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By Alex Ruoff
Sept. 16 — The House Energy and Commerce Committee's health agenda for 2017 will largely be shaped by the results of the November election, committee members told Bloomberg BNA recently.
House Republicans remain dedicated to repealing and replacing the Affordable Care Act, although that would be likely only if Donald Trump wins the presidential election and Republicans retain control of the House and Senate.
If Democrats retain the White House or gain control of the Senate, Republicans will have hard choices to make about their approach to health reform, outlined in the party's official Better Way platform.
“Can you push a Better Way agenda in the midst of a Democrat president who will likely be wedded to the health care law? … we don't know,” Rep. John Shimkus (R-Ill.) told Bloomberg BNA.
Some House Republicans want to keep a few key provisions of the ACA.
Regardless of the November election, current House Energy and Commerce Committee members want to see the 21st Century Cures Act—an effort to spur development and approvals of new drugs and devices—become law, remove Medicare's restrictions on telehealth reimbursement, address rising health insurance premiums and continue efforts to reform the nation's mental health-care system.
The committee will also be responsible for overseeing authorization of drug industry user fees in 2017 and funding the Children's Health Insurance Program (CHIP) into 2018. The user fees are paid by industry to help fund Food and Drug Administration operations, along with congressional appropriations.
Energy and Commerce will have new leadership in 2017 as current chairman Fred Upton (R-Mich.) has reached his six-year term limit. Upton, as a member of the Republican Steering Committee, will help choose his successor but told Bloomberg BNA he hasn't decided who he'll support for the role.
“I don't know if anyone's got the votes wrapped up,” Upton said.
Shimkus said he's hoping to take over as chairman. Reps. Joe Barton (R-Texas) and Greg Walden (R-Ore.), as well as Shimkus, are considered likely frontrunners for the position.
The House Energy and Commerce Health Subcommittee will also have a new chairman because Rep. Joe Pitts (R-Pa.) is retiring. The full committee chairman selects subcommittee chairs.
Republican leadership remains dedicated to a full repeal and replacement to the six-year-old ACA, also known as Obamacare, regardless of the November elections.
“No amount of tinkering around this law is going to fix it,” House Speaker Paul Ryan (R-Wisc.) said during his weekly press conference Sept. 9. “This is why we as Republicans have come forward to offer a better way around health care.”
While repeal has long been a mantra of the Republican party, Pitts told Bloomberg BNA that the Republican replacement plan will seek to keep intact some key provisions of the ACA, such as a requirement that insurance companies cover people with pre-existing health conditions and to allow young adults to remain on their parent's insurance plan.
However, Republicans also want to inject the insurance market with competition-oriented and free market changes, such as allowing insurance companies to compete across state lines and cross-state pooling of risk by insurers, he said. These changes could bring down the cost of insurance premiums, Pitts said.
Conservatives will also look at legislation to expand contribution limits for health savings accounts, allowing Americans to use more of their income to pay for health services tax-free, Pitts said.
Outside of ACA reforms, committee members are looking to expand Medicare reimbursement for telehealth services.
Both Republicans and Democrats have supported the change, seeing it as a way to extend health services to areas without ready access to certain medical specialties, Rep. Gregg Harper (R-Miss.) told Bloomberg BNA.
Harper in February introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 4442), which would create a program that would waive for participating providers Medicare's requirement that telehealth services occur at a qualified site and other restrictions. The House version now has 32 cosponsors, and 21 of them Democrats.
A major task for lawmakers in 2017 will be overseeing the implementing of the Medicare doctor payment system created under the Medicare Access and CHIP Reauthorization Act (MACRA), a 2015 law.
Clinicians have expressed concerns in comment letters and hearings that the quality reporting under the new system, called the Merit-Based Incentive Payment System (MIPS), is too complicated. They have also said there are limited opportunities to join alternative payment models that would offer them a chance to receive extra funds.
In response, members of the House Ways and Means and Energy and Commerce committees sent a Sept. 6 letter to the Department of Health and Human Services, asking the agency to have “appropriate systems ready and in place” for reporting to begin by January 2017. Performance in 2017 will be used to grade and pay doctors in 2019, the first year of MACRA implementation.
On Sept. 8, the federal government said it would offer flexibility to doctors and other clinicians to participate in the new Medicare quality-based payment system reporting requirements (175 HCDR, 9/9/16).
Lawmakers will be paying close attention to how the Centers for Medicare & Medicaid Services collects quality data from doctors in 2017 and how the agency responds to doctors' concerns, Rep. Michael Burgess (R-Texas) told Bloomberg BNA.
“It's our job to make sure this gets done correctly,” Burgess said.
House Energy and Commerce Democrats will push for the committee to consider legislation to require insurers to explain why they’re denying claims for mental health services.
Insurance companies are denying claims for mental health care at twice the rate of general medical care, raising concerns that current mental health parity laws aren’t working, Rep. Joseph Kennedy III (D-Mass.) said during a recent committee hearing.
Rep. Frank Pallone Jr. (D-N.J.), ranking member of the Energy and Commerce Committee, and Upton both told Bloomberg BNA they'll support more hearings in 2017 on mental health parity legislation.
Pallone also said Democrats will want the committee to explore how to encourage more states to expand their Medicaid programs, a move most Republicans oppose. He said Medicaid expansion would extend insurance coverage to more Americans. Such expansion was included in the ACA but made optional by the U.S. Supreme Court in 2012.
The Republicans' Better Way calls for turning Medicaid into a block-grant program. Under a block-grant system, the federal government would give states annual lump sums for their Medicaid programs. States would have more flexibility to run their Medicaid programs, but they would also be responsible for covering costs beyond the federal grant.
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