HealthCare Roundtable e-News – October 12, 2021


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Preliminary Agenda


Health Priorities May be Cut As Democrats Continue Negotiation on the Reconciliation Package

West Virginia Sen. Joe Manchin’s (D) $1.5 trillion top-line reconciliation number left lawmakers and advocates scrambling to protect their health care priorities even before the White House and Democratic leaders left meetings last week without a compromise on their reconciliation package. One advocate said Congress needs to be careful not to ratchet back policies to a point they won’t help those they are intended for.

As first reported by Politico, Manchin in late July penned a document, signed by Senate Majority Leader Chuck Schumer (D-NY), saying Manchin would agree to a $1.5 trillion reconciliation package. Manchin recently told reporters he still supported that number. He also stood by his earlier call in the memo for all social programs to be means tested. Manchin’s July memo did not include drug price negotiation — a policy the senator has since said he favors — and that could indicate potential room for maneuvering, a lobbyist said.

As the reconciliation package shrinks, it becomes increasingly difficult for Democrats to fund all their priorities: a Medicaid gap fix, additional Medicare benefits, home- and community-based services and an extension of the enhanced Affordable Care Act tax credits. Each policy’s champions spent the last week making their case for their respective policies.

House Majority Whip Jim Clyburn (D-SC) recently indicated he could go for a temporary five-year Medicaid gap fix. He also argued that limited funds should be targeted to a Medicaid gap fix rather than expanding Medicare benefits because Medicare is not means tested.

Meanwhile, Senate Budget Committee Chair Bernie Sanders (I-VT) last week continued his push for additional Medicare benefits — and did not mention the Medicaid gap fix or ACA tax credit policies pushed by other Democrats. However, Manchin pushed back on adding new Medicare benefits when the trust fund is set to be insolvent in 2026. (InsideHealthPolicy)

Employer Groups Oppose House Mental Health Parity, ACA Affordability Policies

Employers who offer health insurance coverage tell Congress that several provisions in the House’s initial $3.5 trillion draft reconciliation proposal could raise costs for businesses, including a piece that would align the “affordability threshold” for employer coverage with the 8.5 percent contribution limit proposed for the exchange market. Employers also worry about proposed penalties for failing to adhere to requirements under the mental health parity law, and some employers are piqued that the bill language undermines a key tenant of the Affordable Care Act: the firewall between the exchange and employer-sponsored coverage.

The concerns could come into play as Democrats on both sides of Capitol Hill and the White House work to cut back the package to around $2 trillion to get moderates from the party on board and buy-in from the Senate.

In a recent letter to Congress, the American Benefits Council outlined key issues with the House proposal. Topping the list is employers’ much-discussed opposition to any bill that fails to extend benefits of drug prices reforms to the private sectors.

Employers also worry about the proposed change in the determination of affordability for the purposes of the employer mandate. Under current law, employers must offer affordable coverage, defined as costing no more than 9.5 percent of income and indexed every year – or face a penalty. Under the bill, the affordability threshold would be lowered from 9.5 percent of income to 8.5 percent of income and the indexing of that threshold would be removed. This means anyone with an offer exceeding 8.5 percent of income would be able to purchase subsidized coverage through the exchange.

Employers argue that such a change would result in additional costs for employers, which could translate into less generous benefits and more cost-shifting to workers. There are some employers that offer plans that are so generous that the change would make little difference, but those companies are in the minority, says one source. It’s much more likely that employers would lower the value of plans or increase cost-sharing. But sources tell Inside Health Policy that they don’t expect the provision will be removed. This is for two main reasons: Senate Finance Chair Ron Wyden (D-OR) previously expressed support for lowering the affordability threshold; and secondly, the provision is likely to be scored as a cost-saver.

CDC Vaccine Advisers Will Meet to Discuss COVID-19 Vaccine Boosters

The Centers for Disease Control and Prevention announced Friday (Oct. 8) that its vaccine advisory committee will meet in October and November to vote on the use of COVID-19 vaccines for children, and on boosters for individuals who received their primary vaccination with either Moderna’s or Johnson & Johnson’s coronavirus vaccines.

CDC’s Advisory Committee for Immunization Practices’ first meeting, scheduled for Oct. 20-21, will address the risk-benefit profile for Moderna and J&J booster shots. The meeting will take place just a week after FDA’s vaccine advisory committee is set to discuss whether to allow boosters of the companies’ vaccines in adults over the age of 18.

J&J sent data to FDA Tuesday (Oct. 5) supporting an extra dose of its one-shot COVID-19 vaccine but did not suggest a timeline for when an individual should get the booster after having received the initial dose.

Moderna also submitted data to FDA on Sept. 1 laying out the benefit of an additional shot. The company recommended the booster dose be half the amount of the original shot and administered six months after original inoculation.

Pfizer submitted an emergency use authorization application to FDA for the use of its COVID-19 vaccine in children aged 5 to 11 on Thursday (Oct. 7). The company submitted an initial batch of data to FDA on Sept. 28 showing a smaller dosage of its vaccine demonstrates a favorable safety profile and robust neutralizing antibody response in that age group. (InsideHealthPolicy)

Republican Leaders Ask GAO to Probe APTCs for Fraud

As Democrats look to expand the higher Affordable Care Act premium tax credits (PTC) enacted under the American Rescue Plan (ARP), the top Republicans on the Senate and House committees that oversee tax and health policies are asking the Government Accountability Office to review whether states and the federal government are adequately preventing fraud or improper payments.

Senate Finance Committee raking member Mike Crapo (R-ID) and House Ways & Means Ranking Member Kevin Brady (R-TX) note that the federal government spent $53 billion on ACA tax credits in 2019 and the number is set to increase since the ARP boosts the credits and expands them to people earning more than 400% of poverty. House Democrats’ current reconciliation proposal would increase these expenditures by making them permanent.

In their letter to the Comptroller General, Crapo and Brady note that the GAO has reviewed PTC program integrity in the past. Crapo and Brady say that given the various vulnerabilities, they want GAO to determine whether select states and the federal government have set up sufficient controls to prevent improper payments. (InsideHealthPolicy)