June 5, 2015



In This Issue
Leading the Way
King Case: A Hearing, a Proposal and a Bill
Up, Up They Go! Where They’ll Wind Up Nobody Knows!
New Rule on ACOs
Hit Parade
HUPAC Roundup
What We’re Reading
E-mail the Editor
Visit the NAHU Website
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Leading the Way

A major milestone achievement for NAHU’s lobbying efforts was reached this week when the House Ways and Means Committee passed H.R. 2581 during its Tuesday markup of Medicare legislation. This bill is a compilation of several Medicare-related measures and includes two key NAHU priorities. The first is language to restore Medicare’s open enrollment period (OEP), which was spearheaded by Representatives Keith Rothfus (R-PA) and Kurt Schrader (D-CO) and represents an idea first proposed by NAHU almost five years ago when the health reform law eliminated the OEP for seniors. The Ways and Means passed H.R. 2581 also includes language from a recently dropped bill by Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR) that covers a more recent NAHU priority—encouraging the use of value-based insurance design (VBID) as a cost containment measure in Medicare Advantage (MA) plans. Finally the bill includes biologics in the definition of infusion drugs, which will pay for the cost of the bill’s other provisions.

Before the PPACA was signed into law, Medicare enrollees had the benefit of an annual OEP following their annual election period (AEP). This OEP gave seniors enrolled in MA plans the ability to make a one-time switch to another MA plan or original Medicare if they realized their plan benefits did not meet their needs in their first 90 days of coverage. Unfortunately, the PPACA removed the OEP and replaced it with a more limited option to simply switch to original Medicare. Many seniors currently miss their old consumer protection when they find out too late that the plan they choose during the AEP no longer meets their needs, possibly due to a change in health status with the development of a new condition or due to network issues for managing their care. NAHU members have been working to restore the OEP since the protection was taken from senior clients and we are thrilled the measure to do it is finally moving forward in Congress.

The bill also included language to establish a VBID demonstration project in MA for beneficiaries with chronic clinical conditions. This would help encourage individuals to treat their conditions on a proactive basis with low-cost care management, such as improving access to insulin for diabetics or beta blockers for those with heart disease. They would have lower copayments or coinsurance to use specific evidence-based care approaches; however it would prohibit plans from increasing copayments or coinsurance to discourage services. The hope behind VBID is that by encouraging patients to take the small, low-cost steps to manage their chronic conditions, it should help stave off the need for much more expensive or catastrophic care by not following their care management. The demonstration project requires an independent review, upon which if it has lowered costs and improved quality it could be expanded throughout all MA plans.

The Medicare OEP and VBID bill was not the only one considered during the markup hearing on Tuesday. The full agenda included nine other items, such as the repeal of the controversial Medicare Independent Payment Advisory Board (IPAB), the oft-maligned medical device tax and five other MA bills. The repeal of IPAB was passed with a bipartisan 31-8 vote, while the medical device tax repeal was passed by a vote of 25-14, with Representative Ron Kline of Wisconsin being the lone Democrat in support. While many Democrats elsewhere in the chamber have called for repealing the tax, the Party has not supported the repeal without coming up with a budgetary offset for the $24.4 billion that the provision is expected to bring in over 10 years to help pay for the cost of the PPACA. Movement of these bills signals that the House is moving forward with smaller fixes to the law, which they have been hesitant to do under previous Congresses, opting instead for full repeal measures.

The bills that were passed this week will next head to the full House floor. House Majority Leader Kevin McCarthy is shooting for this round of legislation to be considered before the Supreme Court releases its decision in the King v. Burwell case challenging federal marketplace subsidies. The earliest that they could be considered is the week of June 15. We will keep your posted on the status of these bills, but in the meantime, we encourage you to send an Operation Shout to your member of Congress asking them to support H.R. 2581 when it is considered on the House floor.

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