Senate Permanent Subcommittee on Investigations Initiates Review into Income Verification Procedures for Tax Credits…
The Senate Permanent Subcommittee on Investigations, led by Chairman Rob Portman (R-OH), is launching an investigation into the Department of Health and Human Services’ (HHS) efforts to “assess eligibility and prevent improper payments” of the ACA’s premium tax credits through the federally facilitated and state-based exchanges. Portman’s letter to Secretary Sylvia Burwell asks a series of 15 questions on subsidy distribution and income verification. The letter highlights various reports from government agencies and the media that have shown how the systems are flawed, potentially harming a number of tax credit recipients and wasting taxpayer dollars.
…As Treasury Inspector General Report Finds IRS Unable to Manage Risk of Improper Tax Credit Payments
The Senate investigation into the premium tax credits coincides with the release of a report by the Treasury Inspector General for Tax Administration (TIGTA) on IRS compliance with annual
improper payment reporting requirements. In this report, the Treasury Department watchdog notes the complexity of the ACA premium tax credit (PTC) process and concludes, “Because the IRS and the Department of Health and Human Services are responsible for the administration of the PTC, improper PTC payments can result from weaknesses in either agency’s programs. As a result, the IRS cannot effectively assess the risk of PTC improper payments, estimate the improper payment rate and dollars, or establish corrective actions to address the causes of and reduce improper PTC payments.”
21st Century Cures Legislation Moving to Full Committee Markup
This week, the House Energy and Commerce Health subcommittee approved the 21st Century Cures bill, sending it to the full committee for markup next week. The latest draft of the bill was released this week and while it fills in a lot of the missing provisions from the previous draft, many details remain to be finalized. The bill now includes a section on interoperability of electronic health records, essentially putting teeth into existing law regarding EHR requirements that begin in 2018. The bill include $10 billion over five years in mandatory funding for the National Institute of Health. Chairman Upton has said that he hopes to find a funding offset to pay for the bill by next week.
Rep. Price Releases ACA Replacement
House Budget Committee Chairman Rep. Tom Price (R-GA) released a proposal for repealing and replacing the Affordable Care Act, an update to his previous proposal, “Empowering Patients First Act.” Among other reforms, the major provisions of his plan include repealing the ACA and providing refundable tax credits to individuals based on age. The bill also provides individuals with a one-time tax credit of $1,000 as a contribution to a health savings account to use for out-of-pocket expenses. Furthermore, it would limit the tax exemption available to those with employer-sponsored coverage and allow individuals to choose between the new tax credit or their current employer coverage.
House Passed a Bill to Ban Abortions after 20 Weeks of Pregnancy
This week, the House passed the Pain Capable Unborn Child Protection Act, voting 242-184-1 to place a federal ban on abortions after the 20th week of pregnancy. This is the same bill that Republicans were not able to bring to a vote in January due to disagreements over certain reporting requirements for rape victims.
California. The state’s exchange, Covered California, has released its proposed budget for fiscal year 2015-2016, with a focus on reducing expenses in order to avoid increasing fees charged to exchange customers. Covered California is proposing to spend $58 million, or 15 percent less, next year. After receiving $1 billion in federal grant money to establish and operate the exchange, under ACA rules the exchange must now fund future operations with non-federal money. The exchange will be funded by a fee assessed on exchange enrollees of $13.95 per member per month, the same amount as last year.
The exchange has also lowered future enrollment projections to less than 1.5 million to better align with the lower-than-anticipated enrollment of 1.4 million this year.
Florida. According to Governor Rick Scott, the House Energy and Commerce Committee will hold a hearing this summer on the controversy between the Obama Administration and Scott regarding the Administration’s connection of the ACA’s Medicaid expansion to continued federal funding for Florida’s Low Income Pool (LIP) program. Florida has filed a lawsuit against the Administration, claiming that connecting the two issues amounts to coercing the state into expanding Medicaid.
Hawaii. Hawaii’s state-based exchange revealed at the end of last year that it was facing a funding shortfall estimated at $28 million through 2022, and thus would not meet ACA requirements to be self-sustaining by January of 2015 without an infusion of state funding. The Hawaii State Legislature rejected a plan that would have allowed the exchange to stay afloat by issuing debt. Hawaii officials submitted a contingency plan to the federal government, at the request of CMS, to begin winding down exchange operations, transferring customers to the federal exchange and shifting some operations to state agencies. The future of the exchange remains uncertain as federal and state officials continue to discuss options.
A study by the Kaiser Family Foundation analyzes national and state-level data on nursing homes’ quality scores based on CMS’s five-star rating system, finding that nearly 40 percent of nursing home residents are staying at homes with one- or two-star ratings.
A report by the General Accountability Office (GAO) analyzes the CMS approval process for new, extended or amended Section 1115 demonstrations (waivers) and finds a lack of clarity both with the criteria used for decision-making and with the intended use of the expenditures.
A letter sent from six bipartisan senators to HHS Secretary Sylvia Mathews Burwell requests a one-year delay in the FDA’s menu-labeling requirements for grocery stores and similar retail food establishments.
A policy brief from Health Affairs and the Robert Wood Johnson Foundation analyzes the implementation and impact of ACA’s temporary Medicaid primary care physician pay increase.
A study by American Action Forum, reports on ACA premium tax credit, economic and federal mandate impacts if the government loses in the King v. Burwell lawsuit now before the Supreme Court.
A report by the Government Accountability Office finds that, “[E]ach fiscal year from 2009 through 2011, the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. In contrast, the least expensive 50 percent of Medicaid-only enrollees accounted for less than eight percent of the expenditures for these enrollees.”
Clarifying guidance from the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury says that under the ACA, insurers must cover without any cost-sharing at least one form of birth control from the 18 FDA-approved methods.