Jul 24, 2017
We've paid a lot of attention this year to the bill that would“Repeal and Replace” the Affordable Care Act but that is not theonly bill related to health care that is moving through Congress.In this episode, learn about the other health care bills that havemade it just as far as the Repeal and Replace bill, including onethat is already law. Also in this episode, we laugh at the Senatefor inventing holidays and doing so in the dumbest waypossible.
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Bills Outline
Laws
H.J. Res.430: Providing for congressional disapproval under chapter 8 oftitle 5, United States Code, of the final rule submitted bySecretary of Health and Human Services relating to compliance withtitle X requirements by project recipients in selectingsubrecipients.
- Overturns a rule finalized by the Obama Administration that would haveprevented States from cutting off Federal funds for"family-planning services".
Bills In Progress
H.R.372: Competitive Health Insurance Reform Act of 2017
- Repeals an antitrust exemption that currently applies to healthand dental insurance
- Allows antitrust exemptions for life insurance, and property orcasualty insurance
H.R. 1101:Small Business Health Fairness Act of 2017
- Orders the Executive Branch to use regulations to create aprocedure for certifying Association Health Plans (AHPs), which arenot regulated like the state small group health insurancemarkets.
- Association Health Plans and the insurance companies thatprovide coverage will select the services included and their decisions areexempt from State laws.
- Creates a fund that will pay insurers to continue coverage ifthe plans disappears.
- The fund can be raided by the Executive Branch to pay for other things"whenever the Secretary determines that the moneys of the fund arein excess of current needs."
- A working group would be created to write the regulations.
- The applications for plans will include the States in which the plan intends to dobusiness.
- If the association plan becomes insolvent, the government will become the trustee and can try to fix the plan,cancel the plan entirely, and can invest the plans assets.
- Would become effective one year after being signed into law and enactment regulationswould be created by the Secretary of Labor.
H.R. 1215:Protecting Access to Care Act of 2017
- Enacts a statue of limitations on filing health care lawsuits whichwould be one year after the injury is discovered but never morethan three years after the malpractice occurred
- The states can make the statue of limitations shorter
- Limits non-economic damages (such as pain, suffering, physicalimpairment, disfigurement, and mental anguish) to $250,000,"regardless of the number of parties against whom the action isbrought or the number of separate claims or actions brought withrespect to the same injury."
- Actual economic losses (such as medical expenses, past andfuture earnings losses, and loss of employment) in health carelawsuits will remain unlimited.
- Each guilty party in a health care lawsuit will only be held liable for the percentage of the damages indirect proportion to that party's percentage ofresponsibility.
- Doctors who prescribe a medicine that has been approved by theFDA can't be sued along with manufacturers, distributors, orsellers in product liability lawsuits
- Any statements or conduct expressing "fault" (along withapology, sympathy, etc.) made by a health care provider in regardsto an unexpected medical outcome "shall be inadmissible" for any purpose as evidence of anadmission of liability.
- The statute of limitations would be effective immediately upon enactment and the limits on damageswill be for all lawsuits started after the law is signed.
Additional Reading
- Document: H.R. 1628 Obamacare Repeal Reconciliation Act of 2017 CostEstimate, Congressional Budget Office, July 19, 2017.
- Article: The Washington Post's New Social Media Policy Forbids DisparagingAdvertisers by Andrew Beaujon, Washingtonian, June 27,2017.
- Document: H.R. 1628 Better Care Reconciliation Act of 2017 Cost Estimate,Congressional Budget Office, June 26, 2017.
- Document: H.R. 1628 American Health Care Act of 2017 Cost Estimate,Congressional Budget Office, May 24, 2017.
- Article: Examining The Final Market Stabilization Rule: What's There, What'sNot, And How Might It Work? by Timothy Jost, Health AffairsBlog, April 14, 2017.
- Document: Guidance to States on Review of Qualified Health Plan CertificationStandards in Federally-facilitated Marketplaces for Plan Years 2018and Later, Centers for Medicare & Medicaid Services, April 13,2017.
- Article: Treasury Inspector General Assesses ACA-Related Tax Issues byTimothy Jost, Health Affairs Blog, April 11, 2017.
- Document: Compliance With Title X Requirements by Project Recipients inSelecting Subrecipients by Department of Health and HumanServices, Federal Register, Vol. 81, No. 243, December 19,2016.
- Article: Is the ACA the GOP health care plan from 1993? by JonGreenberg, Politifact, November 15, 2013.
References
- American Civil Liberties Union: Public Fundingfor Abortion
- GovTrack: Health Bills Tracker
- Cornell Law School: 15 U.S. Code §1013
- Kevin McCarthy Majority Leader website: Health Care Phase 3: The Small Business Health FairnessAct
- ConsumersUnion: Letter to the House Opposing the Small Business Health FairnessAct
- OpenSecrets: Clientslobbying on H.R. 1215
- American Medical Association: Support for House-Passed Bill on Medical Liability
- Google: UnitedHealth Group Stock
- US Senate Financial Disclosure: JamesInhofe Stock Purchases
- American Health Insurance Plans: Letter to President Trump
- Dept of Health and Human Services: Letter to Governor regarding Medicaid
- Medicaid: About Section 1115 Demonstrations
- Washington Post: About WPBrandstudio
Videos
Sound Clip Sources
Hearing: Rules Committee Hearing, House of Representatives Committee onRules, February 14, 2017.
Timestamps & Transcripts
- 6:40 Rep. Jim McGovern (MA): I’llmake the point I continue to make about the process. Both of theserules, or protections, went through a long process, and whether youagree with them or not, there was a process. Here we are; thecommittees with jurisdiction did no hearings on this, havebasically—there’ll be no opportunity for review. We know what theoutcome is going to be: two more closed rules. So it’s kind of thiswhole hearing is kind of pointless because, again, the process isgoing to be the most restrictive that it can be.
- 9:40 Rep. Tim Walberg (MI): As youknow, Title X is the only domestic federal program that providesgrants for family-planning services. Grants go directly to statesand non-governmental organizations, which then distribute moneyamong healthcare providers. Over half of the grantees are state andlocal governmental agencies, which serve as intermediaries todistribute funding to subgrantees. Prior to this rule, states werefree to direct their Title X funds to healthcare providers that didnot participate in abortion. When states had this freedom, theywere able to choose to invest in women’s health care instead ofabortion. The new rule blocks states from restricting grants topotential recipients for reasons other than the ability to provideTitle X services. Under this rule, states are prevented fromestablishing criteria that would eliminate abortion providers fromreceiving Title X grant money.
Hearing: H.R. 372, the "Competitive Health Insurance Reform Act of2017", House of Representatives Judiciary Committee, February16, 2017.
Timestamps & Transcripts
- 10:15 Rep. John Conyers (MI): I ampleased that the subcommittee’s first hearing of this new Congressis on H.R. 372, the Competitive Health Insurance Reform Act of2017, which repeals the antitrust exemption in theMcCarran-Ferguson Act for the health insurance business. For manyyears I’ve advocated for such a repeal, so I’m heartened to see thebipartisan nature of the support for this position.
- 11:50 Rep. John Conyers (MI):Congress passed McCarran-Ferguson Act in response to a 1944 SupremeCourt decision, finding that antitrust laws applied to the businessof insurance, like everything else. Both insurance companies andthe states expressed concern about that decision. Insurancecompanies worried that it would jeopardize certain collectivepractices like joint-rate setting and a pooling of historical data,and the states were concerned about losing their authority toregulate and tax the business of insurance. To address theseconcerns, McCarran-Ferguson provided the federal antitrust lawsapply to the business of insurance only to the extent that it isnot regulated by state law, which has resulted in a broad antitrustexemption. Industry and state revenue concerns, rather than the keygoals of protecting competition and consumers, were the primarydrivers of the Act. In passing McCarran-Ferguson, Congress,however, initially intended to provide only a temporary exemptionand, unfortunately, gave little to consideration to ensuringcompetition.
- 26:15 Rep. Austin Scott (GA): Bedefinition, health care and health insurance are not the samething. But when one insurance company controls such significantportions of the cash flow of all of the providers in a region, noprovider can stay in business without a contract with that carrier.Therefore, the insurance company gets to determine who is and whois not able to provide health care: sign a contract with acompeting carrier, and we’ll cancel your contract. Accept the lowerreimbursement, or we’ll cancel your contract. It’s closer toextortion than negotiation.
Hearing: LegislativeProposals to Improve Health Care Coverage, House Committee on Education and Workforce, March 1, 2017.
Witnesses
- Allison Klausner: American Benefits Council, which representsFortune 500 companies
- Lydia Mitts: Associate Director of Affordability at FamiliesUSA, a consumer advocate org.
- Jay Ritchie: Executive VP of Toko Marine HCC-Stop Loss Group &Chairman of the Self-Insurance Institute of America
- Jon Hurst: President of the Retailers Association ofMassachusetts
Timestamps & Transcripts
- 25:50 Rep. Virginia Foxx (NC):Ultimately, they are fighting to maintain governmentcontrol—government control over the kind of health insurance youcan buy, government control over the kind of health insuranceemployers can and cannot offer workers, government control over thedoctors you can see and the doctors you can’t see, and governmentcontrol over certain healthcare benefits that many individuals maynot need. Yet despite the cost and pain inflicted on so manyAmericans by Obamacare, the answer for some is still moregovernment control.
- 47:35 Lydia Mitts: The second bill Iwould like to speak to is the Small Business Health Fairness Act.This bill would exempt association health plans from adhering tocritical state and federal requirements for small-group coverage.These requirements have benefited small employers and their workersalike. They include protections that prevent plans from chargingsmall employers exorbitantly higher premiums because theiremployees have poor health, are older, or are disproportionatelywomen. They also include requirements that plans covercomprehensive benefits that meet the needs of a diverse workforce.By allowing association health plans to ignore these keyprotections, this bill would increase premiums and threaten stableaccess to comprehensive coverage for many small employers and theirworkers. Employers with a young workforce that is in pristinehealth may be able to get lower premiums. However, the rest ofsmall businesses would see coverage become less affordable, whetherthey sought it through an association or the existing small-groupmarket. On top of this, employees move to association plans wouldbe at risk of facing skimpier coverage that doesn’t cover the carethey need.
- 1:41:20 Rep. Suzanne Bonamici (OR):Ms. Mitts, the ACA included, as we know, unprecedented new consumerprotections for patients, such as eliminating annual and lifetimelimits, preventing insurers from dropping people when they getsick, charging women higher premiums. What will happen to theseprotections in association health plans? LydiaMitts: Under the bill put forth to you today, thoseassociation health plans would no longer have to comply with somany of those rating protections that have been a huge benefit tomany small businesses that prior before the Affordable Care Actactually had a really hard time finding affordable coverage fortheir employees because they employed employees who actually hadhealthcare needs, who were maybe older, and the market didn’t workfor them before. And so we would move back to a situation wherewe’d have a segmented market, and people who are healthy, inpristine health, could move into an association health plan. Ithink the thing that’s important to keep in mind is that thatdoesn’t mean that association health plan would always be there andwork for that small employer. If their workforce got older, claimswent up, they might find that that association health plan chargesthem more, and it’s not a viable option for them anymore.Bonamici: Can you address—I know there’ve beensome solvency concerns about some of the association health plans.Can you address that concern as well? Mitts: Yeah,there’s historically been concerns about association health plansnot having adequate solvency funds. They have leaner, less rigidrequirements than typical health insurance coverage. Partiallystate oversight was added to that to help address some of theseproblems, bigger problems, where they were just under ERISA. Andwhen an association plan goes insolvent, their employers and theirworkers are still left with all of those unpaid medical claims andthen on the hook for them. And if the plans are not under statejurisdiction, they won’t be able to benefit from state guarantyfunds that help pay those claims, so they’ll be left on the hookfor them.
Hearing: H.R.1215 Hearing-Part 1, House Committee on the Judiciary, February28, 2017.
Timestamps & Transcripts
- 44:20 Rep. Steve King (IA): One ofthe drivers of higher healthcare spending is defensive medicine.It’s a very real phenomenon confirmed by countless studies in whichhealthcare workers conduct many additional costly tests andprocedures with no medical value that are charged to the federaltaxpayers and to other consumers simply to avoid excessivelitigation costs.
- 45:25 Rep. Steve King (IA): Theyinclude the following: a bedside sonogram with an “officialsonogram” because it’s easier to defend yourself to a jury ifyou’ve ordered the second sonogram; a CT scan for every child whobumped his head, or her head, to rule out things that can bediagnosed just fine by observation; x-rays that do not guidetreatment such as for a simple broken arm; or CT scans forsuspected appendicitis that has been perfectly well diagnosedwithout it. In fact, I have an orthopedic surgeon who has said tome that when he has a knee injury, 97% of the tests that he ordersare protection from malpractice. He knows what he’s going tooperate on before he actually starts the surgery.
- 51:55 Steve Cohen: And if we want tomake health care cheaper, which we should, and make it moreaffordable, we ought to have a single-payer system. That would makeit more affordable. And if that’s the nexus that makes this lawapplicable for the federal government to usurp the states, and theChairman said that the nexus was that it makes things cheaper andanything makes health care cheaper is so important that we need totake it away from the states, well, if you’re concerned about cost,you should be for a single-payer system, and that would make itcheaper and take profits away from insurance companies that rightnow are paying for ads to get people to buy drugs and makingimmense profits and having their executives draw salaries in theareas of 40 and 50 million dollars. This bill takes away frompeople who are hurt by medical malpractice in ways that areartificial and wrong, and we should not be on the side of thosepeople who commit medical malpractice and cause injuries to others.With all of that said, I respectfully suggest that the agenda we’refollowing is not the agenda of the American people at the presenttime, and it’s the agenda of the American Medical Association,who’s here today, and this is the bill du jour.
Hearing: Tom Price, HHS Fiscal Year 2018 Budget Request, Senate FinanceCommittee, June 8, 2017.
Timestamps & Transcripts
- 44:37 Sen. Tom Carper (DE): And Ilike those ideas. I studied a little bit of economics at Ohio Stateas navy ROTC midshipman. I like market forces. I like trying toharness market forces and make them work. You came up with a goodidea in 1993, and I just wish to heck that you would work with usto try to make sure that those good ideas have a chance of working.And the reason why the marketplaces are failing in places, like youmentioned Ohio in your statement, Mr. Chairman, the reason whythey’re not working, we’ve basically undermined the individualmandate so that people will know if they really have to getcoverage. Young people aren’t. We’ve taken off the training wheels,so to stabilize the marketplaces and insurance companies. They losttheir shirts in 2014 because of it. They lost less money in 2015.Got better. They raised their premiums, they raised their copays,they raised their deductibles, and they did better in it. And tellsthat rather than the marketplaces being a death spiral at the endof 2016, they’re actually recovering, until a new administrationcame in and said, well, we’re not sure if we’re going to enforcethe individual mandate, and, by the way, we don’t know for surewhether they’re going to extend the cost-sharing arrangements. Thatprovides unpredictable lack of certainty for the insurancecompanies. What do they do? They say, we’re going to raise ourpremiums more. What you’re destabilizing, the very idea that theseguys came up with 24 years ago. Sen. Orrin Hatch(UT): Well, if I could just interrupt for a second. Thosewere ideas that were against—it was part of the anti-Hillary carebill, and it— Carper: They were good ideas.Tom Price: Well— Carper: And Icommend you for them. If my life depended on telling what Hillarycare did, I couldn’t tell you. But I know what your bill did, and,frankly, there were good ideas, and now we’re underminingundercutting them. Why? Dr. Price, why? Price:Senator, I appreciate the observation. I would add to that thatthere are significant challenges out there, and there were sobefore this administration started. In your state alone, premiumswere up 108% before this administration started. In your statealone, there were fewer insurance companies offering coverage onthe exchange before this administration started. So what we’retrying to do is to address especially that individual andsmall-group market that is seeing significant increases inpremiums, increases in deduct— Carper: What areyou doing? What are you doing to doing? How are you stabilizing themarketplaces? Price: Well, we—Carper: Just give us some ideas. The three Rs.What are you doing on those? Reinsurance, risk adjustment, riskcorridors. What are you doing there? Price: Wepassed it—or we put in place a market-stabilization rule earlierthis year that identified the special enrollment periods and thegrace periods to make certain that they were more workable for bothindividuals and for insurance companies. We allowed the statesgreater flexibility in determining what a qualified health planwas, to try to provide greater stability for the market. We put outword to all governors across this nation on both 1115 and 1332waivers and suggestions regarding what they can do to allow forgreater market stabilization in their states, and we look forwardto working with you and other senators to try to make certain thatall those individuals, not just in the individual and small-groupmarket but every single American has the opportunity to gain accessto the kind of coverage that works for them and theirfamilies.
Sen. Mazie Hirono designated February 3rd as "National Wear RedDay." This is what she wore.
Music Presented in This Episode
- Intro & Exit: Tired of Being Lied To by David Ippolito (found onMusic Alley by mevio)
Cover Art
Design by OnlyChild Imaginations