AUCD Legislative News In Brief

December 21, 2009

Congressional Schedule
The House is in recess.  In spite of a major winter blizzard in D.C. over the weekend, Senators spent the entire weekend in session-- first finalizing a Defense spending bill-- then trying to bring health care reform bill to a closure. 

Health Care Reform
Last night (or actually this morning at 1 a.m.) the Senate passed (60-40) a motion to end debate on the Patient Protection and Affordable Care Act (HR 3590). Following this "cloture" vote, the Senate is allowed 30 hours of debate.  This timeframe will allow for a Christmas Eve vote on the final Senate package.   This action followed a week of negotiations to get the 60 votes needed to end the debate.  Majority Leader Harry Reid (D-NV) stopped allowing amendments and filed a "manager's amendment" with changes to appeal to the holdouts, mainly Sen. Ben Nelson (D-NE) and Sen. Joe Lieberman (I-CT).  

Even if the Senate bill is passed this week, it will still have to be reconciled with the House-passed bill that is significantly different.  The manager's bill does not include a public option; nor does it include the Medicare buy-in compromise.  As is often the case on major legislation like this one, compromises are necessary and no one is completely pleased with the final outcome. It may be that the House will mostly defer to the Senate-passed bill in order to avoid a lengthy and contentious conference.  It is expected that a final bill will be voted on in January as soon as the Second Session of the 111th Congress begins. 

For a side by side of the House and Senate bills please see the Kaiser Family Foundation's interactive comparison:

Casey Autism Amendment
The bad news is that Sen. Casey (D-PA) did not have a chance to offer his autism capacity building amendment and it does not appear in the manager's amendment (see previous issue of In Brief).  Casey's amendment would have provided supplemental grants to UCEDDs or other institutions to help build the workforce and service capacity to serve the growing needs of individuals with autism spectrum disorder, similar to the Doyle amendment that was included in the final House bill.  The amendment was co-sponsored by Sens. Durbin (D-IL) and Menendez (D-NJ) .  AUCD will be advocating for this provision to remain in the final health care reform bill but this will depend on whether there will be a formal conference of the two bills or not.

Children's Health
There is good news for kids in the Senate health bill, due in large part to the leadership of Senators Rockefeller (D-WV) and Casey (D-PA). Senator Casey introduced an amendment to the Senate bill that would make a number of enhancements to CHIP (which is maintained in the Senate bill). These include providing full funding for the program through 2019, requiring states to cover children in CHIP up to at least 250% of the federal poverty level and providing EPSDT coverage to children in CHIP. AUCD signed on to a letter to Casey in support of his amendment. Over 600 national, religious, state, and local organizations support the Casey amendment. Dawn Horner of the Georgetown Health Policy Institute provided this summary of provisions related to SCHIP:  

·         CHIP funding is continued for another two years (September 30, 2013 through September 30 2015). Originally, the bill provided funding only through September 30, 2013. This funding ensures that children can keep their CHIP coverage during a critical period when health reform is just getting off the ground. 

·         States will still need to maintain current Medicaid and CHIP eligibility and enrollment procedures for children above 133% of the FPL through fiscal year 2019. However, the amendment clarifies that states must meet this "maintenance of effort" requirement or lose their Medicaid funding.

·         States will still receive the 23 percentage point increase in their CHIP match rate but its timing was delayed for two years. Now the increase will go into effect October 1, 2015. Since the bill assumes coverage will be maintained through 2019 but there is no funding after 2015, Congress will need to further revisit these funding issues.

·         As before, if there is no federal funding, children previously eligible for CHIP will be enrolled in the Exchange. The amendment strengthens this provision by requiring that children first be screened for Medicaid and, if eligible, enrolled. For children not eligible for Medicaid, the state must establish procedures to enroll the children in comparable coverage. 

·         The Secretary of HHS will be required to review and certify which plans in the Exchange provide CHIP-comparable benefits and cost sharing, but it is unclear what mechanism will be in place to ensure that these plans exist in the Exchange.

·         Extends and increases funding provided in CHIPRA for Medicaid and CHIP enrollment and renewal activities. Now, $140 million (an increase of $40 million) will be available through 2015. 

·         Creates a new option for states to provide CHIP coverage to children of state employees eligible for health benefits. These children can now enroll in CHIP if the state premium contribution for family coverage is less than 1997 levels (adjusted for inflation) or if the employee's premiums and cost sharing exceeds 5 percent of the family's income.

·         Requires the Secretary of HHS to issue regulations to establish a more defined process for public input for section 1115 waivers in Medicaid and CHIP.

·         Makes technical changes to tighten up the definition of cost-effectiveness in the new CHIPRA premium assistance option and removes the requirement that Medicaid programs do premium assistance as part of the Medicaid expansion in the underlying bill.

·         Immediately prohibits insurers from denying coverage to children for pre-existing conditions. The new regulation would go into effect for adults with the rest of the legislation, in 2014.