On Tuesday, Jan. 25, President Obama gave his 2011 State of the Union address in the chamber of the House of Representatives, calling on citizens and lawmakers to do what is necessary for America to "win the future." To achieve this, he urged for congressional bipartisanship in a number of crucial areas, including education and health care. Obama said he would be willing to work with Congress to improve the 2010 health care reform legislation, starting with a provision that he said places unnecessary bookkeeping requirements on small businesses. He also said he would listen to ideas on reducing Medicare and Medicaid costs, including a Republican idea for medical malpractice reform to end frivolous lawsuits. However, the president said he would not be willing to consider any legislation that allows insurance companies to deny coverage based on a pre-existing condition, a reference to the House’ s recent vote to repeal the health care law.
On Jan. 26, Sen. John D. Rockefeller IV (D-W.V.) introduced S.195, a bill reinstating the federal match for state spending of child support incentive payments. This bill would reverse the changes made by the Deficit Reduction Act that eliminated the federal match of child support incentive dollars reinvested into child support activities at the 66 percent rate. Those in the child support community are especially fearful that the elimination of the federal match rate for incentive funds represents a serious cut to federal funding for child support programs and that the restoration of this matching rate for incentives awarded to high-performing states is critical if the program is to continue to evolve.
A number of attempts have been made in the 111th Congress to restore the federal match for child support incentive funds; the last attempt was as late as last December as attempts were made to include the federal incentive match to the Claims Resolution Act of 2010 that extended the TANF state block grant program through Sept. 30, 2011, yet the provision was pulled from the bill at the last minute due to budget offset issues.
The bill boasts bipartisan support; cosponsors for S.195 include Sens. John Cornyn (R-Texas), Herb Kohl (D-Wis.) and Olympia Snowe (R-Maine). APHSA supports congressional efforts to restore the child support federal incentive match, a stance reflected in policy documents such as Focal Point and the TANF Reauthorization Recommendations, which are both available on APHSA’ s web site. Please contact Robert Ek at robert.ek@aphsa.org if you have questions.
Sen. David Vitter (D-La.) introduced legislation (S. 83) that would require states to implement drug testing for TANF applicants as a condition for receiving TANF assistance. At this point there are states that have introduced similar legislation at the state level; however, there is no national requirement to drug test and past attempts to pass legislation mandating drug testing for TANF recipients have failed. The bill has now been referred to the Committee on Finance. For questions, contact Robert Ek at robert.ek@aphsa.org.
Sen. Orrin Hatch (R-Utah), ranking member of the Senate Committee on Finance, led 20 additional senators in introducing a proposed amendment to the constitution requiring the federal government to maintain a balanced budget and requiring supermajority vote for any upward adjustment of the federal debt ceiling. The joint resolution (S.J. Res.3) was read twice and referred to the Senate Committee on the Judiciary on Jan. 26, 2011.
Hatch’ s Balanced Budget Amendment has been cosponsored by Sens. John Cornyn (R-Texas), Saxby Chambliss (R-Ga.), John Ensign (R-Nev.), Mike Enzi (R-Wyo.), John McCain (R-Ariz.), Mike Crapo (R-Idaho), Chuck Grassley (R-Iowa), Olympia Snowe (R-Maine), Jim Inhofe (R-Okla.), Johnny Isakson (R-Ga.), Roy Blunt (R-Mo.), Kelly Ayotte (R-N.H.), Richard Burr (R-N.C.), Rob Portman (R-Ohio), John Barrasso (R-Wyo., Mike Johanns (R-Neb.), Mark Kirk (R-Ill.), Pat Roberts (R-Kan.), Richard Lugar (R-Ind.), and John Hoeven (R-N.D.).
On Jan. 26, the House Energy and Commerce, Oversight and Investigation Subcommittee held a hearing on the "The Views of the Administration on Regulatory Reform." Providing testimony on behalf of the administration was Cass Sunstein, administrator at the Office of Management and Budget’ s Office of Information and Regulatory Affairs. Sunstein discussed the history and intent of Executive Order 13563, "Improving Regulation and Regulatory Review" issued on Jan. 18 as a supplement to the regulatory review process established in 1981 by Reagan’ s Executive Order 12291 and later in Clinton’ s Executive Order 12866 issued in 1993 as a supplement to Reagan’ s. EO 13563 directs the Office of Information and Regulatory Affairs to implement six provisions to the current process including an increase public participation in the process, coordination across agencies, and use of scientific integrity to ensure information supports regulatory actions, among others. The rest of the executive order can be found at http://www.whitehouse.gov/the-press-office/2011/01/18/improving-regulation-and-regulatory-review-executive-order.
Chairman Stearns questioned Sunstein on the amount of regulations implemented under the Administration and how many are under development. In FY 2009, 43 major rules were implemented and 4,225 rules are currently under development under the current administration. Stearns also expressed concern around the provisions within Obama’ s executive order allowing agencies to utilize "human dignity" as a qualitative measure in regulatory review. In a later response, Sunstein discussed that the human dignity and the equity measures will be quantified and cost/benefit analyses will be conducted.
As the president mentioned in the State of the Union Address on Tuesday night, there are current regulations that are burdensome that his administration is willing to reexamine. While there is bipartisan support for regulatory reform, the majority of the hearing focused on the amount of and/or need for regulation of the Environmental Protection Agency. Joe Barton (R-Texas) charged the subcommittee with drafting bipartisan legislation to fix these issues.
On January 26, the House Ways and Means Committee held a hearing on the "Health Care Law’ s Impact on Jobs, Employers and the Economy." Austan Goolsbee, chair of the Council of Economic Advisers, provided testimony highlighting that small businesses’ biggest problem is the cost of health care for workers. Goolsbee discussed the beneficial provisions within ACA such as the reduction of the hidden tax for employers (estimated as high as $1,000 per worker per year) used to pay for uninsured emergency visits as well as cost-reduction initiatives focusing on research, innovation, payment reform and the federal financial assistance toward expanding the health care workforce.
Richard Foster, chief actuary at the Centers for Medicare and Medicaid Services, provided testimony at the House Budget Committee’ s hearing on the "Fiscal Impact of Health Care Overhaul" on Jan. 26. Foster’ s testimony outlined the provisions within ACA affecting consumers of the Exchanges and more specifically, ones affecting Medicare (i.e., phasing out the Part D coverage gap) and Medicaid (i.e. , reducing Disproportionate Share Hospital expenditures) aimed toward reducing the long-term cost of health care for consumers and the federal deficit.
"The Congressional Budget Office and the Joint Committee on Taxation have estimated that the total net amount of Medicare savings and additional tax and other revenues would somewhat more than offset the cost of the national coverage provisions, resulting in an overall reduction in the Federal deficit through 2019." Foster did mention that through an analysis of the Medicare Trust Fund-related provision within ACA, there is a possibility that any savings created through the extension and the sustained reduction in payment updates of the Hospital Insurance fund may have an adverse effect on the coverage provisions as the costs would be shifted to them. Foster recommended legislative action on this issue.
Relative to Medicaid, Foster’ s testimony included that, "the percentage increase in Medicaid expenditures will be considerably lower than the increase in enrollment, since adults and children have much lower average health care costs than aged and disabled enrollees." He also stated that the "net impact of Medicaid and CHIP provisions on State Medicaid costs is a reduction totaling $33 billion through fiscal year 2010 [as a] result in part because certain provisions reallocate costs from states to the federal government."
HHS Secretary Kathleen Sebelius provided testimony on Jan. 27 at the Senate Health, Education, Labor and Pensions Committee hearing "The Affordable Care Act: The Impact of Health Insurance Reform on Health Care Consumers." She testified about the major provisions already being implemented and that already are helping consumers such as the creation of the Pre-existing Conditions Insurance Plan; insurers not being allowed to deny coverage to children because of pre-existing health conditions; revised medical loss ratio regulations requiring insurers to utilize 80–85 percent of premium dollars on health care and quality improvement rather than marketing and CEO bonuses; public notification of unreasonable rate increases by insurers; creation of and financial assistance with state-based exchanges; investments in the health care workforce; and insurance for those close to retirement but not yet eligible for Medicare. Sebelius did assure the committee that HHS continues to work with state insurance commissioners and with state regulators on policy development and implementation that promote state independence within ACA’ s state-based initiatives.
While the overall tone of the hearing seemed to be supportive of ACA and the work being done by HHS, there was discussion about some provisions. Senator McCain questioned Sebelius about steps HHS is taking to decrease the burden of the maintenance-of-effort requirements under ACA, specifically requesting information about ways the agency is addressing them. Sebelius responded that HHS is providing teams of staff to assist governors in identifying where there is flexibility in the MOE for each state. Additionally, Sen. Richard Burr (R-N.C.) asked the secretary if the permanent fix of the medical loss ratio would utilize all of the cost savings projected to which the secretary indicated that she was not certain whether this would be the case.
On Jan. 19, the Food and Nutrition Service issued a memo outlining cuts in the Supplemental Nutrition Assistance Program’ s education program. Section 241 of the recently enacted Healthy, Hunger-Free Kids Act of 2010 (P.L. 111-296) establishes a new grant program that replaces the existing SNAP-Ed program. The new program provides total funding of $375 million for FY 2011, an amount calculated on reported state SNAP-Ed expenditures for 2009 and on the new law’ s 10-year reductions of $1.305 billion compared to previous law. Total expenditures for 2012 and later years will be indexed on the rate of inflation. Formulas for allocation of available funds among states will at first be based on 2009 expenditures, but will change beginning in 2014. State plans will continue to be based on existing FNS SNAP-Ed guidance through 2012. The grants will not require matching state funds, but they will entirely replace the current SNAP-Ed program and its essentially uncapped federal match of state expenditures. The change means that a number of states will experience reductions over the amounts expected to be available under prior law. The grants are intended to provide nutrition education and obesity prevention services. Grant programs may include low-income persons other than just SNAP recipients. The full memo is posted at http://snap.nal.usda.gov/nal_web/snap/pdf/ImplementationMemoHealthyHungerFreeKidsActof2010.pdf.
This Week in Washington is published by the American Public Human Services Association each week Congress is in session and on other dates. Editors: Larry Goolsby and Amy Plotnick. Writers: Rashida Brown (child care), Robert Ek (TANF, child support), Megan Lape (health services), Bertha Levin (children and family services), Anita Light (children and family services), Poornima Nayak (health services), Nanette Relave (health services), Alex Tenaglio (legislative intern), and Jessica Wiecezak (health services).
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