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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Five Health Policy Issues to Watch in 2015

January 8, 2015 | Federal Budget | Medicaid | Medicare | Comments
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Because no New Year would be complete without a “top five” roundup of the year ahead, we’ve put together a summary of the top five health policy battles we’ll be watching in 2015 – and why you should, too.

1. Recurrent Threats to Medicaid, Other Entitlement Programs. With the end of a divided Congress, entitlement reform advocates hope that 2015 will be their year to achieve major reforms to Medicaid, Medicare, and Social Security. Their first opportunity will come with the 2016 budget resolution, which outlines instructions for the upcoming budget process. Though entitlement programs are not subject to the annual appropriations process, a commonly used process called “budget reconciliation” can be used to enact policy reforms that affect national spending and revenues. Moreover, budget reconciliation bills need only a majority of votes in each chamber for passage, eliminating the filibuster as a means of thwarting proposed changes. Past years’ proposals to reform Medicaid have included converting it to a block grant or imposing a per-capita cap on federal spending for Medicaid enrollees. The National Council opposes both proposals because of their deleterious effect on Medicaid providers and patients.

Why it matters: The words “budget reconciliation” might put most readers to sleep, but the reconciliation process will play a major role in reformers’ efforts to drastically modify the Medicaid program this year. The National Council will be closely monitoring this process and will keep readers updated through Capitol Connector and our action alerts. If you haven’t already, sign up today!

2. Expiration of the Current Medicare Physician Pay Fix. The current law postponing a major scheduled cut to Medicare physician pay will expire in March of 2015, once again confronting Congress with the now-familiar dilemma: come up with a (costly) permanent fix to avert these cuts, or push the question down the road by enacting a (less expensive) postponement? In 2013-14, members of key committees in the House and Senate agreed on a framework for permanent reform, but couldn’t find consensus on how to pay for it before the looming deadline. Will this year be different?

Why it matters: Enacted on a near-yearly basis, the “Medicare pay fix,” as it is known, provides both a respite from reimbursement cuts for physicians and a vehicle on which related legislation can ride to passage. Astute observers may remember that the Excellence in Mental Health Act passed Congress as part of last year’s Medicare pay fix. Health care groups will be looking to this year’s bill as a potential vehicle for other changes to the Medicare or Medicaid programs.

3. Emergence of a Movement for a Balanced Budget Constitutional Amendment. The National Council has recently learned of an emerging threat to federal spending on health care and other priorities occurring in state legislatures across the country. Led by the fiscal-conservative group ALEC, state legislatures are taking up and passing resolutions calling for a constitutional convention for the purpose of adopting a balanced budget amendment to the constitution. To take effect, 34 state legislatures would have to approve identically worded resolutions; thus far, 24 states have enacted differing versions. Because this strategy for amending the constitution has never been used before, it is unclear whether there is a timeframe within which the resolutions must be enacted or if it is possible for the resolutions to limit the constitutional convention to consider only the balanced budget amendment.

Why it matters: Such an amendment would require the federal government to pass a balanced budget each year, hindering the government’s ability to respond to economic downturn or elevated need for social and health care programs by requiring such spending to be offset with cuts elsewhere in the budget. If successful, this movement could devastate health care programs across the board: from Medicaid to the substance abuse and mental health block grants, and more. Stay tuned to Capitol Connector for the latest updates and opportunities to get involved.

4. Supreme Court decision on federal exchange subsidies in King v. Burwell. This case marks the second major challenge to the Affordable Care Act before the Supreme Court. In 2012, the Court upheld the constitutionality of the law’s individual mandate and made the Medicaid expansion optional for states. Now, it’s being asked to rule on whether the ACA permits the federal government to offer premium subsidies to consumers who purchase health insurance on the federal marketplace, Critics argue that the language of the law permits subsidies to be offered only on state-run exchanges. Proponents argue that the intent of the law was clearly to make subsidies available to all consumers.

Why it matters: If the Court overturns the federal exchange subsidies, it could suddenly make insurance unaffordable to most of the 90 percent of people who qualify for financial help in the federal marketplace. Most experts agree this would fundamentally undermine the law and could require urgent congressional action to fill the gap. Read our coverage of the case on Capitol Connector.

5. Piecemeal Attacks on the Affordable Care Act. After repeatedly failing to repeal the entire ACA, opponents are poised to pass multiple pieces of legislation repealing individual elements of the law. First up is the law’s definition of a full-time workweek, currently set at 30 hours per week. Because employers’ obligations to provide health insurance to employees are tied to their number of full-time employees, changing the definition of who qualifies as full-time could have a big effect on businesses that are responsible for providing coverage to their workers. The House today is debating legislation  that would establish a 40-hour per week threshold for full-time workers. Critics on both sides fear that no matter the number of hours, employers may cut employee’s work schedules to avoid the health coverage mandate.

Why it matters: The debate on the 40-hour workweek is just the opening salvo in a battle by ACA opponents to dismantle the law piece by piece. Other targets include the medical device tax, the Independent Payment Advisory Board, and others. While some ACA provisions are unpopular on both sides of the aisle and are easy targets for repeal, others will encounter steep opposition. Watch to see how the debate over the 40-hour workweek unfolds for a clue to how much of the ACA might be at risk in the coming year. Read our take on the ACA’s future in the November Ambassadors Brief.