Dewonkify – Markup

The Meaning:  A legislative process for considering and making any recommended adjustments to a piece of legislation prior to moving the legislation forward for a committee vote of passage or defeat.

Used in a Sentence: On December 12, 2013, the Senate Finance Committee will markup legislation that aims to provide a permanent fix to the Medicare Sustainable Growth Rate (SGR) formula, and several amendments are expected to the text of the bill.

What It Means:  A markup may be the most critical part of the congressional legislative process, as it provides a true test of whether a bill can ultimately pass the House or Senate.  It is during the markup process where one can truly learn of a legislator’s position (for or against) a bill and what adjustments would be needed to ensure the support of individual committee members.  It is also where most consensus can be achieved for a piece of legislation, as it typically results in a negotiation between political parties.

During a Congressional markup, members of the Committee may ask questions to Committee staff regarding technical provisions of the pending legislation.  In addition, Members of the Committee also may offer amendments to the underlying legislation.  At the conclusion of the markup the Committee will “report out” legislation (assuming passage) and legislation is then ready to be moved to the floor of the respective Congressional chamber.

History: In many cases, when a bill comes before a committee for markup, negotiations have already occurred behind the scenes between members of Congress and interested external organizations, and the chairman of the Committee will introduce a manager’s package (an amended version of the original bill set to be marked up) or a bill in the nature of a substitute for the Committee to consider and “markup.”  When this is the situation, a markup can be brief and primarily offer an opportunity for opening statements for Committee members to be recognized and to explain their position on the legislation.

Initial Health Exchange Enrollment Fails to Meet Projections

Since the state and federal health exchange marketplaces went live on October 1, 2013, approximately 106,185 people have either selected health plans or fully signed up and paid for coverage through these markets.  The first official reporting of these numbers from the Administration comes after weeks of congressional and public frustration and scrutiny over significant problems with the federal enrollment website,  Original goals for enrollment extended into the millions by spring 2014, but in the weeks leading up to today’s announcement, the Administration sought to significantly lower expectations while promising to fix the enrollment website and help people obtain coverage.

The announcement came on the heels of a politically contentious four and a half hour hearing by the House Oversight and Government Reform Committee on challenges with the website.  During the hearing, White House Chief Technology Officer Todd Park testified before the committee and could not commit to the Administration having the website problems fixed by November 30, a promise other top Administration officials have been making since Health and Human Services (HHS) Secretary Kathleen Sebelius testified before Congress last month.

Enrollment levels within the exchanges are significant because low enrollment means that next year’s premiums will be higher, as costs are spread across a much smaller pool of individuals and individuals who have enrolled are more likely to be high utilizers of health care services.  Unless enrollment significantly increases by the March 31st deadline for open enrollment, one of the hallmark issues of the Obama Administration may fail to reach its goal of providing affordable health care to millions of uninsured Americans.

Secretary Sebelius Testifies on ACA Implementation

After weeks of scrutiny, accusations, and calls for resignations by Republicans, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius testified before the House Energy and Commerce Committee today to defend the Affordable Care Act (a.k.a. “Obamacare”) after a month of significant enrollment challenges.  She faced questions on the cost and management decisions associated with the challenged website, the enrollment portal for the federal health care exchanges.  Ironically, the website was down and inaccessible as she gave her testimony.

Sebelius’ testimony follows an October 24, 2013 House Energy and Commerce Committee hearing where federal contractors hired by the Centers for Medicare & Medicaid Services (CMS) and HHS to manage the website and paper enrollment processes pointed the finger at HHS when asked who is responsible for the website’s flaws and challenges.  Today, Sebelius did not point the finger at CMS or HHS staff, stating that she and CMS Administrator Marilyn Tavenner have been responsible for decisions to date.  CMS Administrator Tavenner provided similar testimony before the House Ways and Means Committee yesterday.

Sebelius faced questions on costs expended to date, stating that approximately $118 million has been spent on the website and about $56 million on additional IT to support it.  She offered to get back to the Committee by mid-November 2013 with numbers concerning enrollment in the exchange marketplaces.

While both political parties expressed concern or outrage over the massive exchange website problems to date, Republicans largely defined the problems as an illustration of how flawed Obamacare is overall, while Democrats overwhelmingly characterized the problem as a short-term, fixable glitch.

Some Democratic lawmakers likened the problems to those faced during implementation of the Medicare Part D prescription drug benefit.  However, several on the Committee also sought to distinguish the implementation challenges from those of past programs and mention other problems beyond the website, including data privacy.  The federal data hub meant to link exchange applicant data to determine eligibility for subsidies has become a political target.  Whether personal information is protected and for how long it is stored by the federal government is something of great question, which has resulted in varying answers from the Administration.

The Senate is planning similar hearings next week, with CMS Administrator Tavenner testifying before the Senate Health, Education, Labor, and Pension (HELP) Committee on Tuesday, November 5, 2013, and HHS Secretary Sebelius testifying before the Senate Finance Committee on Wednesday, November 6, 2013.  Additional hearings and scrutiny over the next several months are anticipated in the lead-up to the January 1 enrollment date for the exchange marketplaces.

Government Shutdown Now Over – But What About Sequestration?

The government may be back up and running and funded under a short-term continuing resolution (CR), but the battle is far from over as Congress heads toward new deadlines to address budgetary matters.  There has been some confusion about what the current budget agreement means in terms of sequestration’s annual cuts to discretionary and mandatory programs instituted in 2012.  The law signed by the President to address the short-term continuing resolution and temporarily raise the debt ceiling does not provide federal agencies flexibility to administer new sequestration cuts at this time.  With the government spending levels remaining at FY 2013 levels for the duration of the CR, a new round of sequester cuts are not set to kick in until January 2014.

The law established a short-term budget conference committee, with a set deadline of Dec. 13, 2013 to outline recommended spending levels and program cuts.  Of note is that the committee deadline is set in advance of when the second year of the sequester will begin.  The deadline provides a window of opportunity for the new budget conferees to address how the sequester cuts are applied in FY 2014.   The conferees may contemplate making other adjustments to entitlement programs (Medicare and Medicaid) to address health care spending issues that will be negotiated during their deliberations.  In addition, Medicare payments to physicians are set to be cut by approximately 25 percent if Congress does not address the cut by December 31, 2013 and offset the cut with a payfor that would likely include cuts to other health care entities. Any of these negotiations and decisions, if ultimately accepted by Congress, could impact the size of the Medicare sequester cuts in January FY 2014.

Supercommittee Part Deux?

Still facing a stalemate, on Tuesday, October 8, House Republicans discussed plans to bring to the floor HR 3273, legislation sponsored by Reps. Sessions (R-TX), Woodall (R-GA), and Burgess (R-TX) that would establish a short-term bipartisan, bicameral working group to attempt a deal on funding the federal government and addressing the debt limit.  The House Rules Committee approved and reported out the bill on Tuesday.

The proposal for such a working group showcases how broken negotiations are between Congress and the Administration as the country spirals closer to the deadline on the debt ceiling, just one-week away.  Memories of the failed Supercommittee of 2011 are still fresh in the minds of those on the Hill and those who tried to influence the group when the budget negotiations broke down back then.  However, unlike that Supercommittee, the proposed working group would simply work as a short-term negotiating body and have no ultimate authority, as its recommendations would be voted on by Congress through normal process.

President Obama and Congressional Democrats continued to oppose any negotiations – working group or otherwise -  unless and until congressional Republicans agree to reopen the government and no longer threaten defaulting on the debt ceiling.

Dewonkify – Actuarial Value (of health benefit plans)

The Word: Actuarial Value (of health plan benefits)

Definition:  Actuarial value outlines the percentage of medical costs that a health plan will cover.

Used in a Sentence: Actuarial value can help consumers navigate different health insurance plans as they weigh coverage options and their associated costs.

What It Means:  Actuarial value is meant to define how “generous” a health plan is in covering health care costs.  Understanding the actuarial value of a health plan helps consumers understand what they might have to pay (deductibles and coinsurance/copays) out-of-pocket in order to cover their overall health care costs.

History: Under the Affordable Care Act, actuarial value is utilized to help individuals and the small business market understand and compare health plan options offered inside and outside of new health insurance exchange marketplaces.  Health plan coverage options to be offered within the health exchanges, beginning in 2013, will be outlined through “metal” coverage tiers (bronze at 60%, silver at 70%, gold at 80%, and platinum at 90%).  For example, if a plan has a gold actuarial value at 80%, on average, an individual would have to pay 20% of the cost of their covered benefits.

Dewonkify – Pro Forma Session

The Word: Pro Forma Session

Definition:  A pro forma session is a short period of time when either the House or Senate is technically in legislative session but when no votes are held and no formal business is typically conducted.  It is a Latin term meaning “in form only.”

Used in a Sentence: Both the House and the Senate held pro forma sessions to block the President from making recess appointments.

What It Means: Pro forma sessions are authorized by the Constitution, which requires that each House of Congress grant permission to each other if a recess lasts longer than three days.  Members of Congress can gavel in and out of the House and Senate galleries to show that either Chamber is still in a pro forma session.

History: Pro forma sessions have become mired in controversy over the years and have been used as a strategy by political parties to restrict a President’s ability to make recess appointments to temporarily fill cabinet/political positions.  Under the Constitution, the President has the authority to make appointments when Congress is in recess.  However, if Congress is in-session (normally conducting daily business and votes or in a pro forma session where business is not being conducted), the President is not supposed to be able to make temporary recess appointments, pocket-veto bills, or call for a special session of Congress.  In 2012, the Obama Administration challenged the law and appointments were issued, regardless of the Senate claiming that it was not in recess but otherwise in a pro forma session between recess periods.

Dewonkify – Sequestration

Word: Sequestration (related words:  sequester; sequestered)

Definition:  A fiscal procedure rarely included in budget-related legislation that calls for automatic spending cuts to all federal discretionary and most mandatory federal spending programs, ranging from Medicare to military spending.

Used in a Sentence: “Sequestration Now in Mainstream Consciousness

History: The Budget Control Act of 2011, enacted August 2011, authorized an increase in the federal debt ceiling in exchange for $2.4 trillion in deficit reduction over the next ten years. This total includes $1.2 trillion in spending cuts identified by the legislation, with an additional $1.2 trillion that was to be determined by a bipartisan group of Senators and Representatives known as the “Super Committee.” In the event the Super Committee failed to reach agreement, the bill created a trigger mechanism to implement spending cuts through sequestration. In November 2011, the Super Committee announced it could not reach an agreement and, as such, the scheduled sequestration would move forward in January 2013 unless Congress acted to stop it prior to December 31, 2012. To see the budgetary impact of various proposals to replace the sequester, click here for a Congressional Research Service report. Additionally, the Office of Management and Budget released a report in August on the impact of sequestration on federal agencies. For more on sequestration and the fiscal cliff, click here.

Super Committee 2.0?

As the deadline of February 29 rapidly approaches, House and Senate negotiators continue to remain at an impasse on how to address the looming Medicare physician pay cut. Starting March 1, 2012, physician fees will be cut by 27 percent if an agreement is not reached to avoid the cuts with either a short- or long-term fix.  The bipartisan group of lawmakers, several  of whom also served on the failed Supercommittee last fall, have been considering proposals that would pay for a fix that lasts anywhere from 1 to 10 years.  The disagreement on how to pay for the fix, which the Congressional Budget Office believes would be between $9 billion (one - year fix) and $316 billion (10 - year fix),  does not always fall cleanly  along  partisan lines.  Republican negotiators disagree among themselves on using war savings to cover part of the cost of the doc pay fix.  Democrats have opposed House Republican proposals for significant cuts to hospitals to make up the cost.   MedPAC data citing significantly higher Medicare costs for physician services performed in a hospital outpatient department versus a physician office have painted a bit of bull ’s eye on the hospitals, who are aggressively pushing back.  If war funds are not an option, health providers fear cannibalism as the provider community seeks to protect its own and avoid being part of a list of offsets for a doc pay fix.  Indeed, the same stalemate that affected the Supercommittee and House-Senate discussions that followed at the end of 2011 hareared  its  head again.  This time, the deal - making is further complicated by election-year politics on an issue that affects the future of physician participation in Medicare, and therefore, access to Medicare services.