACA), which also requires high-income earners to assist in paying for the ACA’s health insurance expansion. 

CMS announced the launch of a direct enrollment pilot program with 16 issuers of qualified health plans in Texas, Florida and Ohio in an effort to sign up consumers. The pilot will allow insurance companies to sign people up for ACA coverage directly, circumventing HealthCare.gov.

On November 25, HHS released a proposed rule outlining various options under consideration to implement President Obama's allowance for insurance policies to extend cancelled plans even if they do not meet the ACA's requirements for an additional year. The proposed rule seeks input on risk pool program modifications.

On December 6, CMS proposed a new timeline for the implementation of meaningful use for the Medicare and Medicaid EHR Incentive Programs, and the Office of the National Coordinator for Health Information Technology (ONC) proposed a new approach for updating ONC's certification regulations. The revised timeline extends Stage 2 through 2016 and has Stage 3 beginning in 2017 for those providers that have completed at least two years in Stage 2.

On November 27, CMS released the 2014 Medicare physician payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction. The physician payment rates represent significant reductions that would go into effect if Congress does not step in to change the SGR formula, or halt the cuts temporarily.

On November 27, CMS released a final calendar year 2015 hospital outpatient and ambulatory surgical centers (ASC) payment rule that CMS says will give hospitals and ASCs new flexibility to lower outpatient facility cost and strengthen the long-term financial stability of Medicare. The rule merges five outpatient codes into one for hospital clinic visits and increases hospital outpatient payment by 1.7 percent. Additionally, it establishes an encounter-based payment for certain device-related procedures, but unlike the proposed rule delays this until 2015.

AT THE WHITE HOUSE

President Obama and his administration, congressional Democrats and other outside allies of the ACA launched a coordinated campaign on December 3 to reboot ACA publicity and encourage participation. The White House has scheduled three weeks of ACA promotion events and activities. In a kickoff speech on December 3, Obama touted the benefits of the Affordable Care Act, as part of an effort to reframe the narrative around the health law after the website repairs.

On November 26, representatives from the major physician lobbying groups met at the White House with Chris Jennings and Jeanne Lambrew to discuss various exchange issues, including that new ACA insurance plans only offer limited provider networks and low reimbursement rates for doctors, which could lead to many of those who are enrolled not having access to care despite their insurance.

IN THE STATES

On December 6, Pennsylvania Gov. Tom Corbett’s administration posted key details from the proposal it plans to submit to the federal government mid-January to cover the state’s Medicaid expansion population. Corbett’s proposal is similar to the one submitted by Arkansas and approved by the federal government, using federal funds to cover costs through a private insurance exchange system created under the ACA, instead of expanding Medicaid rolls. Additionally, the plan proposes that recipients pay modest monthly premiums and that working-age recipients be engaged in a job search in order to qualify.

The enrollment numbers released by HHS show that 2,207 Pennsylvanians enrolled in health insurance coverage in October.

On November 26, Pennsylvania Insurance Commissioner Michael Consedine said Pennsylvania’s state insurance department will follow the White House’s request to allow insurers to extend existing individual policies by a year.

On December 3, Idaho Governor Butch Otter announced that he would like insurers to extend canceled plans and other non-complying non-grandfathered plans as allowed for by President Obama’s proposed administrative fix.

The District of Columbia’s new insurance commissioner announced on November 27 that the D.C. insurance department would not pursue the White House’s proposal to allow consumers to keep canceled insurance policies an extra year.

On December 2, the director of Oregon’s health insurance exchange, Rocky King, stepped down on medical leave not providing information on whether he would be back. King led the exchange project in his state for almost two years, and it still does not function properly; however, it is predicted to be operational later this month.

IN THE COURTS

The Supreme Court has agreed to hear two private companies’ challenges to the Affordable Care Act’s contraception mandate. The Court is expected to hear the cases in March and issue a decision by June, Sebelius v. Hobby Lobby Stores, Inc., and a similar suit brought by Conestoga Wood Specialties Corp. The White House then released a statement on November 26 calling the requirement that private companies provide contraceptive coverage “lawful and essential to women’s health.” The Supreme Court declined to review the case of Liberty University, which would have required the Court to review the constitutionality of the ACA’s employer mandate for a second time. 

On December 3, the U.S. District Court in Washington heard a case on whether the ACA provides for federal premium subsidies for people buying insurance through the federally facilitated exchanges in the 36 states that did not set up their own exchanges. Three private employer and four individual taxpayer plaintiffs argued that the way the ACA was drafted – consumers are eligible for federal tax credits when they buy through an exchange “established by the state” – only those buying coverage through state-run exchanges are permitted to receive subsidies. If the plaintiffs were to be successful in their challenge, millions of people in the states with federal exchanges could be denied government subsidies to assist them in paying for health insurance.

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

Every Word Matters 12/5/13 - #InnovationAct

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #InnovationAct - the House passed H.R. 3309, the Innovation Act, by a bipartisan vote of 325-91 today. The bill would limit abusive and excessive patent litigation, the aim of which is to prevent companies commonly referred to as "patent trolls" from using their patents through such lawsuits and stifling innovation.

 

 

Infrastructure Alert - December 4, 2013

The American Road & Transportation Builders Association is forecasting that the U.S. transportation infrastructure construction market will grow by 5 percent from $129 billion in 2013 to $135 billion in 2014. ARTBA forecasts that bridge and tunnel construction will grow from $28.5 billion in 2013 to $30.1 billion in 2014, port and waterway construction will grow an additional $100 million to $3.0 billion in 2014, airport runway and terminal construction will grow 17 percent to $14.7 billion in 2014, domestic light rail and subway construction will grow from $7.5 billion in 2013 to $7.9 billion in 2014, and heavy rail will increase from $11.6 billion in 2013 to $12.6 billion in 2014, largely driven by Class 1 freight rail.

ON THE HILL

Yesterday, the House passed H.R. 2719, the Transportation Security Acquisition Reform Act, unanimously. The bill, introduced in September and passed by the Committee on Homeland Security on November 21, directs the Administrator of the Transportation Security Administration to develop a multiyear technology acquisition plan to be updated every two years. The bill allows for the plan to include a classified addendum for sensitive material, and also requires the TSA to report justifications to Congress 30 days prior to any acquisitions in excess of $30 million.

The House also passed H.R. 1204, the Aviation Security Stakeholder Participation Act of 2013, yesterday by a vote of 411-3. The bill directs the TSA to create an Aviation Security Advisory Committee, as well as subcommittees for air cargo, general aviation and airport perimeter security.

As the House and Senate conferees continue to work on a reauthorization bill for the Water Resources Development Act, interest groups are weighing in on what they believe should be in the final bill. The U.S. Chamber of Commercewrote the conferees to support project authorizations without earmarks. The Chamber also supported the provision in the Senate version that restricts Harbor Maintenance Trust Fund revenues to be utilized, as well as the Senate bill’s approach to the Olmstead Lock and Dam project that would shift 100 percent of remaining costs to the general treasury, instead of the House bill’s provision that would shift only 75 percent to the general treasury. The Chamber praises the House bill’s utilization of public-private partnerships, but urges the conferees to include the Senate bill’s Water Infrastructure Finance and Innovation Act of 2013, modeled after TIFIA loans and loan guarantees. The Heritage Foundation, by contrast, has urged conferees to not make HMTF spending mandatory and to require a 2-to-1deauthorization-to-authorization ratio until backlog is reduced to in between $10 billion and $15 billion, but agrees with the Chamber that project authorizations should not be granted through earmark.

Rep. John Delaney (D-Md.) wrote an op-ed for the Washington Post, calling for his infrastructure bank bill to be included in the budget conference deal. The bill, H.R. 2084, the Partnership to Build America Act, has 25 Democrat and 25 Republican co-sponsors. The bill would create the American Infrastructure Fund capitalized with $50 billion that could be used to create up to $750 billion in infrastructure financing to state and local governments for transportation, energy, water, communication and educational infrastructure. President Obama and Vice President Biden have been calling for the creation of such a fund on several of their recent visits to ports.

On November 22, the House Small Business Subcommittee on Contracting and Workforce held a hearing to examine the implementation of the new hours of service rules issued by the Federal Motor Carrier Safety Administration and their effect on the trucking industry. The FMCSA issued the new rules on July 1 to reduce the number of fatigued drivers. The rules include a 34-hour restart requirement, including that the 34 hours include four-hour time periods between 1:00 a.m. and 5:00 a.m. FMCSA Administrator Anne Ferro testified that the new rules combat the fatigue that drivers experience, many of whom had 82 hour work weeks. The new rule reduces the maximum allowable hours of work per week from 82 to 70. Ferro included that FMCSA research indicates that 85 percent of the commercial truck driver workforce has a weekly load of 60 hours or less, and therefore would not need to use the voluntary 34-hour restart. Tilden Curl, Jr. testified on behalf of the Owner-Operator Independent Drivers Association and stated that because of the industry’s pay-by-mile system, most drivers are not paid for time that is not spent driving, and as such, this will result in the loss of pay for many drivers. Curl called for greater flexibility in the hours of service rules.

The American Transportation Research Institute released a report titled “Operational and Economic Impacts of the New Hours-of-Service.” The report finds that 66 percent of drivers have reported increased fatigue since the new rules and that 80 percent of carriers have seen productivity losses as a result of the new rules. 

On November 21, the Senate Commerce Committee held a hearing to consider the nominations of Paul JaenichenSr. to Administrator the Maritime Administration and Debra Miller to the Surface Transportation Board. During the hearing, Acting Maritime Administrator Jaenichen said he would work to promote U.S. exports from small businesses and ensure that government offices are working closely with their counterparts abroad to attract foreign investment.Jaenichen also stated that he intends to work on a strategy to revitalize the U.S. Merchant Marine program and ensure that a significantly higher proportion of U.S. overseas trade is carried on U.S. flag vessels.

AT THE AGENCIES

The Maritime Administration has released Phase I of its Panama Canal Expansion Study. The Phase I preliminary report identifies the pending developments in world ocean trade routes and the global economy likely to affect U.S. and international freight corridors in light of the Panama Canal expansion. The report explains how the expansion will affect more concentrated U.S. port calls, use of foreign container transshipment ports, development of marine highways, and readiness of U.S. ports and related infrastructure, including navigational channel depth and height restrictions, terminal handling and storage capabilities, rail connectivity and capacity, and inland transportation systems. MARAD intends to release three more reports on phases of the study. Phase II of the study will provide a detailed assessment of the physical attributes of U.S. ports and inland infrastructure, evaluating port and infrastructure investment plans in preparation for the expansion. Phase III of the study will assess potential opportunities for applying investment funding towards future development of port capacity. Phase IV of the study will revisit the issues in this Phase I report, including feedback and recommendations from stakeholders.

The Department of Transportation Inspector General has released its Semiannual Report to Congress. The scope of the report is from April 1, 2013 to September 1, 2013.

The Federal Highway Administration has released its draft map of the “Primary Freight Network” that is required under the Moving Ahead for Progress in the 21st Century Act (MAP-21). MAP-21 limits the network to no more than 27,000 centerline miles of existing roadways that are most critical to the movement of freight. The Primary Freight Network, as well as Critical Rural Freight Corridors and portions of the Interstate System that are not designated as part of the Primary Freight Network, is a component of the National Freight Network that MAP-21 has directed the Department of Transportation to establish. Critical Rural Freight Corridors are designated as such by the states. 

IN THE STATES

California: House Railroads Chairman Jeff Denham has asked the Government Accountability Office to review whether the California High-Speed Rail Authority is violating federal agreements and whether the FRA should reevaluate the project in light of a recent court ruling. On November 25, Sacramento County Superior Court Judge Michael Kenny blocked a request from the California High-Speed Rail Authority to sell $8 billion to $10 billion in bonds that voters approved in 2008.

Pennsylvania: On November 27, Governor Tom Corbett signed a $2.3 billion bipartisan transportation bill. The law will direct $1.65 billion to highways and bridges and $476-$497 million for the state’s mass transit systems. The law repeals a 12¢ per gallon tax that gas station owners pay to the state, but removes the $1.25 per gallon cap on the Oil Company Franchise Tax and increases it over three years, generating about $2 billion in revenue per year. On January 1, 2014, a 9.5¢ increase on unleaded gasoline and a 13¢ per gallon increase on diesel will be implemented. The bill narrowly passed after being defeated twice in the House by votes of 98-103 and 89-112.

Nevada: The Legislature has set aside $4 million for the economic development office for use in attracting drone test site development. If Nevada is selected by the FAA, Governor Brian Sandoval estimates that the drone testing will generating $125 million in annual state and local tax revenue, have an overall economic impact of $2.5 billion, and create thousands of jobs for the state. Congress has mandated through the National Defense Authorization Act and the 2012 FAA reauthorization that the FAA establish test sites for drones.

Every Word Matters - #GetCovered vs. #RateShock

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #GetCovered vs. #RateShock - as Healthcare.gov improves, Democrats and Republicans are calling attention to the effects of the Affordable Care Act. Democrats are using #GetCovered to encourage those to acquire health insurance through the exchanges, whereas Republicans are calling attention to the #RateShock that some are experiencing under new plans.

 

Every Word Matters - Proposed P5+1 and Iran Agreement

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is the proposed P5+1 and Iran Agreement. This weekend, the P5+1 nations and Iran reached an agreement for Iran to temporarily halt its nuclear program. "P5+1" refers to the five permanent members of the UN Security Council (United States, Russia, China, United Kingdom, France) plus Germany.

 

Health Care Reform Implementation Update - November 25, 2013

Though administration officials are now downplaying the date, the November 30 deadline government consultants set for fixing HealthCare.gov is this week. Some Democrats who have gone to the mat for the Affordable Care Act (ACA), especially those who are up for reelection, are getting worried the deadline will not be met, and Wall Street analysts are predicting November 30 to be a telling day, not only in terms of how Congress will treat the law going forward but also for health care stocks. Late last week, the Department of Health and Human Services (HHS) announced it plans to delay the start of year two (2015) ACA enrollment by one month, which would fall right after the November midterm elections. Another delay was announced this week as well; due to the continued trouble withHealthCare.gov as well as plan cancellationsHHS announced a one-week delay in the deadline to apply for January 1 coverage, from December 15 to December 23. Finally, the Senate Finance Committee scheduled a markup of the sustainable growth rate (SGR) formula proposal for December 12; however, no decisions have been made on offsets for the cost of repeal.

ON THE HILL

On November 21, the Senate voted to change Senate rules, abolishing the chamber’s filibuster for most presidential appointments. The Senate’s rule change is likely to raise partisan tension and further frustrate the ability for agreement. With respect to health care, the change should make it significantly easier for President Obama to fill the Independent Payment Advisory Board (IPAB), the panel created by the ACA tasked with slowing the growth of Medicare spending, and other executive appointments and federal judicial openings, but not legislation or Supreme Court nominations.

On November 13, the Congressional Budget Office (CBO) issued its annual report citing five health care reform possibilities that could reduce the federal deficit. These options are: converting Medicaid to a block grant program, converting Medicare to a premium support model, imposing restrictions on Medigap plans, bundling Medicare’s payments, and reducing tax preference for employment-based health insurance.

The Senate Finance Committee will hold a markup to consider legislation to repeal the sustainable growth rate system and health care extenders on December 12. If Congress does not act, Medicare pay cuts of 24.4 percent are set to take effect on January 1.

During a Senate Small Business and Entrepreneurship Committee hearing on November 20, members agreed that small business owners shopping for health plans need assistance from brokers and agents. Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen testified before the committee on SHOP exchanges, and when asked, said he was neither surprised nor unsurprised by the cancelled insurance policies.

Congressmen Paul Ryan (R-Wis.) and Tom Price (R-Ga.), as well as other House Republicans, are pushing a plan to limit the amount of federal funding that can be used toward Medicaid expansion. The federal government has currently pledged to cover 100 percent of newly eligible Medicaid beneficiaries for the first three years. While this proposal is not officially being considered by the budget conference committee, it is being widely discussed by Republicans on the hill. Though such a plan has very little chance of passing in the Senate, the very reintroduction of the concerns may dissuade governors still deciding on Medicaid expansion from expanding.

The House Committee on Energy and Commerce Subcommittee on Oversight and Investigations hosted a hearing on November 19 at which the Centers for Medicare and Medicaid Services’ deputy chief information officer, Henry Chao, testified. Mr. Chao said that making HealthCare.gov work for the vast majority of users by November 30 was an attainable goal, but he would not give a guarantee. In a play on what many have charged is a broken promise by President Obama, Chairman Tim Murphy (R-Pa.) began the hearing by saying that the website “screams to those trying to break in to the system if you like my health care information, you can steal it.”

On November 14, Democratic House members met with HHS Sec. Sebelius to discuss options for legislation to supplement President Obama’s policy unveiled earlier that day to allow insurers to offer existing coverage to consumers despite not meeting ACA minimum standards.

Senators John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Orrin Hatch (R-Utah), and eight of their Republican colleagues introduced the Union Tax Fairness Act (S.1724) on November 19. The bill would prevent union health care plans, known as Taft-Hartley plans, from being exempted from the ACA reinsurance tax, which is scheduled to begin in 2014 and would require all self-insured plans to pay a tax for each person covered under a health plan. Additionally, last week, Sens. Thune, Alexander and Hatch led 18 of their Senate colleagues in sending a letter urging the Obama administration not to move forward with a proposed regulation to exempt unions from the reinsurance tax.

On November 15, the House voted 261-157 in favor of a bill sponsored by Energy and Commerce Chairman Fred Upton (R-Mich.), the Keep Your Health Plan Act. The bill would allow plans that existed on the individual market on January 1, 2013 to stay in effect through 2014. Thirty-nine House Democrats voted with Republicans to support the legislation to allow health insurers to continue selling plans canceled under the ACA through 2014. Meanwhile, interest and momentum are growing for a bill introduced by Senator Mary Landreiu (D-La.) and seven others, theKeeping the Affordable Care Act Promise Act, to allow individuals to keep their individual market plans that have been canceled as a result of ACA requirements. President Obama has threatened a veto to the House legislation.

The House Science, Space and Technology Committee held a hearing on the security of information onHealthCare.gov, titled “Is my Data on HealthCare.gov Secure?”

The Medicare Payment Advisory Commission, MedPAC, the independent body that advises Congress on issues affecting the Medicare program, is next scheduled to meet on December 12 and 13. We will provide further information on the agenda when it becomes available.

The Medicaid and CHIP Payment and Access Commission, MACPAC, a non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, is next scheduled to meet on December 14 and 15. We will provide further information on the agenda when it becomes available.

AT THE AGENCIES

As we noted last week, the administration released enrollment numbers for the Affordable Care Act (ACA) health insurance exchanges on November 13. The results came in far below the administration’s predictions, with 106,185 people signed up for health insurance plans through the ACA in October.

Top administration technology officials, as well as contract workers, say that they are making progress onHealthCare.gov; however, it is unlikely to be functioning perfectly by November 30, the day contractors and the administration had set in early October. On November 13, the government's top information technology experts testified before the House Oversight Committee. At the hearing, White House Chief Technology Officer Todd Park told a House panel that the ACA enrollment website still needed a lot of work. Government and contract workers have been reporting that HealthCare.gov can handle only half its projected volume. On November 15, Jeff Zients, whom President Obama named to fix the HealthCare.gov problems, said that 50 top-priority items remained on the list of tech fixes that were needed.

During a House Committee on Homeland Security hearing on November 13, Roberta Stempfley, acting assistant secretary of the Department of Homeland Security's Office of Cybersecurity and Communications, said that her agency was aware of about 16 reports of cybersecurity threats related to HealthCare.gov.

Centers for Medicare and Medicaid Services (CMS) spokeswoman Julie Bataille said the Spanish-language federal health insurance exchange website will be accepting applications by the end of November.

In reaction to the malfunctioning website, CMS contacted about 275,000 people who unsuccessfully attempted to enroll in coverage onHealthCare.gov, and encouraged them to try again. Additionally, the administration is now working with insurers to allow those who qualify for premium subsidies to enroll directly with insurance companies. CMS Communications Director Julie Bataille said HealthCare.gov can now determine subsidies for consumers signing up for coverage directly through insurers, as opposed to through the federal website.

Due to health plan cancellations and HealthCare.gov difficulties, HHS is delaying the deadline to apply for January 1 coverage from December 15 to December 23.

On November 22, CMS released calendar year 2014 payment rules for end stage renal disease facilities and home health agencies.

AT THE WHITE HOUSE

As we addressed in last week’s update, on November 14, President Obama announced that health insurers would be able to extend existing plans for individuals through 2014 that would otherwise have been cancelled due to changes under the ACA. This proposed fix does not guarantee that extensions will be available, but rather allows insurers to offer the extension and for state regulators to approve it. Several Republicans, including House Speaker John Boehner, spoke out afterwards arguing that the president might not have legal authority to enact this administrative fix.

On November 20, President Obama, Secretary Sebelius, and CCIIO Director Gary Cohen met with state insurance commissioners about the president’s proposal to prevent or undo plan cancellations. President Obama acknowledged the diversity of states’ needs in the meeting, and state insurance commissioners may decide on their own whether to go along with the president’s proposal. As many states continue to make their decisions, Washington State, Rhode Island and Massachusetts have already said that they will not go along with the plan. Florida said it would, and California said it would go along with the administrative fix; however, California health insurers are opposing the plan citing risk pool distortion concerns. Other insurers and state regulators also are citing concerns that the fix will undermine the ACA and hike premium prices.

On October 21, the White House released a letter for insurers to circulate to their customers providing information on health coverage options.

On November 21, the Obama administration confirmed that it is planning to delay the ACA’s second-year enrollment period to provide insurers with more time to set rates after considering their plan experiences during 2014. This also pushes open enrollment period until just after the November midterm elections.

On November 15, President Obama and senior administration officials met with the CEOs of several big insurance companies, along with leadership from America’s Health Insurance Plans (AHIP). In attendance were CMS Administrator Marilyn Tavenner, Director of the Health Reform Office at HHS Mike Hash, the White House Chief of Staff Denis McDonough, White House Senior Advisor and Assistant to the President for Intergovernmental Affairs and Public Engagement Valerie Jarrett, White House Deputy Assistant to the President for Health Policy and Coordinator for Health Reform Chris Jennings, as well as the CEOs from Aetna, Humana, CareFirst, Cigna Healthcare, Health Net, Inc., Blue Shield of Florida, Health Care Services Corporation, Independence Blue Cross, America’s Health Insurance Plans, Molina Healthcare, Tufts Health Plan, Blue Cross Blue Shield Association, Wellpoint, Kaiser Permanente and Blue Cross Blue Shield North Carolina. The group discussed best ways to eliminate disruption for consumers as they transition to new coverage.

On November 14, the White House announced that President Obama plans to nominate Vivek Hallegere Murthy to succeed Regina Benjamin as surgeon general. He is the co-founder and president of Doctors for America, which was originally Doctors for Obama in 2008.

IN THE STATES

On November 14, Wisconsin Governor Scott Walker said he was planning to delay for three months his state’s plan to move 77,000 low-income people into the health law’s new marketplace.

On November 15, Alaska Gov. Sean Parnell said his state would not expand its Medicaid program under the ACA due to a new report estimating that the expansion would cost Alaska around $200 million over seven years.

The D.C. city government named Chester A. McPherson the new acting insurance commissioner, following the former commissioner, William White’s termination. The day before he was fired, former insurance commissioner White had released a statement titled, “White says president's announcement undercuts exchanges."

IN THIRD PARTIES

Leaders from the insurance industry, including CEO of America’s Health Insurance Plans (AHIP) Karen Ignagni, continue to say that the “fix” could destabilize the health insurance market.

A new poll from Gallup shows that 56 percent of adults do not believe that the government has a responsibility to ensure Americans have health insurance, and 42 percent say it is the government’s responsibility.

Last week, the American Medical Association (AMA) submitted 12 pages of recommendations for revamping the SGR replacement proposal of Senate Finance and Ways Means. The recommendations include: reduce penalties, increase pay, make CMS determine prospectively whether doctors are in alternate pay models, compare doctor performance among practices of similar size, and put in context data on what Medicare pays doctors.

 

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

Every Word Matters - #NuclearOption

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is the #NuclearOption - after numerous filibusters from Republican Senators over President Obama's judicial nominees, the Senate voted to change its filibuster rules by a simple majority vote, a tactic known as the "nuclear option." Most judicial and executive branch nominees will now require only a simple majority vote from the Senate and will not be subject to the possibility of needing 60 votes to defeat a filibuster from the minority.

 

Every Word Matters - #passMJIA

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #passMJIA - the Military Justice Improvement Act of 2013, S.967, and now a proposed amendment to the NDAA reauthorization for FY2014. If enacted, MJIA would shift the decision of whether or not to prosecute military sexual assaults from the military chain of command to independent military prosecutors . While the effort to #passMJIA has garnered at least 50 votes in the Senate, the bill will likely need to survive a cloture vote, which requires 60 votes.

 

Infrastructure Alert - November 19, 2013

President Obama and Vice President Biden have made several recent trips outside Washington to highlight the need for increased infrastructure spending. On November 8, President Obama appeared at the Port of New Orleans, calling for Congress to create a $50 billion National Infrastructure Bank for roads, bridges and ports that would utilize private-sector investment in the form of public-private partnerships. The President requested Congress fund $10 billion for the bank’s capital. This echoes a policy focus that the President spoke about in his most recent State of the Union address. Yesterday, Vice President Biden visited the Port of Houston and also stressed the need for an infrastructure bank, particularly for port investments in anticipation of the Panama Canal expansion. Vice President Biden has now arrived in Panama, where he will tour the expansion project.

ON THE HILL

The House has named its Water Resources Reform and Development Act (H.R. 3080) conferees. The 28 conferees were drawn from the Transportation and Infrastructure Committee as well as from the Natural Resources Committee. The full list is available here. The Senate has already named its conferees, and the conference will move forward to resolve discrepancies between the two bills.

On November 14, Sen. Mark Warner (D-Va.) has introduced S. 1716, the Building and Renewing Infrastructure for Development and Growth in Employment (BRIDGE) Act, a bill that would create a $10 billion national infrastructure bank. The bill currently has nine co-sponsors: four Democrats and five Republicans. The bill creates a seven-member board that, by statue, will be split 4-3 on party lines, called the Infrastructure Financing Authority. The Authority would finance only up to 49 percent of any given project, and for most projects to qualify, they must be of “national or regional significance” and cost at least $50 million. The bill would reserve 5 percent of the bank’s funding for rural projects costing at least $10 million. S. 1716 is similar to H.R. 2084, the Partnership to Build America Act introduced by Rep. John Delaney (D-Md.), which would create a $50 billion fund. Rep. Delaney’s bipartisan bill has 49 co-sponsors.

Sen. Mike Lee (R-Utah) and Rep. Tom Graves (R-Ga.) have introduced a bill named the Transportation Empowerment Act (TEA) which would require staggered reductions in the federal gasoline tax and federal surface transportation spending over five years while shifting almost all authority of the federal highway and transit program to the states, allowing states to supplement their own respective transportation systems through their own means. The federal gasoline tax would be lowered from 18.4¢ per gallon to 3.7¢ per gallon over the five-year period.

On November 14, the House passed a technical change on H.R. 3363, the Small Airplane Revitalization Act of 2013. The bill, which was passed by unanimous consent in the House on October 4, was modified slightly by the Senate before the Senate passed it by unanimous consent. The bill now awaits the President’s signature.

The Congressional Budget Office released a report titled “Options for Reducing the Deficit: 2014 to 2023,” examining methods to balance the budget, including several infrastructure-related ones. The report suggests raising the federal gasoline tax by 35¢ and indexing it to inflation, which the CBO estimates would raise $207 billion over the next five years and $452 billion over the next 10. The report also includes suggestions to eliminate Airport Improvement Grants to smaller airports, saving $8 billion over 10 years, ending transit capital investment grants, saving $14 billion over 10 years, restricting Highway Trust Fund spending to its available balance, saving $65 billion over 10 years, and eliminating substantial Amtrak funding, saving $15 billion over 10 years.

On November 21, the Senate Commerce, Science and Transportation Committee will hold a hearing to consider the nominations of Paul Jaenichen, Sr. to Administrator of the Maritime Administration (MARAD) and Debra Miller to the Surface Transportation Board. The hearing will be available to be streamed here.

Also on November 21, the House Small Business Subcommittee on Contracting and Workforce will hold a hearing titled “Wrong Way: The Impact of FMCSA's Hours of Service Regulation on Small Businesses.” Anne Ferro, the Administrator of the FMCSA, will testify. Following her testimony and questions from the subcommittee, a second panel will testify. The following comprise the second panel of witnesses: Tilden Curl Jr., Tecco Trucking, representing Owner-Operator Independent Drivers Association; Brian Evans, President and Owner, L&L Freight Services Inc., representing Transportation Intermediaries Association; Paul P. Jovanis, Professor, Civil and Environmental Engineering, and Director, Transportation Operations Program, Larson Transportation Institute, Pennsylvania State University; and Duane Long, Chairman for Logistics, Research Triangle Park, representing the American Trucking Association. Hearing testimony and streaming will be available here.

Rep. Howard Coble (R-N.C.), a member of the House Committee on Transportation and Infrastructure, has announced that he will not seek re-election. While fellow committee members Rep. Shelley Moore Capito (R-W.Va.) and Rep. Mike Michaud (D-Maine) are not retiring, but running for Senate and Governor respectively, the three of them will be leaving the House at the end of the term.

AT THE AGENCIES

On November 13, the Department of Justice settled their antitrust suit against the US Airways-American Airlines merger. Under the terms of the settlement, the new airline will relinquish 52 slots at Regan National Airport, 17 slots at LaGuardia Airpo16 sixteen slots at Reagan National and Southwest Airlines will receive 10 slots at LaGuardia.

The Federal Aviation Administration has released the “Integration of Civil Unmanned Aircraft Systems (UAS) in the National Airspace System (NAS) Roadmap.” The roadmap outlines the FAA’s intentions for sharing the commercial national airspace system with manned and unmanned aerial vehicles alike by 2015. The document states that the FAA will choose six test sites for integration of UAS for the FAA to study as pilot programs.

On November 13, the Department of Transportation announced that 183 tribes will receive $8.6 million for 195 projects from the Federal Highway Administration’s Tribal Transportation Program Safety Fund. This is the first instance that funds have been awarded since the program was created by the Moving Ahead For Progress in the 21st Century Act (MAP-21).

IN THE STATES

California: The California High-Speed Rail Authority has only acquired one parcel of the 370 needed to complete the first 30 miles of construction. The High-Speed Rail Authority has stated that of the remaining 369 parcels, which can be acquired either through sale or seizure by eminent domain, 38 are expected to be acquired within the next month. The High-Speed Rail Authority has been delaying the deadlines for residents to move out for months.

New York: On November 17, Gov. Andrew Cuomo announced five storm mitigation and resiliency projects for LaGuardia Airport totaling $37.5 million. Of the total cost, $28.1 million will be funded by federal grants funded by Superstorm Sandy relief funds allocated by the Port Authority of New York and New Jersey. The five projects include the installation of flood barrier berms around the West Field Lighting Vault, construction of a concrete floodwall around the West End Substation, construction of gravity drains to supplement the airport’s existing drainage network, replacement of existing generators with larger, more efficient emergency back-up generators, and rehabilitation of the airport’s monitoring and control system for LGA power distribution grid to enable the airport to more quickly monitor and address issues with its electrical distribution system.

Washington: Despite the state legislature meeting in a special session to pass tax incentives for the manufacture of the upcoming 777X plane, the Boeing deal has fallen apart in Washington as the International Association of Machinists voted down its labor contract that had major concessions in exchange for long-term job security. The contract would have ended the traditional pension plan in 2016, freezing it for current employees and ending it for future ones in lieu of a company-funded defined contribution retirement-savings account. The proposal also included a $10,000 signing bonus before Christmas, increase of wages by 1 percent yearly in addition to a yearly cost-of-living adjustment, and increased employee health care premiums and copays. After the union vote, in which 67 percent of members rejected the contract, Boeing is reportedly looking to build the plane in another state.

Every Word Matters #HR3350 11/15/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #HR3350 - the Keep Your Health Plan Act of 2013. Following up on yesterday's #KeepYourPlan, the House passed Rep. Upton's H.R. 3350 by a vote of 261 to 157. 39 Democrats joined 222 Republicans to vote for the bill, but the White House has issued a statement that President Obama plans to veto the bill if it passes Congress.

 

Every Word Matters #KeepYourPlan 11/14/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Today's topic is #KeepYourPlan - President Obama announced a new policy today that would allow health insurers and state regulators to approve existing health plan that would have otherwise been cancelled through 2014. Sen. Mary Landrieu (D-LA) and Rep. Fred Upton (R-MI) have each introduced different bills that would allow existing health insurance plans to be grandfathered in and not subject to certain requirements of the Affordable Care Act.

 

Health Care Reform Implementation Update - November 14, 2013

Earlier today, President Obama announced that health insurers will be able to extend existing plans for individuals through 2014 that would have been otherwise canceled due to changes under the Affordable Care Act. This proposed fix does not guarantee that extensions will be available, but rather allows insurers to offer the extension and for state regulators to approve it.

The administration has now released enrollment numbers for the Affordable Care Act (ACA) health insurance exchanges. Coming in far below the administration’s predictions, 106,185 people have signed up for health insurance plans through the ACA. A quarter of these individuals enrolled through HealthCare.gov, while the rest signed up in state-run exchanges. Congress continues to grill those responsible for the exchanges and ACA implementation more generally at hearings and through subpoenas for documents, with Republicans, Democrats and individuals throughout the country requesting or insisting that they be permitted to keep their health insurance plans. Notably, former President Bill Clinton spoke out this week saying that President Obama should let Americans keep their health insurance plans. Meanwhile, interest and momentum are growing for a bill introduced by Senator Mary Landreiu (D-La.) and five others to allow individuals to keep their individual market plans that have been canceled as a result of ACA requirements. It is not clear what, if any, position the White House will take on this legislation.

In the past week, Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner testified before the Senate Health, Education Labor & Pensions (HELP) Committee, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius testified before the Senate Finance Committee, and top operational officials for the ACA exchanges, including Chief Technology Officer Todd Park, testified before the House Oversight and Government Reform Committee. Comments on the Senate Finance and House Ways and Means draft Sustainable Growth Rate (SGR) formula repeal were due on November 12, and MedPAC discussed its intent to avoid interfering with discussions on the topic in order to enable Congress to move more swiftly in light of the reduced Congressional Budget Office (CBO) cost of eliminating the formula this year.

ON THE HILL

On November 5, CMS Administrator Marilyn Tavenner testified before the Senate HELP Committee. Chairman Sen. Tom Harkin (D-Iowa) defended the ACA and criticized Republicans for making implementation difficult. Ranking Member Sen. Lamar Alexander (R-Tenn.) brought up the cancelations in light of President Obama’s promises. Administrator Tavenner highlighted improvements that had been made to the website including faster response times, greater ease in browsing options and ensured security. Administrator Tavenner said the administration was shooting for enrollment in October and November around 800,000. Her communications director later clarified that this number includes total enrollment in federal and state exchanges, as well as Medicaid and Children’s Health Insurance Programs (CHIP) programs.

On November 6, HHS Secretary Sebelius testified before the Senate Finance Committee. Ranking Member Orrin Hatch (R-Utah) said he wants monthly hearings with Sec. Sebelius. Sen. Roberts (R-Kan.) again called for Sec. Sebelius to resign; however, Chairman Max Baucus (D-Mont.) said she needed to remain at HHS. Additionally, Sec. Sebelius warned that she expected enrollment numbers to be low.

The House is planning a vote for November 15 on a bill sponsored by Energy & Commerce Chairman Fred Upton (R-Mich.), the Keep Your Health Plan Act. The bill has 88 co-sponsors in the House and would allow plans that existed on the individual market on January 1, 2013 to stay in effect through 2014.

On November 13, the Committee on Oversight and Government Reform held a hearing to investigate the operational challenges in the development of Healthcare.gov. Committee Chairman Darrel Issa (D-Calif.) called the website “an insult” to the online shopping sites that the online health insurance exchanges had been compared. White House Chief Technology Officer told the Committee that the technology teams were working aggressively to fix the website so it could work for the vast majority of Americans by the November 30 deadline the administration set. Committee Ranking Member Congressman Elijah Cummings (D-Md.) said that though CMS had failed to deliver what it said it would deliver, Republicans are refusing to be helpful in making the reforms work.

House Oversight and Government Reform Committee staff interviewed Henry Chao, who supervised the construction of HealthCare.gov and participated in signing off on the launch of the website, in a nine-hour closed session on November 8.

The House Committee on Oversight and Government Reform sent letters to health insurance exchanges in states running their own exchanges requesting documents related to the in-person assisters who are assisting with enrollment.

On November 5, Ways and Means Committee Chairman Dave Camp (R-Mich.) issued a subpoena to CMS requesting that it provide all data on enrollment in the exchanges. Congressman Camp first requested this information during a hearing with Administrator Tavenner and then again in a letter on November 1. Additionally, Chairman Camp sent a letter requesting that IRS Acting Commissioner Daniel Werfel disclose all information the agency has about eligibility determinations for premium tax credits under the ACA.

On November 14, the House Committee on Education and the Workforce held a hearing on how the ACA is affecting the country’s education system. The Committee highlighted news that schools at all levels are struggling under the weight of the ACA.

On November 7, HHS announced $150 million in awards under the ACA to support 236 health center sites across the country, which will help care for approximately 1.25 million additional patients.

Sens. Joe Manchin (D- W.Va.) and Mark Kirk (R-Ill.) introduced legislation that would delay the ACA’s individual mandate until January 2015. The proposal would waive the $95 penalty for 2014 entirely.

The Medicare Payment Advisory Commission, MedPAC, the independent body that advises Congress on issues affecting the Medicare program, met on November 7 and 8. The meeting was broken into the following sessions: synchronizing Medicare policy across delivery systems, measuring quality across Medicare’s delivery systems, Medicare accountable care organizations (ACOs), rationalizing Medicare’s payment for post-acute care, improving Medicare payment for chronically critically ill patients in hospital settings, Medicare managed care topics, initial approach to the payment update and other policy options for physicians and other health professionals, and Medicare beneficiaries’ access to hospital care and near-term changes in Medicare’s payment policies. Notably, during the ACO panel, there seemed to be support for a phase in over a two-sided risk model; on the topic of Medicare managed care and the issue that employer-group Medicare Advantage plans bid differently than non-employer plans, the general consensus of the commissioners was in favor of setting the employer bid to benchmark ratio equal to the nationwide non-employer ratio; and in the panel on the topic of a payment update for doctors, Chairman Hackbarth expressed that MedPAC is very supportive of Congress’s work on the SGR repeal formula and will not vote on a strategy for offsets to pay for SGR repeal in order to allow Congress to move swiftly on its proposal.

The Medicaid and CHIP Payment and Access Commission, MACPAC, a non-partisan federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, will meet on November 14 and 15. The meeting is divided into sessions on the future of CHIP, long-term care, short and long-term issues for CHIP, Medicaid Interactions with the ACA, and Medicaid Non-DSH Supplemental payments.

AT THE AGENCIES

On November 8, long-awaited mental health parity final rules, which arise from the 2008 Mental Health Party and Addiction Equity Act, were released. The regulations implement requirements that treatment for mental illness and substance abuse be treated equally to physical care.

The Obama administration has decided that neither the federal insurance exchange nor the federal subsidies paid to insurance companies on behalf of low-income individuals qualify as “federal health care programs.” The significance of this categorization is that it results in the exchanges and exchange subsidies being exempt from a federal law banning rebates, kickbacks, bribes and some other financial arrangements in federal health care programs.

CMS Chief Information Officer Tony Trenkle announced his resignation on November 6, effective November 15.

AT THE WHITE HOUSE

A group of 15 Senate Democrats up for re-election in a year met with President Obama and other administration officials on November 6 about the ACA exchanges and the HealthCare.gov website. The group meeting at the White House included Sens. Mark Begich (D-Alaska), Cory Booker (D-N.J.), Chris Coons (D-Del.), Dick Durbin (D-Ill.), Al Franken (D-Minn.), Kay Hagan (D-N.C.), Mary Landreiu (D-La.), Jeff Merkley (D-Or.), Mark Pryor (D-Ark.), Jack Reed (D-R.I.), Jeanne Shaheen (D-N.H.), Brian Schatz (D-Hawaii), Mark Udall (D-Colo.), Tom Udall (D-N.M.), Mark Warner (D-Va.), and Michael Bennet (D-Colo.).

IN THE STATES

Terry McAuliffe was elected Governor of Virginia last week. Among the potential implications of McAuliffe’s election is a renewed possibility of Medicaid expansion in the state. Notwithstanding McAuliffe’s support for Medicaid expansion, the state legislature must vote to expand Medicaid before any such legislation gets to the Governor’s desk. Last year, the Virginia legislature gave control of Medicaid reform and expansion to a legislative commission made up of 10 members and controlled by Republicans. The commission has said it is open to expansion if coupled with other major reforms. In his concession speech, gubernatorial candidate Ken Cuccinelli attributed the closeness of the race to the country’s dislike of the Affordable Care Act and the faulty rollout of the exchanges.

Gov. Chris Christie was reelected as Governor in New JerseyGov. Christie had already signed off on his state's expansion of Medicaid.

IN THIRD PARTIES

New analysis by the Kaiser Family Foundation shows nearly six in 10 people eligible for the insurance exchanges next year will qualify for subsidies to help buy coverage.

Under pressure from the state of California, Blue Shield of California agreed to hold off on canceling plans for 115,000 subscribers until March 31, which marks the end of the ACA’s open enrollment period

On November 12, former President Bill Clinton said that President Obama should make changes to the ACA to allow people to keep their existing health insurance plans.

Over the past few weeks, insurers have reported that enrollees in the ACA exchanges are older than expected. To function as intended, the exchange will need a significant proportion of young enrollees as well. Some are very concerned, and others are certain that the young beneficiaries will sign up close to the deadline.

On November 5, The American Academy of Actuaries warned Congress that delaying the ACA’s individual mandate would hike premium rates. The academy has been circulating a letter around Congress warning about the potential danger of a delay in the individual mandate.

IN THE WHITE HOUSE

On November 7, President Obama offered an apology to those losing their health insurance plans and said in an interview, “I am sorry that they are finding themselves in this situation based on assurances they got from me.” Sen. Ron Johnson (R-Wis.) pushed back saying that the president’s apology was not genuine.

 

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

Every Word Matters - 11/7/13

#Sequestration

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less. Today's topic is #Sequestration - The Senate Armed Services Committee held a hearing today to discuss the impacts of budget sequestration, a series of mandatory, across-the-board budget cuts, on the military. 

Infrastructure Alert - November 6, 2013

 

ON THE HILL

On October 23, the House passed H.R. 3080, the Water Resources Reform and Development Act of 2013 by a vote of 417-3. The near-unanimous vote on a bill with significant authorizations is notable considering the recenthyperpartisanship and congressional gridlock. The Senate bill S. 601, the Water Resources Development Act of 2013, received similar bipartisan support and only 14 votes were cast against it. The Senate has appointed its conferees: Chairwoman Barbara Boxer (D-Calif.), Ranking Member David Vitter (R-La.) , Sen. Max Baucus (D-Mo.), Sen. Tom Carper (D-Del.), Sen. Sheldon Whitehouse (D-R.I.), Sen. Jim Inhofe (R-Okla.), and Sen. John Barrasso (R-Wyo.). The House is expected to appoint its conferees soon, and a conference committee is expected to begin shortly thereafter.

Of the major differences in the House and Senate bill, S. 601 creates several programs to which H.R. 3080 does not have equivalents. S. 601 creates a loan guarantee program for state and local governments, as well as nongovernmental organizations, for use in water infrastructure projects called “Water Infrastructure Finance and Innovation Act” (WIFIA) loans, similar to TIFIA loans. S. 601 would also authorize the Army Corps of Engineers to create grant programs to assist local and state governments with levee safety. H.R. 3080 would authorize several projects that would not be eligible for authorization under S. 601.

The three votes against the bill were from Rep. Jim Sensenbrenner (R-Wis.), Rep. Walter Jones (R-N.C.), and Rep. Collin Peterson (D-N.C.). Reps. Jones and Peterson have stated they voted against the bill because it did not help certain projects in their districts. WRRDA does not reauthorize a flood diversion project in Peterson’s district, and a jetty project that was authorized in 1970 is likely to be cancelled in Jones’ district. Jones sponsored an amendment to try to protect the jetty project, but it was not approved by the Rules Committee.

The White House released a Statement of Administration Policy in support of the bill with only a few exceptions, including concerns over the permitting and delivery provisions that may slow projects and provisions that could constrain “science-based decision making, increase litigation risk, and undermine the integrity of several foundational environmental laws, including the Clean Water Act, the Endangered Species Act, and the National Environmental Policy Act.”

The special panel on 21st Century Freight Transpiration tasked by House Transportation and Infrastructure Chairman Bill Shuster (R-Pa.) to submit a report to the full committee regarding the state of and policy recommendations for the national freight transportation system has released its report, titled “Improving the Nation’s Freight Transportation System: Findings and Recommendations of the Special Panel on 21st Century Freight Transportation.” Among other recommendations, the report recommends that Congress pass legislation to direct the Secretary of Transportation, Secretary of the Army, and the Commandant of the U.S. Coast Guard to establish a comprehensive national freight transportation policy and designate a national, multimodal freight network, to incentivize additional private investment in freight transportation facilities, to maintain and improve the condition and performance of the freight transportation network, to authorize dedicated, sustainable funding for multimodal freight Projects of National and Regional Significance through a grant process and establish clear benchmarks for project selection, and to pass legislation to direct the Secretary of Transportation, Secretary of the Treasury, and the Secretary of the Army to identify and recommend sustainable sources of revenue across all modes of transportation that would align contributions with use of the multimodal freight network. The report also instructs the Committee on Transportation and Infrastructure and Committee on Ways and Means to review these freight funding recommendations from Secretary of Transportation and to develop funding and revenue options to include in the 2014 surface transportation reauthorization bill.

On October 30, House and Senate version of a bill were introduced that would permit testing hair samples for drug violations in the professional trucking industry. In the Senate, Sens. Mark Pryor (D-Ark.) and Jon Boozman (R-Ark.) are co-sponsoring S. 1625, and in the House, Reps. Rick Crawford (R-Ark.), Tom Cotton (R-Ark.), Tim Griffin (R-Ark.), ReidRibble (R-Wis.), and Steve Womack (R-Ark.) are co-sponsoring H.R. 3403.

Today, the Senate Special Committee on Aging will hold a hearing titled “Transportation: A Challenge to Independence for Seniors.” Witnesses include Grant Baldwin, the Director of the Division of Unintentional Injury Prevention of the National Center for Injury Prevention and Control; Therese McMillan, Deputy Administrator of the Federal Transit Administration; Virginia Dize, Co-Director of the National Center on Senior Transportation of the National Association of Area Agencies on Aging; and Katherine Freund, the Founder and President of the Independent Transportation Network America.

Also today, the Senate Homeland Security and Governmental Affairs Subcommittee on Emergency Management, Intergovernmental Relations, and the District of Columbia will hold a hearing titled “One Year Later: Examining the Ongoing Recovery from Hurricane Sandy.” Witnesses include Shaun Donovan, the Secretary of Housing and Urban Development; John Porcari, the Deputy Secretary of Transportation; W. Craig Fugate, the Administrator of the Federal Emergency Management Agency (FEMA), Jo-Ellen Darcy, the Assistant Secretary of the Army for Civil Works; KathleenTighe, Chairwoman of the Recovery Accountability and Transparency Board; and Cas Holloway, New York City Deputy Mayor for Operations. The hearing begins at 2:30 p.m., and written testimony and streaming video will be availablehere.

AT THE AGENCIES

The Federal Aviation Administration released a new rule that will give airlines more leeway in whether or not electronic devices must be powered off during takeoffs and landings. The reversal of the oft-criticized former policy of mandatory shutdown of electronic devices was based on a report by an FAA advisory committee. The FAA stated that it would have likely released this rule earlier but it was delayed due to the government shutdown. The FAA released thisfact sheet with its announcement of the new rule.

In addition to the electronic device rule being delayed, the Department of Transportation released a statement that the October 2013 Significant Rulemaking Report would not be published due to the government shutdown, but the November report will be published on its regular schedule.

On October 28, the Federal Motor Carrier Safety Administration released its final rule titled “Hours of Service of Drivers” to allow for an exception to the mandatory 30-minute rest break for short-haul drivers who are not required to prepare records of duty status.

The Governmental Accountability Office released a report titled “Intelligent Transportation Systems: Vehicle-to-Vehicle Technologies Expected to Offer Safety Benefits, but a Variety of Deployment Challenges Exist.” The Department of Transportation Office of the Inspector General released a report titled “Opportunities Exist to Strengthen FHWA’sCoordination, Guidance, and Oversight of the Tribal Transportation Program.”

IN THE STATES

FHWA published a chart that compares the amounts that each state contributes to and receives from the Highway Trust Fund in FY2012 and each state’s total cumulated contributions and allocations since the inception of the trust fund in 1956.

California: The two largest unions involved with the BART strike voted on November 1 to approve a four-year contract to end the transit workers’ strike. While the next board meeting for BART’s board of directors is not until November 21, the board is expected to approve the deal. The contract will increase pay by 16.4 percent over the next four years, and bonuses of up to $1,000 will be awarded when BART ridership exceeds expectations. The contract also will have workers contribute to their pension for the first time and increase monthly health care contributions.

Massachusetts: The corporation New Balance has offered to help the state of Massachusetts fund its rail station in Brighton. New Balance has agreed to design and build the rail station under MBTA supervision and pay maintenance costs for the next 10 years. New Balance is estimated to pay between $14 and $16 million to fund the project and maintenance. The company’s 500-employee headquarters is located a few blocks from the future site of the rail stop.

New York: The Department of Transportation has announced that the Tappan Zee bridge project has been officially approved for its $1.6 billion TIFIA loan. The loan is expected to lower the bridge tolls below previously estimated projections. New York is still pursuing additional funding options from federal, state and local sources. The TappanZee bridge is a public-private partnership and is the largest design-build transportation project in the United States. The total cost of the project is estimated at $3.9 billion.

Texas: Texas State Highway 130, a privately operated, TIFIA-financed toll road, has been downgraded by Moody’s and is risking default. Moody’s has downgraded the rating of the SH 130 Concession Company to B1, and its rating outlook is negative. The downgrade is significant not only because of the TIFIA financing, but also because the highway is the first privately built and operated in Texas. The TIFIA loan was approved in March 2008TIFIA is awarded today strictly on a credit-worthiness basis.

Virginia: On October 31, the Virginia Supreme Court unanimously ruled that tolls on two tunnels to fund a third tunnel are not unconstitutional, as found by a lower court, but are legally permissible user fees. The tolls are scheduled to begin February 1 at $2 per passenger vehicle but will increase incrementally through 2070. The third tunnel that is funded through the tolls of two others was built through a public-private partnership, and was contracted through the use of provisions in the 1995 Virginia Private Partnership Act. Through this statute, the Department of Transportation could set toll rates, and the lower court found this to be an unconstitutional ceding of taxing authority by the state General Assembly. The Supreme Court ruled that the tolls are user fees and not taxes, as they are used not to raise revenue but to fund a specific project.

Health Care Reform Implementation Update - November 5, 2013

Criticism of the Affordable Care Act’s exchange rollout continued this past week. The main line of attack has moved from the malfunctioning website to canceled plans despite President Obama’s repeated promise that those who liked their health plans could keep them. The Secretary of the Department of Health and Human Services (HHS), Kathleen Sebelius, and the Administrator of the Centers for Medicare and Medicaid Services (CMS), Marilyn Tavenner, testified before congressional committees this week and apologized for the problems in the rollout. Administrator Tavenner testified again this morning before the Senate Health, Education, Labor, and Pensions (HELP) Committee. Also in the past week, the Senate Committee on Finance and the House Committee on Ways and Means introduced a joint legislative framework to replace the Sustainable Growth Rate (SGR) physician payment formula, adopting much of what the House Committee on Energy and Commerce suggested this summer. 

ON THE HILL

On October 30, the Senate Committee on Finance and the House Committee on Ways and Means introduced a joint legislative framework to replace the Sustainable Growth Rate (SGR) physician payment formula that determines how Medicare pays physicians. The proposal adopts many features of H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013, that cleared the House Energy and Commerce Committee with bipartisan support this summer. The key difference between the new proposal from Finance and Ways and Means and the one from Energy and Commerce is that the Ways and Means/Finance proposal would freeze guaranteed annual physician payment updates for 10 years, whereas the Energy and Commerce measure would allow annual increases of 0.5 percent over five years. The discussion draft is now being circulated for comment until November 12.  On October 31, House Energy & Commerce leaders said they support the Finance/Ways and Means proposal.

On October 30, HHS Secretary Sebelius testified at a House Energy and Commerce Committee hearing. She apologized for the website’s malfunctioning and explained a Verizon Terremark network failure that impacted HealthCare.gov on October 28. In response to a question about costs of the website, Sec. Sebelius said $118 million had been spent on the website itself and about $56 million had been spent on additional information technology to support it. When asked about enrollment numbers, Sec. Sebelius said HealthCare.gov’s problems made reliable enrollment numbers impossible to determine at this point.

On October 30, CMS Administrator Marilyn Tavenner appeared before the House Ways and Means Committee. Administrator Tavenner apologized for HealthCare.gov’s problems and told the committee that CMS did not know about the problems until the first week of the website’s launch. Tavenner was asked repeatedly about enrollment numbers, but she did not provide the requested information and continued to say that enrollment data would not be available until mid-November. Chairman Dave Camp (R-Mich.) said that, “We now know the administration was not ready. Frankly, three years should have been enough.”  Administrator Tavenner testified again on November 5 before the Senate HELP Committee.

On October 30, Sen. Mary Landrieu (D-La.) said that she would propose legislation to ensure all Americans could keep their existing insurance coverage under the Affordable Care Act (ACA). Sen. Landrieu faces a tough election as a Democrat in Louisiana in 2014. Similarly, in the House, Chairman of the House Energy and Commerce Committee Congressman Fred Upton (R-Mich.) is introducing the “Keep Your Health Plan Act,” which would allow any insurance plans that were in effect on January 1, 2013 to continue into 2014.

The Congressional Budget Office updated its analysis of an option to raise the eligibility age for Medicare from 65 to 67.  The updated report shows that the age increase would save $19 billion over 10 years, a number that is significantly lower than its 2012 estimate of $113 billion.

House Oversight Committee Chairman Darrell Issa (R-Calif.) has been requesting documents from various entities. He subpoenaed documents from ACA contractor Quality Software Service, Inc. (QSSI), obtained a memo issued days before HealthCare.gov’s launch that reveals knowledge of security concerns and subpoenaed HHS for documents on the “technical problems” with the websites, user capacity of the site, testing information, and number of people who have enrolled or attempted to enroll on the exchanges.

Guidance on October 29 from the House’s chief administrative officer gave members of Congress until the end of the day on October 31 to decide whether their staffs would enter the DC insurance exchange. The guidance said lawmakers could designate their personal office aides as “official,” which would require them to enter the DC exchanges, or not official, which would mean they do not need to go on the exchanges. Sen. David Vitter (R-La.) proposed legislation that would require Congress to make public which of their staff members are enrolling in the insurance exchanges and which are not. In the meantime though, most of these decisions are being made privately within personal offices on Capitol Hill.

On October 30, Reps. Charles Boustany (R-La.) and Ami Bera (D-Calif.) proposed legislation that would delay for two years ACA’s health insurance premium fee. Under the ACA, a new tax is imposed on health insurance companies beginning in 2014. The expected cost of such a delay is about $15 billion, which is significantly less than the $100 billion price tag of a permanent repeal.

A group of 10 Senate Democrats led by Sen. Jeanne Shaheen (D-N.H.) sent a letter to HHS Sec. Sebelius on October 25 urging her to extend the ACA enrollment deadline due to problems with the exchange website. Senators MarkBegich (D-Alaska), Michael Bennet (D-Colo.), Dianne Feinstein (D-Calif.), Kay Hagan (D-N.C.), Michael Heinrich (D-N.M.) Mary Landrieu (D-La.), Mark Pryor (D-Ark.), Mark Udall (D-Colo.), and Tom Udall (D-N.M.) also signed the letter.

The Medicare Payment Advisory Commission, MedPAC, the independent body that advises Congress on issues affecting the administration, will meet this week on November 7 and 8. The meeting will be broken into the following sessions: synchronizing Medicare policy across delivery systems, measuring quality across Medicare’s delivery systems, Medicare accountable care organizations (ACOs), rationalizing Medicare’s payment for post-acute care, improving Medicare payment for chronically critically ill patients in hospital settings, Medicare managed care topics, initial approach to the payment update and other policy options for physicians and other health professionals, and Medicare beneficiaries’ access to hospital care and near-term changes in Medicare’s payment policies.

AT THE AGENCIES

Traditionally, the annual Medicare physician fee schedule is released around November 1; however, it is delayed this year due to the government's shutdown, which slowed down agency work. Also delayed are three payment rules: Medicare’s End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems rule, and the Home Health Prospective Payment System final rule for 2014.

The online exchanges continue to malfunction and to be taken offline for long stretches of time. Americans whose insurance plans have been canceled are further frustrated by their inability to see their options and sign up for plans online. Others are concerned that if the young and healthy cannot sign up soon, insurers would be forced to raise premiums to cover the costs of older, sicker individuals. Additionally, newly released documents from the House Oversight Committee show that on the first day the federal exchange was open, only six individuals enrolled.

On October 28, CMS announced that the premiums and deductibles for Medicare Part B would not increase in 2014. CMS attributed the positive projections, in part, to the ACA. Additionally, CMS announced that seniors had saved $8.3 billion on Part D prescriptions since the ACA went into effect.

CMS announced that it plans to re-open the Comprehensive End Stage Renal Disease (ESRD) Care Initiative to solicit additional participation and respond to stakeholder feedback. The new initiative will allow CMS to partner with groups of health care providers and suppliers to test and evaluate a new model of payment and care delivery specific to Medicare beneficiaries with ESRD.

IN THE WHITE HOUSE

As the White House appoints technical experts to resolve technical problems with the health insurance exchanges, news is surfacing that in the immediate aftermath of the ACA being signed into law, high-level advisors to President Obama, including Larry Summers, director of the White House’s National Economic Council, and Peter Orszag, head of the Office of Management and Budget, agreed with an outside advisor well known for his health policy expertise, David Cutler, who argued that to make the ACA work, those with business, technology and insurance experience should be included in developing the exchanges.

On October 30, President Obama spoke about the Affordable Care Act in Boston. With Faneuil Hall (where former Governor Romney signed Massachusetts’ health reform into law) as a backdrop, President Obama addressed criticisms that he had broken his pledge to Americans that they would be able to keep their health insurance plans if they liked them. The President also discussed the benefits of the law that are already in effect and working well.

On November 4, President Obama spoke about enrolling Americas on health insurance exchanges at an Organizing for Action event. Organizing for Action is the political nonprofit that mobilizes support for the White House agenda.

IN THE COURTS

On November 1, the U.S. Court of Appeals for the District of Columbia overturned a lower court’s ruling and said that the individual owners of Freshway Foods and Freshway Logistics of Sidney, Ohio, should not have to provide coverage for contraception to their employees. The court noted that only individuals could bring these cases, not corporations. The decision came out 2-1, and the majority judges said forcing the owners to cover employees’ contraception was a violation of the owners’ religious rights.

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

Every Word Matters - 11/5/13

#ENDA

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less. Today's topic is #ENDA - The Employment Non-Discrimination Act that passed cloture in the Senate today.

 

Every Word Matters - 11/1/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

Every Word Matters - 10/30/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

 

Health Care Reform Implementation Update - October 29, 2013

 Repair work to Healthcare.gov is underway, and White House advisors are now pledging that it will be functioning smoothly by the end of November. However, the system was met with new problems over the weekend when the website’s online data center crashed on Sunday night. In addition to the tech surge to solve the health insurance exchanges, the Department of Health and Human Services (HHS) continues to work on implementing the many provisions of the Affordable Care Act (ACA).  The Center for Consumer Information and Insurance Oversight (CCIIO) came out with a new rule last week on Exchange Program Integrity and Market Standards. Marilyn Tavenner and Secretary Sebelius have agreed to appear on Capitol Hill this week to discuss health care exchanges and enrollment challenges.

 

ON THE HILL

On October 29, CMS Administrator Marilyn Tavenner will testify before the House Committee on Ways and Means, and on October 30 HHS Secretary Sebelius will address the ACA’s implementation at an Energy and Commerce hearing.

Ranking Member of the Senate Finance Committee Orrin Hatch (R-Utah) and Ranking Member of the Senate Judiciary Committee Sen. Chuck Grassley (R-Iowa) sent letters to 47 companies that worked on the federal exchange website requesting copies of contracts, project schedules, performance reports and other relevant documents by November 8.

House Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.) asked Google, Microsoft and three other companies to give information about their possible involvement in HHS’s “tech surge” to repair Healthcare.gov.

The Senate Finance Committee and House Ways & Means committees are planning to hold separate bipartisan meetings as early as next week to discuss plans to replace the Sustainable Growth Rate physician payment formula.

On October 22, Sen. Marco Rubio (R-Fla.) said he plans to introduce legislation that would delay the individual mandate until six months after the Government Accountability Office (GAO) can certify that the website is functional.

Reps. Darrell Issa (R-Calif.), Mick Mulvaney (R-S.C.) and Lacy Clay (D-Mo.) introduced bipartisan legislation called the Equal Healthcare Access Act. The legislation would allow all Americans to enroll in the health plans that federal employees have.

The Medicare Payment Advisory Commission, MedPAC, the independent body that advises Congress on issues affecting the administration, is scheduled to meet on November 7-8. The agenda for the meeting has not yet been posted, but we will provide further information as it becomes available. The Medicaid and CHIP Payment and Access Commission, MACPAC, is scheduled to meet on November 14.

AT THE AGENCIES

HHS finalized additional regulations for health insurance exchanges. The rule details oversight and financial standards for the exchanges and finalizes details about the timing of enrollment through exchanges and standards for vendors that conduct satisfaction surveys about insurers offering coverage through them.

The online health care exchanges continue to malfunction. On October 22, the Obama administration announced the appointment of economic adviser Jeff Zients to lead the Healthcare.gov tech surge. The administration has pledged to fix the website by November 30. In addition to the underlying structural changes being made to the Healthcare.gov website, the website is being changed to provide more information about plan choices upfront. Also, the website now provides clearer instructions on methods other than through the website for signing up for insurance. President Obama said the administration will contact those individuals who have attempted to register on Healthcare.gov but have not been able to.

Over the weekend of October 20, the administration said that about 476,000 applications had been filed through the exchanges. The number of applications submitted is likely a different number than the number of enrolled beneficiaries. Official enrollment numbers will not be released until next month. On October 24, CMS estimated that about 700,000 people had applied for insurance through the ACA exchanges. CMS did not say though how many of these applications were from state-based exchanges, as opposed to the federal exchange.

In a 600-word blog post on October 20, Sec. Sebelius said that the administration was calling on the “best and brightest” tech experts from both the private sector and the government to fix the Healthcare.gov website.

The White House said this week that starting on October 24, there would be daily briefings directed by SecretarySebelius to address technical problems.

IN THE WHITE HOUSE

The White House announced last week that it would tweak the timing of the ACA’s individual mandate penalties. Prior to the change, the health care law’s open enrollment period ran from October 1, 2013 through March 31, 2014; however, penalties would kick in in mid-February. The tweak will effectively give people the full open enrollment period to enroll in coverage without being penalized.

Insurers say the federal exchange site is generating incorrect data, making it difficult to handle incoming applications. On October 23, top White House and HHS officials met with about a dozen CEOs of insurance companies to address problems with the ACA enrollment site and the issue of flawed information being sent to insurers.

At a Rose Garden event on October 21, President Obama discussed difficulties with the ACA exchange website and expressed his frustration.

IN THE STATES

On October 16, Pennsylvania Governor Tom Corbett signed into law legislation that extends the state’s Children’s Health Insurance Program (CHIP) and eliminates the program’s six-month waiting period that affected some uninsured children.

After months of debate, a legislative oversight panel approved Gov. John Kasich’s move to spend federal money to expand Medicaid in Ohio without the approval of the Republican-held legislature. Gov. Kasich is moving forward on this proposal without state legislative support. If Ohio were to survive legal challenges to this Medicaid expansion, it would be the 24th state to expand.

Though Oregon’s online ACA marketplace is not yet operational, officials have fast-tracked enrollment for the Oregon Health Plan to sign up 56,000 new people and cut the number of uninsured in the state by 10 percent in two weeks.

IN THIRD PARTIES

The head of Americas Health Insurance Plans (AHIP) is calling for a two-year delay of the health insurance tax under the ACA.

Hundreds of thousands of individuals who purchase their own insurance are receiving cancellation letters, primarily because the plans they were previously enrolled in do not meet ACA’s requirements.

IN THE COURTS

On October 21, the D.C. District Court held a hearing on a request for a preliminary injunction in the case of Halbig v. Sebelius, which challenges the IRS rule allowing premium subsidies to states with federal-run exchanges. U.S. District Judge Paul Friedman declined to grant the requested preliminary injunction, ruling that the lawsuit could move forward and he would rule on the overall merits of the case by mid-February.

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

Every Word Matters - 10/28/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Every Word Matters - 10/25/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

 

Every Word Matters - 10/24/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Health Care Reform Implementation Update - October 22, 2013

 After 16 days of government shutdown, Congress voted to reopen the government and avert default without defundingthe Affordable Care Act, delaying the individual mandate, stripping the medical device tax from the law or requiring members of Congress and their staffs to join the ACA exchanges and lose their federal subsidies. The legislation does include a small change to income verification for determining eligibility for exchange subsidies. Additionally, now at the end of the third week of the exchange enrollment websites being up and running online, the federal exchange website is still plagued with glitches, which the Department of Health and Human Services and the president have pledged to correct and restore quickly, using a variety of outside contractors and agency staff to create a “tech surge” whose mission is to reconstruct problem areas and bring functionality to the federal exchange system. 

ON THE HILL

On October 16, Congress passed a bill that ended the government shutdown and raised the debt ceiling. The bill, H.R. 2775, funds and reopens the government through January 15, 2014 and raises the debt limit through February 7, 2014. The deal was brokered by Senate Majority Leader Harry Reid (D-Nev.) and Senate Minority Leader Mitch McConnell (R-Ky.), and other than a change to income verification requirements, the Affordable Care Act was left intact, fully funded, and undelayed. President Obama signed the bill into law on October 17.

The deal that ended the shutdown, however, creates a new brinkmanship timeline that has some physicians worried. While the government is now funded through January 15, 2014, the Sustainable Growth Rate (SGR) formula is scheduled to cut some physicians’ Medicare payments by as much as 25 percent starting January 1. If the SGR fix, or “doc-fix,” becomes a part of the fiscal package and negotiations go down to the wire, some physicians may find Medicare payments for the 11 business days in that period cut or requiring retroactive reimbursement. If the doc-fix does not become a part of the new funding bill, then it will require its own, standalone bill to prevent the upcoming physician payment cut.

This past week, leading up to the final deal, several proposals were floated that involved modifying the Affordable Care Act.  Sen. Susan Collins (R-Maine) had proposed a plan to end the government shutdown with a bill that would repeal the medical-device tax and authorize federal agencies to reallocate sequester cuts within each agency. Democratic leaders in the Senate rejected the offer, arguing that it asked for too much in exchange for too little. On October 12, a cloture vote failed to reach the requisite 60 votes in the Senate to end debate on a Democrat-backed bill to raise the debt ceiling through 2014. The bill, which failed on a vote of 53-45, would have raised the debt limit $1.1 trillion. House Speaker John Boehner (R-Ohio) had previously proposed a short-term plan on October 10 that would have raised the debt ceiling through November 22 while suspending the medical device tax for two years and requiring the president, vice president, the cabinet and members of Congress to join the exchanges. The bill would have also delayed the tax on medical devices for two years and eliminated federal employer subsidies for health care for the president, vice president, his cabinet, members of Congress, and congressional staff. 

Republicans on the House Committee on Energy and Commerce are requesting answers from top HHS officials as to why the exchange websites continue to malfunction. In an October 10 letter, they informed HHS of their intention to schedule a hearing to address the widespread, continued issues on the HealthCare.gov website.  The hearing, titled, “PPACA Implementation Failures: Didn’t Know or Didn’t Disclose?” is scheduled on Thursday, October 24. Although invited as a witness, it is unclear if Secretary Kathleen Sebelius will testify.

On October 16, Reps. Diane Black (R-Tenn.) and Patrick Meehan (R-Pa.) sent a letter to HHS Inspector General Daniel Levinson requesting a copy of HHS’ security control assessment of the federal data hub. Reps. Black and Meehan’s letter seemed especially concerned with cybersecurity safeguards and the background checks of the Navigator program.

On October 10, House Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.) and Sen. Lamar Alexander (R-Tenn.) sent a letter to HHS Sec. Sebelius asking, among other questions, if those who have attempted to enroll in the exchanges but could not due to technical errors will still face tax penalties in 2014. 

Some Republican lawmakers, including Sen. Pat Roberts (R-Kan.), and separately Rep. John Fleming (R-La.), are calling for HHS Sec. Sebelius to resign due to exchange failures and criticized the department’s “gross incompetence” in handling the exchange rollout. 

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the administration, has reopened after weeks of being closed because of the government shutdown. Its November meetings are still scheduled. The Medicaid and CHIP Payment and Access Commission, MACPAC, was also closed during the government shutdown, and cancelled its scheduled October 17 meeting. The next MACPACmeeting is November 14.

AT THE AGENCIES

The Obama administration said this week that to avoid individual mandate penalties you must be registered for health insurance by mid-February.

On October 15, Medicare open enrollment began and will run to December 7. Officials are concerned that the overlap with the ACA exchanges will cause beneficiary confusion.

The health exchanges continue to malfunction. It was revealed this week that CGI Federal is the IT contractor behindACA’s failing websites. HealthCare.gov is in the early stage of launching a new estimate tool to allow users to look at premium estimates before creating an account.

IN THE STATES

ACA state exchanges are experiencing fewer glitches and having more success enrolling uninsured individuals than federal exchanges. 

Ohio Governor John Kasich (R) is currently weighing the possibility of expanding Medicaid in the state without legislative approval, preparing for the likelihood that GOP lawmakers will reject it. GovKasich has requested Ohio’s Controlling Board authorize the Medicaid expansion now that CMS has approved the state’s Medicaid State Plan Amendment. 

IN THIRD PARTIES

A new report from the Kaiser Family Foundation shows that 5.2 million poor, uninsured adults will fall into the coverage gap in the 26 states that have opted out of Medicaid expansion under the ACA.

On October 15, the Republican National Committee (RNC) released a Web video calling for HHS Sec. Sebelius to be fired over the problems with the HealthCare.gov rollout.  RNC Chairman Reince Priebus insisted that “If this were a company and not the government, she’d already be gone.  She should be fired.”  White House Press Secretary Jay Carney has stated that President Obama continues to have full confidence in Secretary Sebelius.

IN THE COURTS

On October 15, Autocam, an Ohio company, became the fourth to request that the Supreme Court strike down the Affordable Care Act’s requirement that employers provide insurance coverage for contraception on religious liberty terms.  Preceding Autocam are Liberty University, Conestoga Wood Specialties Corp., and the Obama administration.  Autocam lost its challenge to the contraception requirement of the law in the 6th Circuit Court of Appeals.

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

Every Word Matters - 10/22/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Every Word Matters - 10/18/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Every Word Matters - 10/17/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Infrastructure Alert - October 16, 2013

The government shutdown has now entered its third week, and the debt limit has become a central part of negotiations. Many infrastructure programs have grinded to a halt, as inspections, environmental review and rule-making personnel have largely been furloughed. While the emerging deal to fund the government and raise the debt ceiling is consuming congressional focus, the Water Resources Reform and Development Act of 2013 has been put on the back burner in the House.

The Economist and The Heritage Foundation published its recommendations for how the United States should address the transportation funding shortfall.

ON THE HILL

During last Friday’s Senate Committee on Commerce, Science, and Transportation hearing on “The Impacts of the Government Shutdown on Our Economic Security,” National Transportation Safety Board Chairwoman DeborahHersman explained that the NTSB has been particularly affected by the shutdown, causing lapses in investigations. She testified that while the NTSB is ready for a major transportation accident, the amount of furloughed employees has left the agency with no other choice but to not pursue investigations that they would have otherwise looked into. Her written testimony can be viewed here, and an archived webcast of the hearing can be accessed here.

On October 11, House Transportation and Infrastructure Committee Ranking Member Nick Rahall (D-W.Va.) wrote Speaker Boehner a letter describing the government shutdown’s costs to the national infrastructure and transportation safety. His letter notes that about 1,700 FAA safety inspectors were furloughed, the National Highway Traffic Safety Administration suspended all vehicle safety activities, and that the U.S. Army Corps of Engineers is not conducting regular inspections or safety reviews of dams, levees and navigation lock structures. His full letter can be viewed here.

The House Transportation Committee’s special panel on the national freight infrastructure held its final hearing on October 10. Despite considerable bipartisan agreement on numerous transportation and infrastructure proposals this term, the panel was not in agreement on how best to fund the Highway Trust Fund. Witnesses and representatives alike suggested numerous methods of compensating for the dwindling federal gasoline tax revenue, including most commonly raising the tax or imposing a vehicle miles traveled (VMT) tax. While all the panelists and witnesses agreed that the funding shortfall is a problem that requires an immediate, long-term solution, there was considerable disagreement on how best to increase revenue. The panel will now finalize its report to the full the committee.

As the House continues to pass piece-meal appropriations bills, the White House has largely opposed the efforts with few exceptions. On October 9, the House passed H.J. Res. 90, a bill to fund the FAA and end its furloughs, by a vote of 252-172. No House Republican representative opposed the measure, and 23 House Democrats voted in the affirmative. The White House released a statement that President Obama would veto the measure, and the Senate is not expected to vote on it. The Congressional Budget Office scored the bill at $10.1 billion in outlays and $11.9 billion in budget authority for the fiscal year.

Rep. Lee Terry, the Chairman of the House Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade, introduced H.J. Res. 87, the “National Highway Traffic Safety Administration Continuing Appropriations Resolution, 2014,” a bill to fund the NHTSA.

The Water Resources Reform and Development Act of 2013, H.R. 3080, will likely be delayed from being assigned floor time at least until the debt ceiling and government shutdown issues are resolved. The House Transportation and Infrastructure Committee had passed the bill in September, but the bill was already delayed floor time over pressing Syria concerns and it will continue to be indefinitely delayed. The bill passed with bipartisan support in committee.

On October 4, the Senate passed H.R. 3095 by unanimous consent. The bill would bar the Federal Motor Carrier Safety Administration from issuing rules pertaining to professional drivers and sleep apnea without going through the formal rulemaking process, and had passed the House on September 26 by a vote of 405-0. The bill is currently awaiting the President’s signature.

AT THE AGENCIES

On October 7, the Federal Aviation Administration announced that it would un-furlough 800 safety personnel, of which about 600 are safety inspectors. About 2,800 safety inspectors are still furloughed as well as those who register new aircraft. Among the furloughed at the Department of Transportation are a considerable amount of rule makers, delaying the rule making process. Workers who conduct Environmental Protection Agency environmental impact statements have also been furloughed, delaying indefinitely any project that requires an environmental impact statement from moving forward. The Federal Highway Administration published a list of 129 projects across 35 states that were amidst the environmental impact statement, all of which have now become delayed.

Amtrak recorded its highest ridership record this fiscal year, serving 31.6 million passengers. Ticket revenue also hit an all-time high of $2.1 billion, an increase of about $500 million from five years ago. Despite several disruptions, including Hurricane Sandy, the Northeast Corridor recorded its second highest ridership to date.

IN THE STATES

California: On October 11, the California High-Speed Rail Authority argued before a Sacramento Superior Court judge that the agency can begin using federal funds to start construction of the first 29 miles of the Central Valley track. The agency argued that doing so would not trigger a 2008 provision that would restrict funds until all funding sources be identified before the start of construction, as they are arguing that provision applies to only state funds and not the $3.24 billion in federal grant money that has been awarded.

Massachusetts: Yesterday, the Massachusetts Turnpike began collecting tolls at six Western interchanges for the first in time in over a decade. The reinstatement of tolling was a part of the recently passed transportation package and is expected to generate about $12 million in additional yearly revenue.

Washington: The Washington State Department of Transportation (WSDOT) released its independent review of the largest state transportation projects. The review recommends a different organizational structure of WSDOT, better assessment of risk, and reforming the contract rewarding methods, among other things. The report is available here.

Virginia: Gubernatorial candidate Terry McAuliffe received the endorsement of the Virginia Transportation Construction Alliance.

Every Word Matters - 10/15/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Health Care Reform Implementation Update - October 10, 2013

 It is now the second week the exchanges have been open and the second week the government has been partially closed. The exchanges still have glitches, and Congress still has not agreed on a way to fund the government, although some evidence of cooling among leading participants was becoming evident as this update was finalized, signaling a temporary way out of at least the dreaded default possibility. The possibility of temporarily raising the debt ceiling was raised this week as a way to give Congress more time to come to a longer-term solution on both the debt ceiling and a continuing resolution. The president and Senate Democrats have been insisting that they will only negotiate once the debt ceiling is raised and government lights are back on; however, House Republicans have been insisting that negotiations be the vehicle for averting the debt ceiling and reopening the government. The House has introduced several bills that would fund individual parts of the government; however, the Senate refuses to vote on these bills and the president threatens to veto them because they want the government to be funded comprehensively, as is normally the case, and because, like the House, they want to protect their priorities.

ON THE HILL

It became clear this week that attempts to pass a continuing resolution and to deal with the approaching debt ceiling may need be tied together in any potential fix or at least considered simultaneously;  however, late breaking developments suggest that the debt ceiling crisis may be averted first, giving negotiators time to arrive at a comprehensive package that both funds the government and further extends the country’s borrowing authority. The Treasury initially projected October 17 as the day we would hit the debt ceiling; however, analysis this week points out that we may not actually default until October 31. Even if the United States technically has more time than the Treasury projected before its bills come due, many are concerned that the markets will be affected by the uncertainty of no solution by October 17. The House has been saying it will not raise the debt ceiling without negotiations, and President Obama and Senate Democrats have been asserting that they will not negotiate until a deal has been struck that addresses the debt ceiling and opens the government. As noted above, some evidence of a short term debt ceiling increase with time to resolve other fiscal issues, including funding government operations, may be emerging as a solution, but resolution remains far from clear at this point.

On October 9, House Budget Committee Chairman Paul Ryan (R-Wis.) offered a two-step plan to lift the debt ceiling and reopen the government for enough time to allow Congress to pass long-term entitlement reform. On October 9, Rep. Ryan authored an op-ed in The Wall Street Journal in which he called for modest structural changes to Social Security and Medicare as a solution to the fiscal crisis. Today, Congressman Ryan is scheduled to head to the White House, along with 17 other House Republicans, for a meeting with President Obama.

On October 6, amid calls for House Speaker John Boehner (R-Ohio) to put a clean debt ceiling bill on the floor, Rep. Boehner said there were not enough votes for it to pass in the House. President Obama and some Senate Democrats argued that there would be enough votes. Congressman Boehner has also told Republican lawmakers concerned about the looming debt-ceiling deadline that he would not allow a federal default.

The Senate Committee on Finance was scheduled to hold a hearing on October 8 on Transforming Medicare Post-Acute Care; however it was postponed, likely because of the government shutdown.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the administration, has canceled its meeting scheduled for October 10 and 11, due to the government shutdown. As of now, its November meetings are still scheduled. The Medicaid and CHIP Payment and Access Commission, MACPAC, however, remains open. We will provide more information as it becomes available.

Sen. Rob Portman (R-Ohio) raised the possibility of a plan that calls for a wide-ranging set of cuts to mandatory spending, preserves the spending cuts under sequestration and makes a change to the Affordable Care Act (ACA) that would ensure the recipients of federal health care subsidies are eligible for them. The plan is based on proposals from Reps. Diane Black (R-Tenn.) and Sen. Tom Coburn (R-Okla.) that would help prevent ACA fraud.

On October 9, the House Oversight and Government Reform Committee held a hearing at which Sarah Hall Ingram, the director of the Internal Revenue Service (IRS) Affordable Care Act office, testified. She reported that despite exchange glitches, things in the IRS office have been running smoothly since open enrollment began last week.

On October 10, House Intelligence Committee Chairman Mike Rogers (R-Mich.) warned that the federal data hub for the ACA exchanges is vulnerable to cyberattacks. Rep. Rogers cautioned that online hackers could access health records, credit histories, Social Security numbers and other sensitive information that enables identity theft.

Republicans on the House Committee on Energy and Commerce asked the Department of Health and Human Services (HHS) for enrollment data in the new exchanges. CMS confirmed this week that it would likely not release enrollment data until mid-November in order to ensure accuracy of the figures.

On October 8, the House voted 224 to 197 to create a bicameral committee similar to the Supercommittee of last year to help Congress overcome the government shutdown and come to agreement on the debt ceiling. The Office of Management and Budget (OMB) said President Obama would veto this proposal.

AT THE AGENCIES

Health exchanges are now in their second week of being online and are still full of glitches and problems, some of which the administration says are due to high traffic but others may be due to a less than perfect foundation. Last week after widespread issues with online enrollment, HHS took the Healthcare.gov application offline for the weekend to perform scheduled maintenance. Officials reported that the repairs performed over the weekend were helpful but that there were still further problems. The system was taken offline on the morning of October 8 for further Web fixes. The administration continues to request patience as glitches are worked out. Though the administration has not predicted a date when the problems would be resolved, it continues to remind potential enrollees that they have several months to enroll.

This week, the chief administrative officer (CAO) of the House sent a fact sheet on a directive from the Office of Personnel Management (OPM) to members of Congress. The OPM directive and the guidance from the CAO instruct that in 2014, members of Congress and designated congressional staff will choose from 112 options in the Gold Metal tier on the DC SHOP exchange.

IN THE STATES

Policymakers and reporters in Ohio are beginning to expect the state to expand its Medicaid program in the near term.

The Covered California exchange said that in its first week of enrollment, 16,311 applications were completed by Californians looking to obtain health insurance.

IN THE WHITE HOUSE

On October 8, President Obama delivered a statement and took questions from reporters on the government shutdown and the dispute over raising the federal debt ceiling. Earlier in the day, he called Speaker of the House John Boehner (R-Ohio) to tell him he would not negotiate until after the debt ceiling and government shutdown issues were resolved.

IN THE COURTS

The Supreme Court started its new term this week. The justices will decide soon whether to hear a new challenge to the Affordable Care Act concerning the law’s requirement that employers provide insurance coverage for contraception. At least three petitions for the Supreme Court to decide the issue have been filed. On September 5, Liberty University filed a petition asking the Supreme Court to review the 4th Circuit Court of Appeals’ decision in Liberty’s case seeking to overturn the ACA’s requirement that employers provide health insurance that covers contraception. On September 19, the Conestoga Wood Specialties Corp., a Pennsylvania company filed a petition arguing that the Religious Freedom Restoration Act prohibits the federal government from imposing the ACA’s preventive services mandate on for-profit secular companies. Also on September 19, the Obama administration took the other side of the case and asked the Supreme Court to uphold the ACA requirement that nearly all employers provide coverage of birth control and other contraceptives in health plans. This third petition greatly increases the odds that the Supreme Court will take up the case.

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

Every Word Matters - 10/10/2013

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Every Word Matters - 10/8/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Every Word Matters - 10/4/13

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less. 
 

Health Care Reform Implementation Update - October 4, 2013

Open enrollment began this week, making it possible for the first time to enroll in Affordable Care Act (ACA) online marketplaces. Technical glitches were widespread, but the problems were overshadowed by the shutdown of the federal government. After several rounds of House-Senate exchanges with a continuing resolution (CR) to keep the government open, October 1 came and went with no agreement. Knowing that this opportunity is one of Republicans’ only chances to have their ACA disputes raised on the Senate floor, Republicans have been refusing to pass a continuing resolution that does not defund or delay the law. Meanwhile Democrats are saying that the ACA is the law of the land and not open for negotiation. While the government shutdown has caused problems of its own, more problems lie on the horizon with a deal also needed on the debt ceiling, which the country is projected to hit by October 17, according to the Treasury Department. Last evening, Congressional leaders met at the White House with President Obama to discuss both the re-opening of government operations and raising the debt ceiling, but no accords were made. Democratic leaders in the Senate in addition to the president insist they will not negotiate on any aspect of either the CR or the debt ceiling increase, and will do so only after both policy priorities pass.

ON THE HILL

On September 20, the House passed a continuing resolution 230-189 to keep the government running until December 15 while defunding the ACA. The CR was then sent to the Senate. On September 23, Senate Majority Leader Harry Reid filed a procedural motion to consider the House bill. Senator Cruz vowed to “speak in support of defunding Obamacare until [he was] no longer able to stand” in order to rally votes against proceeding with the bill. After holding the Senate floor for more than 21 hours, Sen. Cruz had to relinquish the floor, and the Senate voted to proceed to a vote on the bill. Then on September 27, the Senate took three votes: to end debate on the House bill, to strip the provision that would gut the ACA, and to approve a substitute measure. On September 29, the Senate sent the spending bill back to the House. The House then voted to repeal the ACA tax on medical devices, delay the ACA law by a year, and allow employers and health care providers to opt out of contraception coverage. The House then sent the Senate a spending bill with a delay of the ACA, the change in contraception coverage, and a repeal of the medical device tax attached. When the Senate reconvened at 2:00 p.m. on September 30 (just 10 hours from the looming shutdown), within minutes it stripped the health care provisions from the spending bill and sent it back to the House. Around 8:40 p.m., the House voted to delay the individual mandate by a year and cancel insurance subsidies for lawmakers and their staffs and sent the bill back to the Senate with these additions. Around 9:30 p.m., the Senate voted to strip the health care language from the bill again and sent it back to the House. House Republicans appointed formal negotiators to participate in House-Senate negotiations, but shortly before midnight Senate Majority Leader Harry Reid said that the Senate would not appoint conferees. When the clock struck 12 on October 1, the lapse in federal appropriations caused the government to shut down. Many are concerned that the impasse will last past October 17, the date when Treasury Secretary Jacob Lew said the debt limit would be reached.

On September 30, Senate Finance Committee Chairman Max Baucus announced that the committee would host a hearing on October 8 on ways to improve post-acute care for Medicare patients. Those who are expected to testify at the hearing are Medicare Payment Advisory Commission Executive Director Mark Miller, Brookings Institute health reform center Managing Director Barbara Gage, Chairman of Remedy Partners Steve Wiggins, and Partners Healthcare’s Clay Ackerly. In June, the Finance Committee had asked stakeholders for ideas to improve the sector by August. The request yielded close to 90 responses. It is not yet clear how the shutdown will affect the hearing.

On September 25, the Senate Health, Education, Labor & Pensions (HELP) and House Energy and Commerce committees struck a deal on legislation that creates a class of compounders called "outsourcing facilities" to be regulated by the Food and Drug Administration (FDA) and creates a prescription drug “track and trace” system to ensure drugs’ authenticity and safe-keeping. On September 28, the House voted to pass a bipartisan bill that would bolster federal oversight of compounding pharmacies and institute a federal prescription drug track and trace system. The Senate is expected to pass the legislation as well.

On September 24, Chairman of the Senate Republican Conference Sen. John Thune (R-S.D.) and Ranking Member of the Health, Education, Labor and Pension (HELP) Committee Sen. Lamar Alexander (R.Tenn.) led the effort to send a letter to HHS Secretary Sebelius calling for a one-year extension for health care providers to complete the second stage of the Electronic Health Records (EHR) incentive program, which is increasing the adoption of health information technology by hospitals and physicians across the country. Sens. Thune and Alexander were joined by Sens. John Barasso (R-Wyo.), Richard Burr (R-N.C.), Saxby Chambliss (R-Ga.), Dan Coats (R-Ind.), Tom Coburn (R-Okla.), Mike Enzi (R-Wyo.), Johnny Isakson (R-Ga.), Mark Kirk (R-Ill.), Jerry Moran (R-Kan.), Lisa Murkowski (R-Alaska), Rob Portman (R-Ohio), Jim Risch (R-Idaho), Pat Roberts (R-Kan.), Pat Toomey (R-Pa.), and Roger Wicker (R-Miss.).

Following the September 19 House Energy and Commerce subcommittee on Oversight and Investigations hearing at which Gary Cohen, the head of the Center for Consumer Information and Insurance Oversight (CCIIO) testified about his agency’s preparedness for enrollment in insurance marketplaces, Republicans on the committee asked Cohen to answer further questions about navigator groups.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the administration of Medicare is scheduled to meet on October 10 and 11, however, according to its website, the commission is currently closed “due to a lapse in federal appropriations.” We will provide more information as it becomes available.

AT THE AGENCIES

On October 1, open enrollment began, and state and federal marketplaces opened for the first time. Consumers faced numerous error messages, long wait times, in many cases were unable to sign up for coverage, and in some cases entire systems went down. Notwithstanding early problems, October 1 is only the first day of a months long open enrollment period. The administration attributed the problems to the marketplaces’ popularity.

On September 30, HHS Secretary Sebelius announced that the public should be patient with ACA and reminded her listeners that “Tuesday is just the start of a six-month open enrollment period.” On October 1, Secretary Sebelius presented a similar message in the face of the widespread enrollment glitches.

On September 30, HHS announced that it would have to furlough over half of its employees in the event of a government shutdown.

On September 30, the Treasury Department issued proposed rules on how some employers and insurers report the health insurance they provide under the ACA. The purpose of the regulations is to ensure that people enroll for health coverage and that large companies offer insurance to their employees.

On September 23, Louis Lerner, the IRS employee who has been tied to and testified several times on the IRS targeting of conservative groups, announced that she was retiring from the agency. House Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.) said Lerner would likely be brought back before the committee to answer questions about the controversy surrounding the IRS’s targeting of tea-party groups.

On September 26, the administration announced that the start date for online enrollment in the small business (SHOP) exchanges would be pushed back a month until November 1.

On September 25, HHS released average premium cost data that it says shows premium rates under the ACA are affordable, with Americans paying $328 per month on average for a mid-level plan before subsidies are considered. The report shows wide variation in potential unsubsidized monthly premiums across the featured jurisdictions.

On September 23, two years after the FDA released draft guidance on mobile medical apps, it issued final guidance on the issue. Under the final rule, the FDA will regulate only those products that transform smartphones into devices the FDA currently regulates or accessories that regulate devices.

On September 26, CMS awarded a contract to Maximus Federal Services potentially worth up to $383 million over 4 years to  manage the eligibility appeals process on the benefits for which consumers are eligible on ACA exchanges.

On September 30, the Office of Personnel Management released a final rule on how members of Congress and their staffs will get health insurance through the exchanges starting in 2014. The rule requires that they use the D.C. small business exchange regardless of their actual state of residence. These individuals will not be eligible for subsidies to buy insurance no matter their incomes, however, they will be permitted to receive federal employer contributions.

On September 30, the Office of Personnel Management (OPM) released details about the multistate plans that will be offered on 30 state exchanges in 2014. These plans will be offered by Blue Cross Blue Shield Association.

IN THE STATES

On September 25, the D.C. Health Benefit Exchange said that although consumers will be able to submit paper applications by the October 1 exchange launch, they will not have access to their premium prices until mid-November.

On September 27, CMS approved Arkansas’ proposal to use federal money to expand the state’s Medicaid program to help low-income residents buy private insurance under the ACA. Iowa still awaits approval on its own Medicaid expansion proposal.

Early online exchange glitches caused Maryland and Minnesota to delay the opening of their exchanges until the afternoon on October 1.

On September 23, Pennsylvania Gov. Corbett’s administration met with CMS and said the meeting was positive and constructive. Gov. Corbett is seeking assurances that a set of Medicaid reforms in his state can accompany any type of expansion in Pennsylvania before he agrees to expand.

Some Wisconsin residents will be losing Medicaid coverage starting in January due to a change Wisconsin made earlier this year to income eligibility for Medicaid in the state. The change moved income eligibility requirements for Wisconsin’s Medicaid program from 200 percent of poverty level to 100 percent of the poverty level. The University of Wisconsin Health and United Way of Dane County have stepped in to assist these individuals in affording private coverage on the new insurance exchange.

IN THIRD PARTIES

According to a new analysis by Avalere Health, exchanges may have higher out-of-pocket costs than expected. The six-state study shows that consumers could face high cost-sharing requirements in addition to their premiums. The White House highlighted on September 25 that premiums would be lower than expected, however, these figures do not include dollars that will be spent on co-payments, co-insurance and deductibles.

IN THE COURTS

The D.C. District Court scheduled a hearing for October 21 to decide whether to block ACA subsidies to residents of states that are not running their own health insurance marketplaces.

On September 27, Planned Parenthood and over a dozen women’s health providers filed a lawsuit to block two provisions in Texas’ abortion regulations passed this summer.

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

Top Tweets - Oct. 2, 2013

Every word should matter, but in today's media frenzy, the most important policymakers' words often get lost or distorted. Here's our daily, unfiltered roundup of the most important tweets by those shaping policy today, straight from them in 140 characters or less.

 

Infrastructure Alert - October 1, 2013

As Congress has now failed to pass a continuing resolution to fund most federal operations, a government shutdown began this morning, the beginning of the federal government’s 2014 fiscal year. While exceptions are made for “essential” employees that are critical to life and safety, many government functions will be suspended until Congress passes and the President signs a bill to appropriate funds for the operation of the federal government.

ON THE HILL

The House Committee on Transportation and Infrastructure has unanimously advanced the Water Resources Reform and Development Act of 2013 (WRRDA), H.R. 3080. WRRDA sponsor and Transportation and Infrastructure Chairman Bill Shuster (R-Pa.) has voiced concern over how the CBO will score the bill. The bill was expected to receive floor time early this month, but its timetable is likely to be adversely affected by the government shutdown.

WRRDA relies on $12 billion of deauthorizations to fund $12 billion in new projects, but as many of thedeauthorizations are essentially defunct and are generally not expected to be funded, CBO could assess that substantially less than $12 billion is actually being deauthorized, which would lead CBO to classify the bill as increasing the deficit.

Several amendments were withdrawn during the markup. Rep. Janice Hahn (D-Calif.) withdrew two of her amendments that would have increased funding for the Harbor Maintenance Trust Fund but would have required billions in unspecified offsets. Rep. Corrine Brown (D-Fla.) withdrew her amendment to fast-track projects that have been approved by the U.S. Army Corps of Engineers for authorization. Rep. Grace Napolitano (D-Calif.) withdrew a similar amendment to the aforementioned one that Rep. Hahn had proposed and withdrawn. Rep. Peter DeFazio (D-Ore.) withdrew an amendment that would have directed $30 million to combat invasive species of animals in waterways managed by the Corps of Engineers. Rep. Lois Frankel (D-Fla.) withdrew an amendment that would have permitted the Corps of Engineers to use non-domestic sand for beach replenishment.

Continuing her effort to ensure the Morganza project is authorized, Sen. Mary Landrieu (D-La.) has started a petition for the inclusion of Morganza in WRRDA. She has stated that she “will not allow the House water infrastructure bill to see the light of day unless Morganza is added back.”

Yesterday, September 30, the House and Senate each passed bills to authorize relief spending to Colorado infrastructure damaged in the recent flooding. Each bill is deficit neutral. The House bill, H.R. 3174, was introduced by Rep. Cory Gardner (R-Colo.) and co-sponsored by the rest of the Colorado delegation. The Congressional Budget Office score of the bill can be viewed here. The bill passed by voice vote after 40 minutes of debate and a motion to suspend the rules. Sen. Mark Udall (D-Colo.) sponsored S. 1560, the “Deficit Neutral Disaster Relief Act,” with co-sponsor Sen. Michael Bennet (D-Colo.). The bill was passed without amendment by unanimous consent.

On September 26, the House passed H.R. 3095 by a vote 405-0. If enacted, the bill would require the Federal Motor Carrier Safety Administration to only be able to regulate sleep apnea of commercial drivers through the formal rulemaking process instead of merely issuing a guidance. Sen. Roy Blunt (R-Miss.), Ranking Member of the Commerce Subcommittee Surface Transportation and Merchant Marine Infrastructure, Safety, and Security, has introduced a companion bill, S. 1537, which Chairman Mark Warner (D-Va.) and nine others are co-sponsoring. The American Trucking Association has lauded the quick, unanimous passage in the House and introduction of companion legislation in the Senate.

Sen. John Thune (R-S.D.), Ranking Member of the Senate Commerce Committee, wrote representatives of the U.S. Mission to ICAO, Federal Aviation Administration, and Department of State, to urge them to continue to oppose the European Union Emissions Trading Scheme. His bill, the European Union Emissions Trading Scheme Prohibition Act of 2011, was enacted last year to exempt U.S. air carriers from having to participate in the emissions trading scheme.

The Senate Commerce Committee approved the nominations of Deborah Hersman and Christopher Hart to continuing serving on the National Transportation Safety Board. Their nominations await a full vote.

AT THE AGENCIES

With the inception of the government shutdown, hundreds of thousands of federal employees are being furloughed. In the Department of Transportation, 18,481 of the 55,468 employees will be furloughed. Of those employees who will continue working, 8,417 will do so because their salaries are not funded by the lapsed appropriations, and 25,458 are exempt due to being vital for the purposes of life and/or safety. The Department of Transportation’s “Operations During a Lapse in Annual Appropriations” plan can be viewed here.

Due to the life and/or safety exemption, air traffic controllers will not be furloughed. All agencies funded by the Highway Trust Fund will continue normal operations, including the Federal Motor Carrier Safety Administration and the Federal Highway Administration.

Most of the employees at the National Highway Traffic Safety Administration, Federal Transit Administration, Federal Railroad Administration, Surface Transportation Board, Maritime Administration, Inspector General’s office and Office of the Secretary will be furloughed, with exceptions mainly deriving from those who are vital to safety, funded by other fees, or are providing Sandy-related relief.

The Department of Homeland Security’s “Procedures Relating to a Federal Funding Hiatus” is available here. Over 90 percent of the roughly 59,000 Transportation Security Administration employees will continue regular work through the safety exception.

The government shutdown is not expected to delay the beginning of the Department of Justice’s antitrust lawsuit against the pending American Airlines-US Airway merger, despite only 227 of the 619 Antitrust Division employees being exempt from furloughing. The Department of Justice’s FY 2014 Contingency Plan can be viewed here. This morning, however, the Department of Justice did request a stay of proceedings, citing the difficulties that will be caused by the shutdown. The airlines’ lawyers are objecting to the stay request.

Deb Miller, former Kansas Transportation Secretary, has been nominated to the Surface Transportation Board. Kathryn Thomson, the Department of Transportation’s acting counsel, has been nominated to General Counsel of the Department of Transportation.

The Department of Transportation’s Research and Innovative Technology Administration has awarded its 2013 University Transportation Center Grants. The grants, totaling $63 million, were awarded to 33 University Transportation Centers out of the more than 100 universities that applied.

The Government Accountability Office released a report titled “Transit Agencies' Use of Contracting to Provide Service.”

IN THE STATES

Today, October 1, is the initial deadline for 19 states to finalize agreements with Amtrak for funding of short-distance routes. Amtrak has faced significant difficulty negotiating the cost-sharing with Indiana in particular, but agreements with Connecticut, Illinois, Massachusetts, New Hampshire, New York and Rhode Island are still pending as well. Every state except for Indiana has agreed to the draft cost-sharing agreement that has Amtrak pay for certain backbone costs, totaling about 13 percent of the costs of the routes, such as centralized dispatching. Several popular lines are in jeopardy of losing funding without an agreement. Four of the most popular routes are in jeopardy of losing funding, including the Empire Service rail line in New York, one of only five routes outside the Northeast Corridor that served more than 1,000,000 riders in 2012. The 12 states that have reached agreements with Amtrak are California, Maine, Michigan, Missouri, North Carolina, Oklahoma, Oregon, Pennsylvania, Texas, Virginia, Washington and Wisconsin.

Maryland Gov. Martin O’Malley, New Jersey Gov. Chris Christie and Virginia Gov. Bob McDonnell have signed a joint letter endorsing an agreement of the University of Maryland System, Rutgers University and Virginia Tech to operate one of the six sites the FAA will use to test unmanned aerial vehicles.

California: California is rapidly increasing the amount of oil shipments it receives from freight rail due to the shale boom in other states such as North Dakota. The California Energy Commission has compiled data that indicates more than 200,000 barrels of crude oil per month were imported into California this summer, more than four times the amount from 2012. Texas-based Tesoro and Valero Energy have stated their intents to start or increase transporting crude by rail at their California refineries. Some crude oil from North Dakota is being shipped by barge down the west coast to California after being transported by rail to Seattle. More rail is expected to be constructed in the Central Valley to complement California’s existing pipeline network and bolster the movement of shale oil from Colorado, North Dakota and elsewhere. Despite ranking as the third-largest oil-producing state in the United States, California’s output is half that of 20 years ago, and would face adamant environmentalist opposition if it were to explore hydraulic fracturing.

New York: On September 23, construction began on a 800-foot concrete casing to preserve a right-of-way for new rail tunnels under the Hudson River designed to withstand future flooding. The project is being funded with $185 million from the Department of Transportation’s Super Storm Sandy Relief funding, and is expected to be completed in October 2015.

Health Care Reform Implementation Update - September 24, 2013

With a week until a potential government shutdown and a week until open enrollment begins, the Affordable Care Act (ACA) is in the limelight. On September 20, the House voted for a continuing resolution that funds the government past the end of September while defunding the ACA. This week, the continuing resolution will move to the Senate, where Democrats have pledged to add ACA funding back into the legislation, at which point it would be sent back to the House. It is not clear how Democrats and Republicans in the Senate and the House will come to resolution, but they must negotiate before the end of September to avoid a government shutdown. As the pro-ACA and anti-ACA advocates battle it out on the airwaves, in Congress, and at dinner tables around the country, the law continues to be implemented: the Centers for Medicare & Medicaid Services (CMS) released proposed rules on Basic Health Plans and payment rates for federally qualified health centers, as well as new health spending projections, and Center for Consumer Information and Insurance Oversight Director Gary Cohen appeared before the Energy and Commerce subcommittee on Oversight and Investigations to answer questions about health insurance marketplaces and navigators.

ON THE HILL

On September 20, the House passed a bill 230-189 to keep the government running until December 15 while defunding the ACA. The bill will now head to the Senate, where Democrats are likely to amend it to include ACA funding, at which point it will be sent back to the House. A continuing resolution must be passed by October 1 or the government will shut down. After passing the legislation, House Republicans urged the Senate to have the same discussion. Senate Majority Leader Harry Reid (D-Nev.) said the chamber would consider the measure during the week of September 23. He also warned, however, that any legislation that defunds or delays Obamacare would be dead in his chamber. Some House Republicans have said that if this attempt at defunding Obamacare fails, they will try again using the debt ceiling negotiation.

According to the Congressional Budget Office’s (CBO’s) Long-Term Budget Outlook released on September 17, federal spending on health care programs and Social Security is projected to grow to 14 percent of GDP by 2038. This rise in spending is attributable to the aging population, rising health care costs and expansion of health insurance subsidies.

On September 19, the House Energy and Commerce subcommittee on Oversight and Investigations held a hearing at which Gary Cohen, the head of the Center for Consumer Information and Insurance Oversight (CCIIO) at CMS testified about his agency’s preparedness for enrollment in insurance marketplaces. CCIIO is the primary agency responsible for the federally facilitated marketplaces and enactment of new ACA insurance rules. In addition to the usual attacks on the ACA from its opponents and praise for the law by its proponents, members of the committee asked Cohen a few clarifying questions. Cohen said that ACA navigators were being instructed not to go door-to-door and that he would look into posting an official listing of navigators on a government website as a measure to prevent fraud.

The Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on issues affecting the administration of Medicare, will meet on October 10 and 11. We will update you when the agenda becomes final.

AT THE AGENCIES

On September 17, the Office of Management and Budget (OMB) sent a memorandum to the heads of executive departments and agencies regarding planning for agency operations during a potential lapse in appropriations, a guide in case of a government shutdown.

On September 20, CMS released a proposed rule that provides guidelines by which states can begin pursuing Basic Health Plans, which gives states the option of establishing a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the health insurance marketplace. These plans are intended to benefit residents whose income fluctuates below and above Medicaid eligibility.

On September 18, CMS issued a proposed rule that would establish Medicare payment rates and a payment system for federally qualified health centers. Under the rule, federally qualified health centers would receive higher Medicare reimbursement rates beginning next year. The rule would also allow rural health clinics to contract with “non-physician practitioners,” such as nurse practitioners and physician assistants.

The CMS Office of the Actuary released health spending projections this week, published in Health Affairs. CMS said spending growth is expected to increase in 2014 with economic improvement and expanded coverage under the ACA. The finding may indicate that slowed spending is largely tied to the economy, rather than the ACA.

On September 19, CMS announced that enrollment in Medicare Advantage (MA) plans is expected to increase for the fourth year in a row. Additionally, CMS said the average MA premium in 2014 is projected to increase by only $1.64 from last year.

A new analysis from the Department of Health and Human Services (HHS) says that approximately 6.4 million individuals buying coverage on the new marketplaces will have the option to pay $100 or less each month due to subsidies.

On September 12, HHS released a report showing that 6.8 million consumers saved about $1.2 billion on insurance premiums in 2012 due to the Affordable Care Act.

The Census Bureau released its 2012 report, showing more people were insured in 2012 than 2011, due in large part to increased enrollment in Medicare.

The front page of the September 20 edition of The Wall Street Journal featured a story about the pricing glitches the health insurance marketplaces face less than two weeks out from their rollout. According to the article, four individuals familiar with the development of the health marketplace software that determines how much people will pay for subsidized coverage on the federally run exchanges are reporting that the system is still miscalculating prices.

Following the Obama administration’s announcement that multi-employer plan enrollees would not be able to get exchange premium tax credits, an issue for which unions had been lobbying, Republicans are asking questions about a draft regulation that appeared briefly on the Office of Management and Budget’s website last month. Some Republican members are suggesting that regardless of the Obama administration’s announcement that it would not grant union exemptions, the issue will reappear and unions’ requests will be granted once the 2014 reforms are in motion. On September 18, House Education & the Workforce Committee Chair John Kline (R-Mich.) and Phil Roe (R-Tenn.) asked the OMB for clarification regarding administration efforts with respect to the multi-employer plans.

The Republican Study Committee released the American Health Care Reform Act, a proposal to repeal and replace the ACA. The bill would provide $20,000 in tax deductions to families and a $7,500 deduction to individuals to enable them to buy insurance from vendors in any state. Additionally, the bill proposes allowing Americans to keep the money they save by choosing lower-cost providers.

On September 18, JPMorgan Chase & Co sent a research note to clients predicting a delay in open enrollment based on information from its Washington, D.C. contacts and comments from the administration. The administration responded later in the day that the insurance marketplaces would open for enrollment on October 1 as planned. After the administration’s announcement, J.P. Morgan backed away from its earlier predictions.

AT THE WHITE HOUSE

On September 18, state and federal officials met at the White House to discuss efforts to crack down on fraud in health insurance marketplaces. The administration announced a toll-free phone number for complaints of fraud. HHS’s Office of the Inspector General also issued a warning about potential fraud in health exchanges.

IN THE STATES

Pennsylvania Governor Tom Corbett held a press conference on September 16, during which he announced his administration is now hoping to expand the state's Medicaid program. The plan Gov. Corbett outlined would use private health insurance plans and add new requirements for all Medicaid enrollees, such as paying monthly premiums and demonstrating they are searching for jobs.

IN THIRD PARTIES

According to a Pew poll released on September 16, the awareness that health insurance marketplaces are available under the ACA is significantly higher in states with state-run programs than in those that have opted to use a federally run exchange.

Home Depot announced on September 19 that it is planning to shift about 20,000 part-time workers into the health insurance marketplaces. Home Depot said that employees working less than 30 hours a week will no longer be eligible for limited liability health coverage through Home Depot.

Walgreens, which is the largest U.S. drugstore chain, is reported to be planning to move its employees into a private health care exchange much like the ACA marketplaces.

New ads from Generation Opportunity, a Virginia group tied to the Koch brothers, seek to discourage young people from signing up for the ACA. The ads feature Uncle Sam poised to conduct pelvic, prostate and gynecological exams.

IN THE COURTS

On September 19, two different groups asked the Supreme Court to rule on the ACA birth control mandate: the federal government and Conestoga Wood Specialties Corp., a Pennsylvania company. Conestoga Wood Specialties Corp., filed a petition arguing that the Religious Freedom Restoration Act prohibits the federal government from imposing the ACA’s preventive services mandate on for-profit secular companies.

Also on September 19, the Obama administration asked the Supreme Court to uphold the ACA requirement that nearly all employers provide coverage of birth control and other contraceptives in health plans. This third petition the Supreme Court has received on the issue increases the odds that the Supreme Court will decide the case.

Health Care Reform Implementation Update - September 17, 2013

Congress has been back for a week, and already the president and Democrats are engaged in a contest with Republicans to see who will blink first. Additional spending legislation needs to be passed to keep the government running past September 30, and the debt ceiling could be hit as soon as mid-October. Expecting that a deal will not be made until the last minute, Congress is already considering canceling the September recess. At least 43 House Republicans are trying to fund the government but delay the Affordable Care Act (ACA) and all funds for it until 2015, a prospect that has already been rejected by the Democratic Senate and would be vetoed by the White House. Another group of House Republicans is planning to pass a continuing resolution that funds the government after September while prohibiting the president, the vice president, most lawmakers, staff and political appointees from receiving federal subsidies and tax credits. Meanwhile open enrollment begins in less than three weeks, the Centers for Medicare and Medicaid Services (CMS) has released a final rule on Disproportionate Share Hospital payments, the Medicare Payment Advisory Commission (MedPAC) reconvened last week, the Congressional Budget Office (CBO) released a score of a permanent doc-fix that is higher than earlier estimates, and on September 16, Governor Corbett announced Pennsylvania’s intention to adopt a version of Medicaid expansion and Gov. Rick Snyder signed Medicaid expansion into law in Michigan.

AT THE AGENCIES

On September 13, CMS finalized the ACA rule that will reduce Disproportionate Share Hospital (DSH) payments for fiscal years 2014 and 2015. According to the CMS Fact Sheet on the final rule, “State decisions to expand Medicaid will not affect the amount of reduction in DSH allotments.”

The Department of Labor issued guidance in a frequently asked questions document affirming that employers may hire third-party vendors to implement the ACA’s requirement that employees be notified that health insurance is available through the marketplaces.

On September 10, the Board of Governors of the Patient Centered Outcomes Research Institute (PCORI) voted to fund 71 projects that will treat heart disease, cancer, obesity and other chronic conditions totaling $114 million.

On September 12, the federal data hub that will be the conduit for data inputted into insurance marketplaces completed security testing and was certified to operate when the exchanges open for open enrollment on October 1. Many have been, and others still are, skeptical that the system will protect individuals’ private data. A day earlier, at a House Committee on Homeland Security Subcommittee on Cybersecurity hearing, Chairman Patrick Meehan (R-Pa.) said “With just 20 days remaining before the hub goes live, I have grave concerns from a cybersecurity standpoint.” Chairman Meehan pointed to “increasingly sophisticated ways to steal and manipulate information.”

AT THE WHITE HOUSE

On September 13, the Obama administration announced that it would deny the requests of labor leaders for an exemption from the ACA that would have enabled their health care plans to receive tax subsidies.

ON THE HILL

A group of House Republicans including, some have suggested, Speaker of the House John Boehner (R-Ohio), are planning to pass a continuing resolution to fund the government past the end of September with one notable surprise, a clarification to the ACA that would require Congressional members and their staff to join the health care marketplaces established by the ACA and prohibiting most lawmakers, staff, political appointees, the president and vice president from receiving federal subsidies and tax credits. Such legislation would be similar to a bill sponsored by Reps. Ron DeSantis (R-Fla.) and Dennis Ross (R-Fla.), as well as Sen. David Vitter (R-La.). The goal, of course, is to force the Senate to be the chamber to have to make the call on whether to prevent a government shutdown or protect health benefits of their staffs.

On a similar note, 43 House Republicans are backing a plan to fund the governmentwhile delaying and defunding Obamacare for one year.  On September 12, Rep. Tom Graves (R-Ga.) introduced the Stability, Security and Fairness Resolution, which would fund the government for 2014 and delay and defund the ACA until 2015. The original cosponsors of the resolution are listed here.  However, despite momentum from House conservatives, the approach is dead on arrival in the Senate and would certainly be vetoed by the president, raising the stakes for a government shutdown.

On September 11, Senate Minority Leader Mitch McConnell (R-Ky.) submitted an amendment to an energy efficiency bill under consideration to delay the individual mandate for a year and codify the White House’s one-year delay of the employer mandate.

Congress is facing a mid-October deadline to pass legislation that would raise the debt limit. Speaker of the House John Boehner has said that he will not agree to any deal that raises the debt limit unless there are simultaneous changes and reforms made to handle Washington’s spending problem. Some House conservatives plan to demand that no deal be made unless it strips money from the ACA.

Notwithstanding the priority House and Senate committees with jurisdiction over health care issues place on a permanent fix to the Sustainable Growth Rate (SGR) formula, the CBO’s latest report likely will make a permanent fix near to impossible this year. On September 13, the CBO said in a report that the Energy and Commerce Committee bill to repeal and replace the SGR formula would cost $175 billion over 10 years, without the added cost of traditional extended policies. It is unlikely that a bill with such a big price tag, for which no one committee has yet to describe offsets, will become law, though we do expect there to be a one or two-year fix to preserve doctors’ Medicare payment rates, likely to be negotiated in the last few days of the calendar year.

On September 11, the House passed a bill, the No Subsidies Without Verification Act, that would require a system be in place to verify eligibility for health insurance subsidies before health insurance subsidies are paid out.

On September 12, the Congressional Long Term Care Commission, organized by Congress after the CLASS Act was effectively removed from the ACA, issued a series of recommendations for addressing long-term care issues. The Commission’s primary general recommendation is to “promote services for persons with functional limitations in the least restrictive setting appropriate to their needs – building a system, including Medicaid, with options for people who would prefer to live in the community.”

The House Energy and Commerce subcommittee on Oversight and Investigations will hold a hearing on September 19 at which Gary Cohen, the head of the Center for Consumer Information and Insurance Oversight (CCIIO) at CMS will testify about his agency’s preparedness for enrollment in insurance marketplaces. CCIIO is leading the launch of the federally facilitated marketplaces and enactment of new ACA insurance rules.

On September 9, Sen. John Thune (R-S.D.) introduced the Union Bailout Prevention Act, which would block a union-backed proposed change to the ACA, and filed it as an amendment to the energy bill being deliberated by the Senate. Additionally, Senate Finance Ranking Member Orrin Hatch (R-Utah) and House Ways and Means Chairman Dave Camp (R-Mich.) wrote to Treasury Sec. Jack Lew to say they oppose any change to the health care law allowing insurance subsidies to be collected for union health plans.

IN THE STATES

Pennsylvania Governor Tom Corbett held a press conference on September 16, at which he announced that his administration is now hoping to expand the state's Medicaid program. The plan Gov. Corbett outlined would use private health insurance plans and add new requirements for all Medicaid enrollees, such as paying monthly premiums and demonstrating they are searching for jobs.

On September 6, the federal government told Gov. Corbett’s administration said that it had to shift tens of thousands of children from the Children’s Health Insurance Program (CHIP) to Medicaid. Sec. Sebelius told Gov. Corbett in a letter that the ACA requires the switch to simplify coverage for families by putting children in the same program as their families. Gov. Corbett has argued that such a switch would be difficult for children who already have doctors and relationships with those doctors. As recently as September 10, Pennsylvania’s insurance regulator, Michael Consedine said that he could not say whether the administration would comply.

On September 16, Governor Rick Snyder signed Michigan’s Medicaid expansion plan into law.

D.C. United, the District’s professional soccer team, is going to help publicize the District of Columbia’s ACA marketplace. This partnership follows last week’s news that the Baltimore Ravens will be promoting Maryland’s state marketplace.

IN THIRD PARTIES

The Medicare Payment Advisory Commission (MedPAC) reconvened this past week. The commission discussed the possibility of recommending that Medicare create a supplemental Medigap coverage plan to encourage patients to seek treatment from a single accountable care organization (ACO).

On September 9, Rite Aid announced that it will help individuals enroll in the Affordable Care Act’s new insurance marketplaces and help educate them on the law as well.

On September 11, the AFL-CIO Convention passed a resolution that expresses its support for the ACA’s goals but highlights several implementation issues with which it takes issue. Chief among the AFL-CIO’s concerns is the way the ACA treats multi-employer health care plans. In the resolution the AFL-CIO expresses that its ultimate desire is a single-payer model.

On September 10, the Service Employees International Union (SEIU) announced that the organization would assist HHS with ACA outreach in 30 cities in the coming weeks.

Time Warner Inc. is planning to move U.S. retirees from company-administered health plans to private exchanges, and instead put funds into accounts retirees can use to shop for health coverage.

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

Infrastructure Alert - September 17, 2013

Yesterday, Vice President Joe Biden and Transportation Secretary Anthony Foxx spoke at the Port of Charleston, S.C. Vice President Biden stressed that investing in infrastructure projects is vital for growing the middle class and the overall economic growth of the United States. The port and the Army Corps of Engineers are currently amidst a harbor deepening project that is expected to cost more than $300 million to deepen the harbor from 45 feet to 50 feet to facilitate larger ships that will be able traverse the Panama Canal in 2015. On September 9, Vice President Biden, Secretary Foxx, and Sen. Barbara Mikulski (D-Md.) spoke at the Port of Baltimore, highlighting the $10 million TIGER grant that the port received.

The Associated Press conducted an analysis of the National Bridge Inventory and found that, of the 607,380 bridges that are subject to uniform bridge inspection standards, 65,605 are classified as “structurally deficient” and 20,808 are classified as “fracture critical.” Between the two categories, 7,795 are considered both structurally deficient and fracture critical.

ON THE HILL

House Committee on Transportation and Infrastructure Chairman Bill Shuster has introduced the Water Resources Reform and Development Act (WRRDA) of 2013, H.R. 3080. The House bill differs substantially from the Senate-passed, $12 billion Water Resources Development Act (WRDA) of 2013, S. 601.

WRRDA authorizes 23 water resources projects that the committee considers vital and have had a complete technical review and recommendation form the Corps of Engineers. The bill would deauthorize about $12 billion in inactive projects that had been authorized before the Water Resources Development Act of 2007, and imposes expiration dates on new authorization to prevent further backlogs. The bill offsets all new authorizations with deauthorizations of old projects. The bill also limits the feasibility studies of the Army Corps of Engineers to three years in duration and $3 million in federal costs per study. If a study is not completed after that three-year period, the Secretary of the Army may allow one additional year to complete it. If a feasibility study is not completed, the authorization for the feasibility study is terminated.

The bill establishes the “Water Infrastructure Public-Private Partnership Program” to permit the Secretary of the Army to engage in public-private partnerships to finance the construction of at least 15 authorized water resource development projects. The bill also allows the Corps to accept funds from non-federal public interests and utility companies to expedite permitting and the regulatory process.

WRRDA staggers increases in Harbor Maintenance Trust Fund (HMTF) spending, culminating in spending 80 percent of revenues to the trust fund in FY2020. WRRDA also allocates 10 percent of the HMTF expenditures for FY2015-2016 on harbors that have a throughput of less than one million tons annually. The bill restricts the Inland Waterways Trust Fund (IWTF) spending on the Olmsted Lock and Dam to a 25 percent cost share, allowing more funding to support the backlog of other IWTF projects. The Corps will be required under WRRDA to submit annual financial plans for any inland navigation project that costs more than $500 million.

The bill instructs the Corps of Engineers to publish a notice in the Federal Register each year requesting proposals from non-federal entities for water resource development projects, and the corps would submit an annual “Report to Congress on Future Water Resources Development” with detailed information of each prospective project. Congress would then use this report to determine which projects to authorize. The bill provides for only projects in this report to be eligible for authorization.

WRRDA enjoys bipartisan support in the committee, will be marked up this Thursday, September 19, and is expected to be scheduled on the House floor in early October. Chairman Shuster is leading the public relations charge on WRRDA and has announced that he will hold a Twitter townhall today at 4:30 pm EST to answer WRRDA questions through the committee’s Twitter account, @Transport. Chairman Shuster has uploaded a video of him utilizing a whiteboard to show how the WRRDA bill would impact the U.S. taxpayer.

Sen. Mary Landrieu (D-La.) has weighed in the House WRRDA bill, saying it would “never see the light of day unless Morganza is put back.” Morganza refers to a project recommended by the Army Corps of Engineers to create a proposed 98-mile levee near the Mississippi River in Louisiana. The House bill lists 23 projects to be authorized, but does not include Morganza. The Senate-passed WRDA bill, on the other hand, allows projects to be authorized that the Army Corps of Engineers deems appropriate, such as the Morganza project. The Morganza project is estimated to cost $10.3 billion.

Rep. Daniel Lipinski (D-Ill.) and Rep. Larry Bucshon (R-Ind.) have introduced H.R. 3095, a bill that prevents the Federal Motor Carrier Safety Administration (FMCSA) from making any sleep apnea-related rules for professional drivers without going through the formal rulemaking process.

On September 11, Sen. Bob Casey (D-Pa.) has introduced S. 1495, the Saracini Aviation Safety Act of 2013. The bill named after the captain of United Flight 175, which was hijacked and flown into the World Trade Center. The bill would require that each commercial aircraft install a barrier, other than the cockpit door, to prevent access to the flight deck of an aircraft. In April, the bill was introduced in the House by Rep. Michael Fitzpatrick (R-Pa.), and currently has 46 bipartisan co-sponsors.

On September 10, the House Transportation and Infrastructure Subcommittee on Coast Guard and Maritime Transportation held a hearing titled “Maritime Transportation Regulations: Impacts on Safety, Security, Jobs and the Environment, Part 1.” The hearing covered a range of proposed rules from the Coast Guard, Federal Maritime Commission and Maritime Administration. Subcommittee members expressed their frustration that proposed rules are missing their statutory deadlines, including the towing vessel safety rule that had a deadline in 2011 and has still not been finalized. An archived webcast of the hearing can be viewed here, and a summary of the rules discussed is available here. Part 2 of this hearing is scheduled for October 10.

Tomorrow, September 18, the Senate Environment and Public Works Committee is holding a hearing titled “Implementing MAP-21's Provisions to Accelerate Project Delivery.” Also tomorrow, the Senate Banking, Housing, and Urban Affairs Subcommittee on Housing, Transportation and Community Development will hold a hearing titled “Recovering from Superstorm Sandy: Assessing the Progress, Continuing Needs, and Rebuilding Strategy” and the Subcommittee on Economic Policy will hold a hearing titled “Implementation of The Biggert-Waters Flood Insurance Act of 2012: One Year After Enactment.” The House Transportation and Infrastructure Subcommittee on Economic Development, Public Buildings, and Emergency Management will hold a hearing on FEMA reauthorization tomorrow as well. On September 19, the House Transportation and Infrastructure Committee will markup H.R. 3080, WRRDA, and H.R. 3095, the aforementioned sleep apnea rule bill. The House Financial Services Committee will hold a hearing on September 19 on the Terrorism Risk Insurance Act, which is set to expire on December 31, 2014. On September 30, the House Transportation and Infrastructure Subcommittee on Aviation will hold a hearing titled “Moving NextGen Forward: Leveraging the Assets of the FAA's William J. Hughes Technical Center.”

AT THE AGENCIES

The Department of Transportation has announced its fifth round of Transportation Investment Generating Economic Recovery (TIGER) grants. $474 million will be made available among 52 different infrastructure projects in 37 states. Rail projects received more than $200 million, and port projects received more than $100 million. TIGER funding has been decreasing since the inception of the program. The 2009 stimulus funded $1.5 billion in TIGER funding. Since then, the program has awarded grant batches totaling as follows, sequentially: $600 million, $527 million, $500 million, and now $474 million. For the latest round of funding, the Department of Transportation received 568 applications in the sum of $9 billion.

President Obama has nominated Captain Paul Nathan Jaenichen, Sr. USN (Ret) for Administrator of the Maritime Administration (MARAD). Capt. Jaenichen has been Acting Maritime Administrator since June 4, 2013. Capt. Jaenichen joined MARAD in July 2012, when President Obama appointed him Deputy Maritime Administrator.

Secretary of Transportation Anthony Foxx has announced two new marine highways. “M-495 Marine Highways Crossing” will connect ports in the District of Columbia, Northern Virginia, and Maryland for passenger services. “M-29 Marine Highway Connector” will connect the upper Missouri River between Kansas City, Mo., and Sioux City, Iowa.

The GAO released several reports of note: Cargo Tank Trucks: Improved Incident Data and Regulatory Analysis Would Better Inform Decisions about Safety Risks, FAA Facilities: Improved Condition Assessment Methods Could Better Inform Maintenance Decisions and Capital-Planning Efforts, and Interstate Compacts: Transparency and Oversight of Bi-State Tolling Authorities Could Be Enhanced.

The Department of Energy has released a list of 38 transportation technology projects that will receive a total of $45 million in federal funding. Through the Advanced Vehicle Power Technology Alliance between the Department of Energy and the Department of the Army, the Army is contributing $3 million in co-funding to support projects focused on lightweighting and propulsion materials, batteries, fuels and lubricants. The technology projects are a part of the Department of Energy’s Vehicle Technologies program and EV Everywhere Grand Challenge Initiative.

IN THE STATES

The American Association of State Highway and Transportation Officials is urging Amtrak to complete agreements with states before the October 16 deadline for new agreements. Amtrak currently operates 21 “state-sponsored” routes across 15 states, and state-supported corridors comprise roughly half of Amtrak’s yearly ridership. Thus far, only Virginia has completed an agreement with Amtrak to keep its intrastate rail operating.

California: On September 8, the California High-Speed Rail Authority board members approved $268 million in unexpected costs, utility relocation and freight railroad collaboration. The board unanimously approved $160 million for potential cost overruns associated with the first, 29-mile construction segment, $18.4 million to reimburse AT&T for relocating fiber optic lines that are in the way of the tracks, and $50.4 million to reimburse PG&E to relocate gas lines, electricity distribution lines and other facilities to make way for the tracks.

Illinois: Chicago Mayor Rahm Emanuel has halted the plan to lease Midway Airport after one of the two infrastructure consortium bidders backed out. The IFM/Manchester consortium removed itself from the bidding process over concerns with valuation issues, and the Macquarie/Ferrovial group was the only bidder remaining. Mayor Emanuel had announced his intention to lease Midway Airport to private investors in December 2012 for a lease of 40 years or less, and would use some of the revenue to pay off Midway’s outstanding bonds.

North Carolina: Charlotte’s application for a $24 million TIGER grant for its streetcar system was not accepted, leaving the project in a funding limbo. Carolyn Flowers, CEO of the Charlotte Area Transportation System, and Mayor Patsy Kinsey have both stated that they do not think that the project will suffer major delays as a result, but will not start the second phase of the project until it is fully funded.

Health Care Reform Implementation Update - September 11, 2013

After spending the past month in their home districts listening to constituents, this week House and Senate members are back in Washington and Congress is back in session. Though the attention of many has turned to back-to-school, back-to-football, and to remembering the events of September 11 and making difficult decisions on Syria, it is not far from anyone’s mind that open enrollment begins in less than one month. The Obama administration is immersed in an all-out push to promote the Affordable Care Act (ACA): The administration is planning a $12 million ad buy in key states, this past weekend Enroll America hosted more than 200 events across the country to promote the ACA, and the Baltimore Ravens have been recruited to help push enrollment in Maryland. Additionally, regulations implementing the Affordable Care Act continue to be released, the Centers for Medicare and Medicaid Services (CMS) has been preparing to inform insurance issuers of their statuses as Qualified Health Providers, the Committee on Energy and Commerce held an ACA hearing on September 10, Senators Rand Paul, Mike Lee and Ted Cruz headlined the “Exempt America Tour” rally on September 10, and the Medicare Payment Advisory Commission will meet to discuss Accountable Care Organizations, Medicare Advantage, dual eligibiles and Medicare Part D on September 12 and 13.

AT THE AGENCIES

The Internal Revenue Service (IRS) issued a proposed rule for the reporting requirements employers will have to meet under Section 6056 of the ACA, which requires employers to report to the IRS information about their compliance with the employer shared responsibility requirements. Enforcement of the employer mandate was delayed earlier this summer until 2015.

In another proposed rule, the IRS detailed how employers and insurers who provide coverage will report to the government which individuals had what type of insurance and when, so the government can determine who is and is not complying with the ACA’s individual mandate.

On August 30, CMS released the third guidance letter for state Medicaid directors on potential paths for Medicaid shared savings programs. In the first two letters, CMS described the framework for Integrated Care Models and pathways that states may use to implement them in their Medicaid state plans or appropriate waivers and demonstrations. The third letter discusses reimbursement methodologies that can be adopted in the context of Integrated Care Models to incentivize improved quality and outcomes and reduce costs.

On September 6, it became public news that CMS program integrity chief Peter Budetti will leave his post as CMS’s first deputy administrator and director for program integrity.

CMS informed issuers of their qualified health plan (QHP) certification statuses on September 9. Further updates to come.

AT THE WHITE HOUSE

The Obama administration is planning a $12 million ad buy to promote the Affordable Care Act. The advertisements are reported to begin airing on September 30 in Arizona, Florida, Georgia, Indiana, Louisiana, Michigan, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee and Texas, states that are largely led by Republicans and in many cases have been hostile to the ACA.

ON THE HILL

On September 6, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) released a score of the House bill to delay the individual and employer mandates by a year, H.R. 2668. The CBO and JCT estimate that the legislation would reduce federal deficits by roughly $36 billion over the 2015-2018 period and by roughly $35 billion over the 2014-2023 period.

The House Committee on Energy and Commerce’s Subcommittee on Health held a hearing on September 10 on the ACA’s “Implementation Challenges for States and Job Creators.”

Unions are becoming increasingly frustrated with a general lack of response from the Obama administration to their concerns as changes are made in implementation to respond to concerns of businesses, churches and other religious groups, and Capitol Hill. Unions argue that the ACA could cut employee hours, that Taft-Hartley health plans will be ineligible for subsidies because they are multiemployer plans, and that workers will be forced off their union health plans into the law’s potentially more costly insurance exchanges. On September 5, Chairman of the House Ways and Means Committee Dave Camp (R-Mich.) and Chairman of the Education and Workforce Committee John Kline (R-Minn.) sent a letter to the CBO and JCT requesting estimates on the cost of providing insurance subsidies to union-sponsored insurance plans.

Republicans on the House Committee on Energy and Commerce sent a records request to several groups that were recently named health care navigators requesting details about their organization and instructing the groups to schedule congressional briefings within the next two weeks. Rep. Henry Waxman (D-Calif.) wrote a letter arguing that these requests were an abuse of authority. On September 9, HHS sent a response to Energy and Commerce House members providing information on the navigator grant recipients.

IN THE STATES

Following the Michigan Senate’s approval of Medicaid expansion last month, the Michigan House approved Medicaid expansion last week. A bill will now be sent to Governor Snyder for signature. Governor Snyder (R) has been pushing for Medicaid expansion in his state despite previous resistance from a Republican-led state legislature. The bill would go into effect 90 days after the current session concludes in December if Gov. Snyder signs it.

On September 3, CMS agreed to allow Indiana to extend an existing program the state has for low-income residents, known as the Healthy Indiana Plan, until at least the end of 2014. Some view this as an indication that the state will expand its Medicaid program under the ACA.

On September 6, CMS approved a one-year extension of Oklahoma's Insure Oklahoma demonstration, which is an existing demonstration to help low-income adults afford health coverage. The demonstration was set to expire at the end of the year.

On September 3, Maryland health officials announced a new partnership with the Baltimore Ravens to promote Maryland’s insurance marketplace.

IN THIRD PARTIES

Enroll America organized 1,000 volunteers to hold more than 200 events across the country to promote the ACA this past weekend. The efforts focused attention on Arizona, Florida, Georgia, Illinois, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania and Texas.

On September 4, the Republican National Committee (RNC) launched a new website and video that highlight local news stories on the cost of insurance under the ACA. The website also features a to-the-second countdown to the “Obamacare Train Wreck.”

On September 4 speaking in Arkansas, former President Bill Clinton urged Congress to revise several issues presented by the ACA. He highlighted an error in the law that prevents a full-time employee’s family from getting subsidized health insurance on the exchange if the individual’s policy is affordable. Clinton also criticized those states that were not taking advantage of incentives for Medicaid funds. He praised Arkansas’ private option Medicaid plan that enables some Medicaid-eligible individuals to use premium assistance to purchase qualified health plans on the state’s exchange.

IN THE COURTS

On September 5, Liberty University filed a petition asking the Supreme Court to review the 4th Circuit Court of Appeals’ decision in Liberty’s case seeking to overturn the ACA’s requirement that employers provide health insurance that covers contraception.

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

Infrastructure Alert - September 4, 2013

Congress will return from its recess on Monday, September 9, and will address a plethora of pressing issues before the end of the month. As neither the House nor the Senate has passed a FY2014 appropriations bill for the Departments of Transportation and Urban and Housing Development, a continuing resolution for those appropriations will be debated and passed before the end of the fiscal year, September 30. Before the recess, the House Transportation and Infrastructure Committee announced that it would release its own water resources bill, the Water Resources Reform and Development Act (WRRDA), in lieu of amending the Senate-passed, $12 billion S. 601, the Water Resources Development Act of 2013 (WRDA). Due to the pressing debate and vote on military authorization in Syria, and given that the House is only in session for nine days in September, WRRDA is unlikely to pass the House this month.

ON THE HILL

On August 15, Sens. Patty Murray (D-Wash.) and Maria Cantwell (D-Wash.) announced new legislation titled “The Maritime Goods Movement Act for the 21st Century.” The bill would increase port spending through eliminating existing tax benefits enjoyed by oil and gas companies and replacing the Harbor Maintenance Tax with the new “Maritime Goods Movement User Fee.” The new fee would be fully available to Congress to direct for port operation and maintenance. The bill would also attempt to prevent shippers from ducking the fee through using Canadian and Mexican ports, as well as prevent funds from the Harbor Maintenance Trust Fund from being used for irrelevant projects. While the bill has been announced, it will not be formally introduced until after the recess.

On August 22, the Congressional Budget Office scored S. 1072, the Small Airplane Revitalization Act of 2013, concluding that, if enacted, the bill would not have any effect on direct spending of revenues. The bipartisan bill, introduced by Sen. Amy Klobuchar (D-Minn.) and currently carrying 15 co-sponsors, would require the Federal Aviation Administration to issue a final rule related to the certification and safety requirements of small airplanes by the end of 2015.

Rep. Mike Michaud (D-Maine) has announced that he is running for governor in the 2014 election. Rep. Michaud is a member of the Committee on Transportation and Infrastructure, and sits on the following subcommittees: Economic Development, Public Buildings, and Emergency Management; Railroads Pipelines, and Hazardous Materials; Water Resources and Environment; and Highways and Transit.

AT THE AGENCIES

The Justice Department’s lawsuit against the proposed American Airlines-US Airways merger has been tentatively scheduled for November 25. The AFL-CIO’s Transportation Trades Department (TTD) wrote the Attorney General to voice its opposition to blocking the merger, stating that the Department of Justice’s “actions run counter to the interests of employees at these two air carriers represented by TTD unions and are inconsistent with the DOJ’s recent treatment of transactions involving airline consolidation.”

The Hurricane Sandy Rebuilding Task Force, a federal task force created by executive order in December 2012, published its report, “Hurricane Sandy Rebuilding Strategy: Stronger Communities, A Resilient Region.” The report includes dozens of policy recommendations, as well as pre- and post-Sandy transportation usage statistics.

Amtrak ridership in July grew 4.8 percent to more than 2.9 million passengers, an all-time record for most passengers in one month.

On August 23, the Federal Motor Carrier Safety Administration (FMCSA) released its final rule on the Unified Registration System, a registration database for motor carriers, brokers, freight forwarders and other required to register with the FMCSA. The rule implements statutory provisions from the ICC Termination Act of 1995 (ICCTA) and the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users, 2005 (SAFETEA-LU).

On August 21, the Federal Transit Administration (FTA) made $29.9 million in FY2013 funds available for the Discretionary Passenger Ferry Grant program. The FTA has decided to limit the grants to capital projects.

IN THE STATES

The National Conference of State Legislatures passed a resolution requesting Congress to create a $20 million program, with no more than $2 million to be allotted to any one state, “to support state-level pilot programs to explore transportation funding alternatives to fuel taxes.”

California: On August 16, Sacramento County Superior Court Judge Michael Kenny ruled that the California High-Speed Rail Authority has failed to comply with various financial and environmental requirements from Proposition 1A that granted initial funding for the project in 2008. The High-Speed Rail Authority was required under Proposition 1A to clear all environmental hurdles prior to construction and secure funding for the entire first segment before construction began. Judge Kenny did not decide to halt the project funding, but instead an additional hearing that has yet to be scheduled will determine the fate of the Legislature’s financial appropriation. The ruling, however, addresses only an older version of the High-Speed Rail Authority’s business plan from 2011 that has since been updated and has reduced the overall cost of the project.

Nevada: Governor Brian Sandoval is urging the Nevada Department of Transportation to complete its study of road-funding options in time for debate by the 2015 Legislature. The study will include the potential impact of a vehicle miles traveled (VMT) tax. With waning revenues from the traditional gasoline tax, the state highway trust fund is expected to garner about 18 percent less revenue per year by 2016, or about $40 million less. A VMT tax would replace the current state gasoline tax with a fee that would be charged for each mile travelled. The debate over the efficacy of a VMT tax, however, will invite concerns over personal privacy and automobile tracking for VMT fee purposes.

Virginia: On August 16, the Department of Rail and Public Transportation and Transit Service Delivery Advisory Committee published its draft report of Performance-Based Operating assistance Allocation Methodology for comment.

Health Care Reform Implementation Update - September 3, 2013

There is only one week left of Congress’ summer recess. While the members have been in their home districts, the agencies in Washington have been finalizing Affordable Care Act (ACA) regulations on everything from the individual mandate to eligibility appeals, and rallies have raged across the country both by those who oppose and those who support the ACA. Arguments continue about whether the exchanges will be ready by October 1, and whether debt ceiling legislation or a continuing resolution are plausible vehicles for opponents of the ACA to chip or hack away at the law. Meanwhile, the ACA continues to root itself into the national dialogue, even making several mentions at this week’s 50 year anniversary commemoration of the Civil Rights March on Washington and Martin Luther King Jr.’s “I Have a Dream” speech.

AT THE AGENCIES

On August 27, the Internal Revenue Service (IRS) issued a final regulation on governing compliance with the individual mandate of the ACA, “Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage.” The regulation addresses the penalty for not having minimum essential coverage under the ACA. The rule establishes a penalty per person per year of the greater of $95 or 1 percent of household income in 2014, eventually moving up to $695 per person or 2.5 percent of household income per person per year in 2016. The rule also details exceptions to the individual mandate.

On August 27, the Department of Health and Human Services (HHS) notified insurance companies that it would delay signing final agreements with the plans for the ACA’s new insurance exchanges until mid-September. These approvals are the last step in what has been a long process for insurance companies trying to sell their products on the health insurance exchanges. The delay moves this last step just a couple of weeks before open enrollment begins.

On August 28, the Centers for Medicare & Medicaid Services (CMS) posted its “Program Integrity: Exchange, SHOP, and Eligibility Appeals” final rule. The rule sets forth standards for eligibility appeals, verification of eligibility for minimum essential coverage, treatment of incomplete applications, and establishes additional consumer protections regarding privacy and security. It also clarifies the roles of agents, brokers and issuer application assisters in assisting consumers with obtaining exchange coverage; provides for the handling of consumer cases; establishes non-discrimination standards for methods of premium payment; and sets forth provisions regarding a state’s operation of the Small Business Health Options Program (SHOP) exchanges.

CMS’s 217-page manual for navigators, the Health Insurance Marketplace Navigator Standard Operating Procedures Manual, is available online. The manual provides guidance on exchanges generally, on standard operating procedures for navigators, as well as general customer service guidelines.

On August 29, in response to the recent Supreme Court ruling on the Defense of Marriage Act, HHS announced that access to care in the same nursing home as one’s spouse is extended to Medicare beneficiaries in same-sex marriages. This coverage will apply equally to all seniors in private Medicare plans who are in legally recognized marriages, regardless of where they reside.

AT THE WHITE HOUSE

The 50th Anniversary of the Civil Rights March on Washington and Martin Luther King Jr.’s “I Have a Dream” speech provided several opportunities for speakers to tout the benefits of the Affordable Care Act. Among its notable shout-outs were those from President Obama and former President Bill Clinton. In the lead up to the ceremony in a radio interview, President Obama said Martin Luther King Jr. would approve of the Affordable Care Act. In Clinton’s speech, he said that he and his listeners “cannot relax in our efforts to implement health care reform in a way that ends discrimination against those with preexisting conditions, one of which is inadequate income to pay for rising health care.”

ON THE HILL

House Republican leaders continue to consider using the national debt limit and other spending legislation as leverage to delay implementation of the Affordable Care Act. Others are pushing for a vote to fund the government without funds for the ACA. Senators Rand Paul (R-Ky.), Mike Lee (R-Utah), and Ted Cruz (R-Texas) will headline the “Exempt America Tour” rally on September 10, urging the defunding of the Affordable Care Act.

Republicans from the House Committees on Ways and Means and Energy and Commerce released a White Paper addressing possible ideas for reforming Medicare. The joint paper reviews 1) the traditional Medicare cost-sharing framework and the impact current thresholds have on beneficiaries; 2) the impact of supplemental coverage with low cost-sharing requirements that reduce incentives to seek cost-effective care; and 3) how modernizing the traditional cost-sharing features could better align beneficiary incentives, ensure beneficiaries greater out-of-pocket predictability and reduce overall Medicare costs.

On August 23, in response to the HHS Inspector General’s report that said the program for rural health care providers had become too bloated and a proposal that Medicare reimbursement rates be cut for critical access hospitals, a bipartisan group of 20 senators signed on to a letter defending these critical access hospitals. Critical access hospitals serve rural communities and populations without easy access to other health care providers.

On August 28, Sen. Rob Portman (R-Ohio) sent a letter to Sec. Sebelius and Administrator Tavenner expressing his concerns regarding the upcoming enrollment of individuals in the health insurance marketplaces. He suggests in his letter that since the infrastructure is not in place to handle the large number of individuals who will be obtaining their insurance through the marketplaces, open enrollment be delayed “until the necessary leadership and preparation are in place to ensure that the Marketplace can handle the volume on day one of enrollment.”

On August 26, Representative Ron DeSantis (R-Fla.) announced a bill that would prohibit congressmen and women and their staffs from receiving employer contributions to their health care costs under the ACA.

IN THE STATES

On August 27, the Michigan state Senate passed a plan to expand Medicaid coverage with a vote of 20-18, making Michigan the 25th state to do so as part of the ACA. Due to its late decision, Michigan may be several months behind other states expanding their Medicaid programs.

IN THIRD PARTIES

On August 29, the Rand Corporation released a new report, in which it argues that the ACA will not lead to a widespread increase in premiums in the individual health insurance market.

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

Health Care Reform Implementation Update - August 26, 2013

In response to security concerns about personal information in the health insurance exchanges, the Centers for Medicare and Medicaid Services (CMS) released a new security agreement for the data hubs where this information will be stored. Opposition to the Affordable Care Act (ACA) continues to be voiced from many directions. Some lawmakers who oppose the ACA are pushing for answers on the employer mandate delay or encouraging the law’s defunding. The National Retail Federation, America’s Health Insurance Plans, the National Association of Health Underwriters, the National Association for Manufacturers and the U.S. Chamber of Commerce have launched a campaign highlighting the problems that will be caused by the ACA’s penalties. Notwithstanding the opposition, major provisions of the law continue to go into effect, and the countdown to open enrollment is less than 40 days.

AT THE AGENCIES

In an effort to raise awareness and enthusiasm among young consumers without health insurance for the ACA, HHS and Young Invincibles launched The Healthy Young America Video Contest on August 19 for videos urging young people to enroll in new insurance policies. Participants may submit by September 23, 2013 videos in three categories: song, short film or video infographic.

On August 20, CMS released a new agreement with state exchanges on the federal data service hub. The agreement requires state exchanges to alert the Center for Consumer Information and Insurance Oversight (CCIIO) within an hour of detecting a possible breach of personally identifiable information on the data hub. Once CCIIO is alerted, it will contact the relevant agencies about the breached data.

On August 23, the IRS released a proposed rule, Tax Credit for Employee Health Insurance Expenses of Small Employers. The proposed regulations provide guidance on the tax credit available to certain small employers that offer health insurance coverage to their employees under section 45R of the Internal Revenue Code, enacted by the ACA.

ON THE HILL

On August 21, Rep. Mark Meadows (R-N.C.) and 79 colleagues sent a letter to Speaker John Boehner (R-Ohio) and Majority Leader Eric Cantor (R-Va.) pressing them to defund the ACA as part of a government funding bill.

On August 21, five Republican members of the House Energy and Commerce Committee sent a letter to Treasury Secretary Jack Lew pushing for more details on the administration’s decision to delay the ACA’s employer mandate. The signing members are Energy and Commerce Chairman Rep. Fred Upton (R-Mich.), and Reps. Tim Murphy (R-Pa.), Joe Pitts (R-Pa.), Marsha Blackburn (R-Tenn.) and Michael Burgess (R-Texas). The members had previously written a letter to the Treasury but have not heard back.

The Government Accountability Office released a report requested by Sen. Tom Coburn (R-Okla.) examining the efficiency and effectiveness of contractors CMS uses to conduct post-payment claims reviews to identify improper payments. GAO recommends that CMS examine ways to make the review processes more consistent among different types of contractors.

A Government Accountability Office report finds that the U.S. Postal Service’s proposal to run its own health care plan in lieu of a federal plan could add slight financial strain to Medicare.

On August 21, Congressman Bill Cassidy, M.D. (R-La.), sent a letter to HHS Secretary Sebelius protesting the Obama administration’s granting of ACA navigator funds to Planned Parenthood. In a statement, Rep. Cassidy said “Every federal dollar that goes to Planned Parenthood, regardless of its stated purpose, offsets their costs to provide abortions.”

IN THE STATES

Notwithstanding Medicaid expansion, many who are currently eligible for Medicaid may lose Medicaid coverage. Maine, Rhode Island, Wisconsin and Vermont are planning to scale back some of their eligibility in January, meaning more than 150,000 will lose access to the program.

Last week the New York Department of Health announced the name of its health benefit exchange. It will be called the “NY State of Health.”

On August 23, Iowa Gov. Terry Branstad and Lt. Gov. Kim Reynolds formally requested a federal waiver to expand its Medicaid program in a way that would allow those between 100 and 138 percent of the federal poverty level to use federal dollars to buy coverage on the health exchange Iowa is running in partnership with the federal government.

On August 20, Rhode Island released rate information for insurance policies sold through the ACA’s exchanges. Rhode Island residents will be able to choose among 12 insurance plans offered through two insurance companies, Blue Cross & Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island. The cost of insurance varies by type of plan and the individual’s age. A plan with a $5,800 annual deductible and a 30 percent co-pay would cost a 21-year-old consumer $169 per month and a 45-year old $244 per month. Rhode Island residents are now able to compare premiums and details of plans by plan and age through HealthSourceRI.com.

On August 19, Montana state officials released prices for insurance under its exchange. According to the released rates, a mid-level plan would cost a 30-year-old somewhere between around $200 a month to $300 a month. The released rates do not include the up-front federal tax credits that will be available to many.

Though Louisiana had pursued funds under the ACA for long-term care reform, it withdrew its application this week citing complicated federal stipulations associated with the program.

IN THIRD PARTIES

The National Retail Federation, America’s Health Insurance Plans, the National Association of Health Underwriters, the National Association of Manufacturers, and the U.S. Chamber of Commerce have launched a campaign called the Affordable Coverage Project, whose slogan is The Health Insurance Tax Will Hurt. The campaign focuses on three main populations it argues will be harmed: families, seniors and small business.

On August 20, the Kaiser Family Foundation released its annual Employer Health Benefit Survey. The results showed that health insurance premiums have grown slowly in 2013, by 4 percent for an employer-sponsored family health plan. For some, this finding should stifle criticism that the ACA will increase health premium costs. Others are quick to highlight, however, that many of the ACA’s largest changes, especially for employers, have not yet gone into effect.

Heritage Action for America began a nine-city tour this week to urge lawmakers to defund the ACA. Heritage Action also announced a $550,000 defunding advertisement campaign that will fund advertisements in 100 congressional districts under Republican control.

According to a new study from the RAND Corporation, an estimated 300,000 fewer people or merely .2 percent of the population will have employer-sponsored health insurance in 2014 as a result of the employer mandate delay. Additionally, the study finds that the government will collect about $11 billion less in penalties.

According to a Kaiser Family Foundation report released on August 14, nearly half of those who currently buy their own health insurance would be eligible for tax credits next year under the ACA.

On August 15, Organizing for Action released a television advertisement touting the ACA. The ad is the group’s third this summer in support of the law.

A new study from the Commonwealth Fund found that the majority of young adults between the ages of 19 and 29 are unaware of the health insurance exchanges (marketplaces).

IN THE COURTS

An Oklahoma judge granted a temporary injunction from a state law that put restrictions on the emergency contraceptive drug Plan B One-Step. The Oklahoma Coalition for Reproductive Justice and Jo Ann Mangili, the mother of a 15-year old girl, sued the state arguing that the bill violates the Oklahoma Constitution’s ban on including more than one subject in a bill.

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

Health Care Reform Implementation Update - August 19, 2013

With less than 50 days until open enrollment begins, tensions in Washington and around the country are high among health care stakeholders.  Businesses, individuals and even some in the government are concerned about whether all the pieces of the Affordable Care Act (ACA) will come together in time for individuals to enroll in exchange plans come October 1. The administration is working around the clock to ensure health reform works, but problems abound. The administration has delayed another key provision of the ACA by a year so that limits on consumer out-of-pocket costs will not kick in until 2015. The Inspector General’s Office at HHS released a report showing that the government is several months behind on testing data security for the exchanges. The heads of health information technology and patient-centered outcomes research who have both been heavily involved in ACA implementation are stepping down from their posts. Partisan tensions continue to boil, especially with respect to the ACA, which many fear will lead to difficulties in passing a budget to keep the government running.

AT THE AGENCIES

The Obama administration delayed another key provision of the Affordable Care Act until 2015. The ACA includes a consumer protection that caps the out-of-pocket insurance costs for consumers. The limit on these costs, which include deductibles and co-payments, is $6,350 for an individual and $12,700 for a family, but is now delayed. The delay, buried in pages of language on the Department of Labor’s website went largely unnoticed until this week.

On August 7, the Office of Personnel Management proposed a rule that amends the Federal Employees Health Benefits Program regulation regarding coverage for members of Congress and congressional staff and details how the federal government can continue to contribute to their health insurance plans. The proposed rule would allow the government to continue to pay for a significant part of their health insurance. Public comments on the rule are due September 9. Committee on Ways and Means Chairman Dave Camp issued a statement in response arguing that the proposed rule is another indicator of the ACA not working.  A day later, the chief of the D.C. health exchange said she welcomed Capitol Hill staff onto the D.C. exchange.

On August 2, the Centers for Medicare and Medicaid Services (CMS) issued final Medicare 2014 payment rules for inpatient stays at acute-care hospitals and long-term care facilities, as well as for hospice care. The rules increase hospital inpatient payments by 0.7 percent, increase long-term care hospital payments by 1.3 percent, and increase hospice payments by 1.7 percent.

On August 15, HHS announced $67 million in approximately 120 navigator grants to 105 organizations. Navigators are tasked with educating the public about the ACA. A list of the navigator grant recipients by state can be found here.

On August 2, the Inspector General’s Office at HHS released a report showing the federal government is several months behind on testing data security for the insurance exchanges scheduled to launch October 1. The report warns that the data hub may contain unidentified security risks when open enrollment in the marketplaces begins.

On August 5, HHS announced the launch of a new feature on Healthcare.gov, My Account. According to HHS, consumers can now open accounts on Healthcare.gov, which is the first step in purchasing coverage through the federal exchange.

It became public this week that Dr. Farzad Mostashari, who has served as the head of the Office of the National Coordinator for Health Information Technology at HHS for the past four years, will leave his post. Additionally, the first chairman of the Patient-Centered Outcomes Research Institute, which was created by the ACA, will step down at the end of the year.

On August 1, HHS’s Office for Civil Rights published a request for information for a rulemaking on non-discrimination requirements under Section 1557 of the ACA.

In a final rule on disclosure of taxpayer information under the ACA, the Internal Revenue Service announced that it would share “return information” with states and other agencies to help verify income, which can help determine eligibility for tax credits through the insurance exchanges.

ON THE HILL

On August 2, the House Ways and Means Committee released draft legislation of President Obama's proposals to strengthen Medicare. The proposal addresses the following changes to post-acute care (PAC): 1) Reducing market basket updates for home health agencies (HHAs), skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals; 2) Creating site neutral payments between IRFs and SNFs for certain procedures; 3) Modifying the criteria required for IRF status; 4) Establishing an SNF readmissions program; and 5) Creating PAC bundled payments. The committee encourages the public to submit comments to any of the draft legislative proposals at entitlementreform@mail.house.gov.

On August 4, House Budget Committee Chairman Republican Rep. Paul Ryan cautioned his party that they would be better off “delaying and ultimately replacing” the ACA rather than threatening a government shutdown over funding.

More than 200 House members signed a letter to CMS expressing concern over CMS’s proposed rule from July 1 that would cut funding for dialysis by 9.4 percent.

IN THE STATES

On August 6, Arkansas submitted a waiver application to CMS requesting to expand the Medicaid population through the state’s health insurance exchange.

Massachusettsresidents are paying more for their insurance, despite the plans decrease in value, a report from the Center for Health Information and Analysis found.

IN THE WHITE HOUSE

On August 9, President Obama held a press conference at which he accused Republicans of making repeal of the ACA their “holy grail” and said that Republicans’ “unifying principle is making sure 30 million people don’t have health care.”

On August 6, the White House launched a new website that helps employers determine the requirements and penalties they face.

IN THIRD PARTIES

On August 5, The Employers for Flexibility in Healthcare Coalition, which is led by the Retail Industry Leaders association, sent a letter to HHS, the Treasury Department, and the Labor Department expressing appreciation of the one-year delay in the employer mandate and requesting more information on it.

On August 6, WebMD announced the launch its new online Health Care Reform Center, which will educate consumers on the ACA and guide them through purchasing coverage in the insurance exchanges. The site incorporates videos, subsidy calculators, countdowns and state-specific information to help simplify the ACA.

According to a Kaiser Family Foundation report released on August 14, nearly half of those who currently buy their own health insurance would be eligible for tax credits next year under the ACA.

On August 15, Organizing for Action released a television advertisement touting the ACA. The ad is the group’s third this summer in support of the law.

IN THE COURTS

On August 6, Liberty University requested that the 4th Circuit Court of Appeals stay its ruling upholding the health care law in Liberty’s case while Liberty applies to have the Supreme Court hear it. On the same day, the court granted Liberty’s request, leading some to believe that the 4th Circuit believed the Supreme Court was considering taking the case. Then on August 7, the 4th Circuit Court of Appeals reversed itself and denied the stay.

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

Health Care Reform Implementation Update - August 12, 2013

The House Energy and Commerce Committee voted unanimously on legislation that would repeal the sustainable growth rate (SGR) formula that has historically led to annual decreases in physician payments that are fixed at the last minute each year; the Centers for Medicare and Medicaid services (CMS) announced a temporary moratorium on the enrollment of new home health provider and ambulance supplier enrollments in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in three “fraud hot spots”; CMS Administrator Marilyn Tavenner testified at a House Energy and Commerce hearing refuting claims from lawmakers that the Affordable Care Act (ACA) was forcing employers to reduce employee hours; President Obama tapped John Koskinen to lead the Internal Revenue Service (IRS); a Congressional Research Service report found that a government shutdown would not stop the ACA’s implementation; and the House passed legislation that would prohibit the IRS from implementing the ACA and separate legislation that would require Congress to vote to approve any regulations implementing the Affordable Care Act, however these bills are not likely to pass in the Senate.

AT THE AGENCIES

The Office of Personnel Management is preparing guidance that will allow the government to continue making contributions to health care premiums of members of Congress and their aides. This will settle concerns over whether the ACA allows the federal government to continue to pay part of the health insurance premiums for members of Congress and thousands of Hill aides when they are using health exchanges.

CMS released its annual update for inpatient psychiatric facilities, boosting their payment in 2014 by 2.3 percent. The total impact of the update is estimated to be approximately $115 million.

The Department of Health and Human Services (HHS) released information on July 29, showing that more than 6.6 million seniors on Medicare have saved in excess of $7 billion on prescription drugs as a result of the Affordable Care Act.

On July 31, an article by Marilyn Tavenner and Niall Brennan appeared on the Health Affairs Blog detailing CMS’ strategy to use health data to promote efficiency and drive improvements in access and delivery.

On July 26, CMS announced a temporary moratorium on the enrollment of new home health providers and ambulance suppliers in Medicare, Medicaid and the Children’s Health Insurance Program in three fraud hot spot areas of the country: Miami, Chicago and Houston. Existing providers and suppliers can continue to deliver and bill for services, but no new provider and supplier applications will be approved in the designated areas.

ON THE HILL

The House Energy and Commerce Committee unanimously voted on Wednesday to pass the Medicare Patient Access and Quality Improvement Act, a bipartisan bill that would repeal the sustainable growth rate formula and reform the system of Medicare physician payments. The SGR repeal bill will move to the full House for a vote, but a way to pay for the cost of repeal has yet to be determined, and the Senate has not yet indicated its position on the House bill

A Congressional Research Service report titled Potential Effects of a Government Shutdown on Implementation of the Patient Protection and Affordable Care Act was released on July 30. It found that a government shutdown would not stop implementation of the Affordable Care Act.

On August 1, the House Committee on Energy and Commerce held a hearing titled “PPACA Pulse Check,” at which CMS Administrator Marilyn Tavenner testified. Administrator Tavenner refuted claims from lawmakers that the Affordable Care Act was forcing many small businesses to reduce work hours of their employees to avoid having to comply with the ACA. Some Republican congressmen argued that the Obama administration was repeatedly failing to notice frequent reports about the ACA's effects on small business. Tavenner also assured the committee that the insurance exchanges would be ready on time regardless of the one-year delay in the employer mandate.

House Speaker John Boehner said in a House Republican Conference meeting that the House would continue a series of votes over the next few months to repeal the Affordable Care Act. These bills will be unlikely to move past the Senate

The House voted to block the Internal Revenue Service from enforcing any components of the ACA in a bill called “Keep the IRS Off Your Health Care Act.” Every Republican and four Democrats voted in its favor.

On August 2, the House voted in favor of an amendment to the Regulations from the Executive in Need of Scrutiny Act, to require Congress to approve all federal regulations relating to the implementation of the Affordable Care Act.

The Congressional Budget Office released a report on July 30 estimating that President Obama's recent decision to delay the Affordable Care Act's employer mandate will cost about $12 billion and result in half a million fewer people insured.

On August 1, the House Committee on Ways and Means held a hearing on the Obama administration’s efforts to implement the ACA, at which Daniel Werfel, Principal Deputy Commissioner and Deputy Commissioner for the IRS and Gary Cohen, Deputy Administrator and Director at the Center for Consumer Information and Insurance Oversight within CMS testified. Central issues discussed included the data hub for the health insurance exchanges and verifying whether someone qualifies for a subsidy.

IN THE STATES

On July 26, Maryland released premium rates for individual health insurance plans. Insurance regulators reduced prices for all nine insurance carriers that are filing to sell their policies in Maryland’s insurance marketplace, cutting rates by as much as 33 percent in some cases. Maryland’s cuts are among the most drastic seen across the country.

Regulators in Florida said premiums in the state will rise by 30-40 percent under the ACA. These percentages are preliminary figures and estimates. The insurance department said premium increases next year "will vary dramatically" based on the policies people have now, but increases will average 30 to 40 percent for individuals and 5 to 20 percent for small businesses.

IN THIRD PARTIES

On July 25, CVS announced it will participate in efforts to get its customers to sign up for ACA coverage, utilizing its health care fairs and pharmacies. Walgreens and Blue Cross Blue Shield have also formed a partnership through which they will promote enrollment.

Liberal groups, led by Americans United for Change and Protect Your Care, will begin a new effort this week to reverse the current narrative and put Democrats on the offensive and Republicans on the defensive over the Affordable Care Act.

On July 29, in its continued efforts to push enrollment in health plans through the ACA, Organizing for Action – an organization that was recently launched to help the White House advance political and policy objectives – launched a website dedicated to “Action August.” The team is planning call pledges, petition drives, advocacy events and other means to put pressure in home districts. House Republican leaders are also encouraging members to hold anti-Obamacare events during August.

IN THE COURTS

On July 26, the U.S. Court of Appeals for the 3rd Circuit ruled against a challenge to the ACA contraception mandate made by owners of a private company, Conestoga Wood Specialties, who wished to not comply because the requirement conflicts with their religious beliefs. Though religious organizations are exempt from having to provide insurance that covers contraception, in this case, the court ruled that the owners’ religious opposition does not exempt Conestoga. Because this case was decided opposite from a recent Denver appellate court ruling, it may be a case that makes its way to the Supreme Court.

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

Infrastructure Alert - August 6, 2013

On Friday, both the House and Senate began their summer recess and will not return until Monday, September 9. After returning from the recess, Congress will have several pressing infrastructure issues to consider. Both the House and the Senate have stalled their respective FY2014 appropriations bills for the Departments of Transportation and Urban and Housing Development (THUD). Neither or both bills may pass, but with $10 billion separating the two, FY2014 appropriations may fall to a continuing resolution. Additionally, the House Transportation and Infrastructure Committee will release its water resources bill once Congress returns from recess. The House will consider its own bill, the Water Resources Reform and Development Act (WRRDA), in lieu of amending the Senate-passed, $12 billion S. 601, the Water Resources Development Act of 2013 (WRDA).

On July 25, President Obama delivered a speech at the Port of Jacksonville touting his “We Can’t Wait” initiative that has allowed for streamlining federal ports projects. Much like his previous speech at the Port of Miami, however, he did not include any funding specifics for his $50 billion infrastructure plan.

ON THE HILL

The House water resources bill, WRRDA, to be released after the recess, will likely be the subject of a markup in September, and as Congress is only in session nine days in September, will probably not be voted on until October. The bill is similar to its Senate counterpart in that it has been prepared in a bipartisan fashion and is expected to pass the Committee with relative ease.

Both the Senate and House THUD appropriations bills have encountered major issues. On July 31, Speaker of the House John Boehner (R-Ohio) pulled the House THUD appropriations bill from the floor only a few hours before amendments were to be voted on. Although Speaker Boehner insists that he had enough votes to pass the measure and instead pulled the bill over the deluge of amendments, this development signals a likely negative outcome for the bill. The House may not reconsider the THUD appropriations bill, and funding for the Department of Transportation and the Department of Housing and Urban Development may be headed for a continuing resolution. While Democratic opposition was united in castigating the bill for its lack of funding, the opposition that existed among Republican members varied between those who thought the bill cut too much funding and those who thought it cut too little.

Following the collapse of the House bill consideration prior to the recess, the Senate bill failed on a procedural vote. Every Senator in the Democratic caucus voted for cloture, and every Republican Senator but Sen. Susan Collins (R-Maine), who co-authored the bill, voted against cloture. Although Sens. Jerry Moran (R-Kan.), John Hoeven (R-N.D.), Mark Kirk (R-Ill.), Lisa Murkowksi (R-Alaska), and Thad Cochran (R-Miss.) passed the bill in a committee vote in July as well, only Sen. Collins voted to end debate on it. Significant Republican opposition to the bill stems from the fact that the bill disregards the spending caps in the Budget Control Act.

Prior to the failure of the procedural vote, the Senate considered several amendments. On July 25, the Senate tabled a motion by Sen. Pat Toomey (R-Pa.) to align the spending in the bill with the Budget Control Act spending caps, reducing the total from $54.0 billion to $45.5 billion, on a vote of 56-42. Several amendments passed by unanimous consent: an amendment from Sen. John McCain (R-Ariz.) to prohibit the Department of Transportation from obligating or expending funds on cybersecurity without detailing to Congress how such funds would be used, an amendment from Sen. Mark Udall (D-Colo.) to require the Federal Railroad Administration to evaluate regulations that govern the use of locomotive horns at highway-rail grade crossings, and an amendment by Sen. Coburn requiring agencies to post reports online that they submit to congressional committees unless such reports compromise national security or contain proprietary information. The only amendment that involved lengthy debate was an amendment from Sen. Rand Paul (R-Ky.) that would have redirected $1.5 billion in foreign aid to Egypt to funding for deficient U.S. bridges. His amendment was defeated by a vote of 86-13.

Before the end of the summer session, the House unanimously passed the Helping Heroes Fly Act, H.R.1344, with the unanimous Senate-passed modifications from the day before. The bill will expedite the airport security screening process for wounded and severally disabled veterans and service members. The bill now awaits the President’s signature.

The Senate re-confirmed Thomas Carper to a five-year term to the Amtrak Board of Directors.

Sen. John Thune (R-S.D.), Ranking Member of the Senate Committee on Commerce, Science, and Transportation, has introduced S. 1462, a bill to extend the positive train control system implementation deadline by five years and would allow the Federal Railroad Administration to grant additional delays of two years. Sens. Roy Blunt (R-Mo.), Claire McCaskill (D-Mo.), and Mark Pryor (D-Ark.) are cosponsoring the bill.

On August 1, Sen. Kirsten Gillibrand (D-N.Y.) and Rep. Jerry Nadler (D-N.Y.) introduced H.R. 2958/S. 1435, the Clean Ports Act of 2013. The bill would update federal law to ensure that ports can implement pollution-reducing programs such as clean truck programs in light of a recent challenge in federal court.

Rep. Rick Larsen (D-Wash.) has introduced H.R. 2944, the Transportation Investment Generating Economic Recovery for Cities Under-funded Because of Size (TIGER CUBS) Act of 2013. The bill would reauthorize the TIGER grant program and allocate 20 percent of TIGER funding for smaller cities with populations between 10,000 and 50,000.

Rep. Nick Rahall (D-W.V.), Ranking Member of the House Transportation and Infrastructure Committee, now has a challenger in his re-election race. State Sen. Evan Jenkins has switched from the Democratic party to the Republican party to challenge Rep. Rahall in the general election instead of the primary. As noted in the last Infrastructure Alert, Transportation and Infrastructure Committee Chairman Bill Shuster (R-Pa.) has two primary challengers.

Del. Eleanor Holmes Norton (D-D.C.) has been elected the Ranking Member of the Transportation and Infrastructure Subcommittee on Highways and Transit, replacing Rep. Peter DeFazio (D-Ore.).

In an op-ed published July 30, Rep. Duncan Hunter (R-Calif.), the Chairman of the Transportation and Infrastructure Subcommittee on Coast Guard and Maritime Transportation, defended the Jones Act as a “faithful defender of U.S. maritime capability” and “essential to America’s security and economic future.”

AT THE AGENCIES

National Transportation Safety Board Chairwoman Deborah Hersman has been re-nominated to another two-year term. She and fellow board member Christopher Hart were re-nominated to the board through 2018 and 2017 respectively.

Sylvia Garcia will be nominated for Department of Transportation Chief Financial Officer and Assistant Secretary for Budget and Programs. She is currently the Acting Assistant Secretary for Budget and Programs and has served as Acting Chief Financial Officer since December 2012.

As required by the Passenger Rail Investment and Improvement Act of 2008 (PRIIA), the Inspector General of the Department of Transportation released its Annual Report on Amtrak’s Budget and 5-Year Financial Plan. The Inspector General’s report found that Amtrak’s plan “lacks some required information, most notably regarding the company’s continued financial stability and several other performance metrics intended to ensure the railroad is improving its operating efficiency” and “ omits several important PRIIA-required metrics — such as debt service costs and equipment reliability statistics — that would demonstrate the extent of the railroad’s operating efficiency improvements.”

The Government Accountability office has released several notable reports of late: a report titled “National Transportation Safety Board: Management and Operational Improvements Found, but Strategy Needed to Utilize Cost Accounting System,” a report titled “Federal Vehicle Fleets: Adopting Leading Practices Could Improve Management,” and a report titled “Intermodal Transportation: A Variety of Factors Influence Airport-Intercity Passenger Rail Connectivity.”

IN THE STATES

California: Governor Jerry Brown has intervened to prevent the Bay Area Rapid Transit (BART) workers’ strike for at least one week because the strike would “disrupt public transportation services and will endanger the public's health, safety, and welfare.” Gov. Brown has created a three-member board to investigate the delayed strike over the course of the following seven days. In early July, the first BART strike lasted four days and cost the city approximately $73 million in lost productivity. The newly appointed board will provide Gov. Brown with a report on the contract negotiations, and Gov. Brown could impose a 60-day “cooling-off” period on BART and its unions that would further delay the strike. The last time a cooling-off period was invoked was to prevent a BART strike in 2001. The union is seeking higher raises than BART is offering and objects to a BART proposal for workers to pay into their pensions and fund some of their health costs, likening the proposed changes to a de facto pay cut.

Maryland: Governor Martin O’Malley announced yesterday that the estimated $2.15 billion Purple Line will be constructed and operated through a public-private partnership with a single firm. The Purple Line will be a 16-mile light rail line with 21 stations from Bethesda to New Carrolton, and while it would run independently from the WMATA Metro system, it would connect with the Metro’s Red, Orange and Green lines.

New York: Governor Andrew Cuomo has expanded open.ny.gov to include public access to over 100 transportation datasets, maps and charts from the Metropolitan Transportation Authority, Port Authority of New York and New Jersey, NYS Department of Motor Vehicles, NYS Department of Transportation, NYS Thruway Authority, Capital District Transit Authority, and the NYS Bridge Authority. The open.ny.gov initiative functions to increase government transparency and allow researchers and activists government data to aid in their efforts to foster innovation and efficiency.

Texas: Governor Rick Perry has now called a third special legislative session as Texas lawmakers try to pass a transportation bill. While the House and Senate have both agreed that about half of the oil and gas severance taxes should be directed to the state highway fund instead of the Rainy Day Fund, there has been disagreement as to whether or not a floor should be set to prevent the account from falling below a set balance. The bill would approve a referendum for a constitutional amendment that is estimated to fund about $840 million annually for transportation funding.

Virginia: The Department of Rail and Public Transportation has released its draft 2013 Virginia Statewide Rail Plan.

Health Care Reform Implementation Update - July 30, 2013

Some Republicans are threatening not to pass any debt ceiling deal that does not defund the Affordable Care Act and Democrats say they will not pass any deal that does; the full House Energy and Commerce Committee is slated to vote on legislation that would repeal the Sustainable Growth Rate (SGR) formula that historically has led to annual decreases in physician payments that Congress ultimately corrects, however offsets from other areas, particularly from healthcare, are still needed to pass the bill off the House floor; and the Obama administration is meeting with groups throughout the country including many celebrities to promote the Affordable Care Act (ACA).

ON THE HILL

The Affordable Care Act is becoming the center of a debate that threatens to shut the federal government down this fall. Some Senate and House Republicans are proposing to block any continuing resolutions that would keep the federal government running if they do not defund Obamacare. More than 60 House Republicans have signed on to a letter being circulated by Rep. Mark Meadows (R-N.C.) urging House Republican leadership to defund implementation and enforcement of the ACA.

On July 22, a group of congressional Republicans, led by the Senate Health, Education, Labor and Pensions Committee ranking member Lamar Alexander (R-Tenn.) and House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) along with Sens. Mike Enzi (R-Wyo.), Johnny Isakson (R-Ga.) and Richard Burr (R-N.C.), and Reps. Tim Murphy (R-Pa.) and Joe Pitts (R-Pa.) wrote to HHS Secretary Sebelius requesting disclosure of potential exchange insurance rates in 34 states.

On July 23, two House Education and the Workforce subcommittees (the Subcommittee on Health, Employment, Labor, and Pensions and the Subcommittee on Workforce Protections) held a joint hearing on potential fallout from the Obama administration’s decision to delay the ACA’s employer mandate. The hearing is archived here.