Health reform implementation

The Internal Revenue Service is seeking public comments on healthcare reform's employer mandate, including feedback on an agency proposal for determining which employers are required to provide coverage.

The healthcare reform law requires companies with more than 50 employees to offer health insurance or pay a fine for each worker who buys coverage on his or her own. The IRS published a request for comments Tuesday that asks how best to determine whether a company meets the 50-employee threshold and which employees count toward the total.

Normally, such calculations would be done on a month-to-month basis, the IRS said, but that could present problems for some employers.

No surprise here, but House Republican leaders are urging their members to vote against five Democratic amendments to a GOP bill that would defund grants for state exchanges.

According to talking points from the office of Majority Whip Kevin McCarthy (R-Calif.) obtained by The Hill, Republicans argue that the grants amount to an unaccountable "slush fund." They're also pushing back against claims that the defunding bill currently on the House floor would end up giving the federal government more control over state exchanges. 

The exchanges "only have the veneer of providing states flexibility," another memo says. "In reality, the federal government … will control what kind of essential benefits must be included and impose price controls on health coverage. States will be a servant, not a partner, of Washington."

House Majority Leader Eric Cantor (R-Va.) said Tuesday that private healthcare plans ration care for profit but that consumers should be free to buy whatever coverage they can afford rather than depend on government rationing.

In remarks to the College of American Pathologists, Cantor warned that Democrats' healthcare reform law mandates benefits that are too generous and will bankrupt the country as the government ends up having to offer ever increasing subsidies. That can only lead to government rationing, he said.

"That doesn't mean those kinds of decisions aren't being made now by the private sector," Cantor added, "because they are."

Some healthcare advocates are upset that the Obama administration is stopping short of issuing a veto threat if Congress strips funding for school-based health centers.

Linda Juszczak, executive director of the National Assembly on School-Based Health Care, said the group was grateful that the White House opposes a House Republican bill to eliminate $200 million in funding, but would have liked it to go further. The House was expected to vote on the defunding bill Tuesday afternoon, but a spokeswoman for House Majority Leader Eric Cantor (R-Va.) tells The Hill it could be postponed until Wednesday.

"We're a little disappointed," Juszczak said. "We wished that he had threatened to veto it as it makes its way through."

Democrats' healthcare reform law set aside $200 million for construction and expansion of school-based health centers, as well as helping them upgrade to electronic medical records. The centers serve the primary care, mental health and oral health needs of students and sometimes their families and the surrounding community. Most of the centers operate under the purview of hospitals, health departments, nonprofits or community health centers, Juszczak explained.

Nearly 80 state and national consumer and healthcare groups have signed onto a letter urging lawmakers to reject a Republican bill that would eliminate grants for states to start their own health insurance exchanges. 

The grants are part of Democrats' healthcare reform law and aim to help states set up and run their own exchanges starting in 2014. Under the law, the federal government would take over in states that don't have their own exchange in place.

The letter, signed by the American Cancer Society, the NAACP and the SEIU among other, points out that exchanges are a bipartisan idea and the first three state bills setting them up — in Massachusetts, Utah and California — were signed into law by Republican governors.

"Although exchanges will ultimately be self-sustaining, without this critical funding, states will not have the resources they need to undertake the many tasks necessary to get their exchanges up and running," the letter states.

The Congressional Budget Office has said the bill could save $14 billion over 10 years.

The House is expected to vote late Tuesday afternoon on two bills that would repeal parts of Democrats' healthcare reform law.

The two bills repeal the law's mandatory funding for state health insurance exchange grants and school-based health center construction. Democrats will argue that defunding the state grants makes it more likely that the federal government will take over the health exchanges.

The Rules Committee on Monday evening allowed a vote on five amendments to the exchange bill from the following members:

• Rep. Sheila Jackson Lee (D-Texas): Requires the Department of Health and Human Services (HHS) to post notice of the rescinded funds;

• Rep. Maxine Waters (D-Calif.): Requires HHS to issue a report in six months on difficulties states are facing in setting up the exchanges because of the defunding;

• Rep. Keith Ellison (D-Minn.): Requires report on potential delays and enrollment reductions caused by the defunding;

• Rep. Frank Pallone Jr. (D-N.J.): Requires report on the advantages of state-run exchanges versus ones where the federal government takes over;

• Rep. Peter Welch (D-Vt.): Preserves funding for states that seek grants before 2012.

Exchange of power? The House is set to vote Tuesday on two healthcare bills, including one that would eliminate federal planning grants to help states set up the new insurance exchanges called for under the healthcare reform law. Republicans have framed the bill as another salvo against a law they've decried as a "government takeover" of healthcare, but some policy wonks say repealing the grant money would actually give the federal government more power. Read the Healthwatch story.

CBO has the score: Repealing the grants would save $14 billion over 10 years, according to the Congressional Budget Office, mostly because fewer people would enroll in the state exchanges and get government subsidies. Healthwatch's Sam Baker has the story.

About that other bill: The House is also set to vote on legislation that would end automatic spending for school-based health centers, as called for in the healthcare reform law.

The Medicare numbers game: GOP Medicare plan supporter Betsy McCaughey is misrepresenting studies she cites in its defense, two economists tell The Hill. 

The former Republican New York Lt. Gov. has been arguing via conservative editorial pages that competing private plans would lead to lower healthcare costs than traditional Medicare. She gave the example of research on private Medicare Advantage plans, but economists whose work she cites have raised several caveats. Get the story from Healthwatch's Julian Pecquet.

Free speech on abortion? The Susan B. Anthony List is battling an Ohio law that outlaws "false" electoral ads. The group is pushing back not only against a complaint by former Rep. Steve Driehaus (D-Ohio) but also against the law's constitutionality. Julian Pecquet has the story.

Defunding battle not over: The Susan B. Anthony List for the first time has hired an outside lobbyist as it pursues its campaign to strip Planned Parenthood of all federal funding. The defunding measure has passed the House, but was soundly defeated in the Senate. Read the Healthwatch report.

President Obama on Monday threatened to veto legislation that would eliminate grants to help states establish the insurance exchanges created by the healthcare reform law. 

"The Administration will strongly oppose legislation that attempts to erode the important provisions of the Affordable Care Act that are making health care more affordable and accessible for all Americans," the Office of Management and Budget said in a policy statement. 

"If the President is presented with H.R. 1213, his senior advisors would recommend that he veto the bill," OMB said of the healthcare bill.

The House is scheduled to take up the legislation this week.

The White House also registered its opposition to a separate bill that would cut off funding for school-based health clinics.

The White House also issued a veto threat Monday evening for the "No Taxpayer Funding for Abortion Act," saying the bill "unnecessarily restricts women’s reproductive freedoms and consumers’ private insurance options."

None of the bills are expected to reach Obama's desk.

A GOP bill to cut off funding for part of the healthcare reform law could ultimately shift decision-making power from the states to the federal government, Democrats and nonpartisan analysts say.

The bill, scheduled for a House floor vote Tuesday, would eliminate grants to help the states establish health insurance exchanges. But it wouldn't strip the federal government's power to run an exchange in any state that doesn't set up its own.

The Congressional Budget Office said last week that the bill would likely result in the federal government running more exchanges than it would under current law.

"Federal money is essential," said Len Nichols, a health policy professor at George Mason University.

Axing the planning grants would only make exchanges more expensive for cash-strapped states while expanding the role for the Department of Health and Human Services (HHS), he said.

Some 600,000 young adults have already enrolled in their parents' or guardians' insurance plans thanks to the healthcare reform law, Kaiser Health News reports, outpacing the administration's expectations.

Democrats' healthcare reform law requires healthcare plans to offer young adults up to the age of 26 the option of enrolling under their parents' insurance starting Jan. 1. The Department of Health and Human Services had estimated that 1.2 million young adults would enroll in 2011, but new data from top insurers indicate that they're signing up faster than expected.

For example, WellPoint, the nation's largest insurer, added 280,000 new members in the first three months of the year thanks to the law's provision, according to KHN.

The provision is seen as a crucial tool to help young adults find affordable coverage after they graduate high school or college. People in their 20s have a 30 percent uninsurance rate, leading to higher costs for the overall insured population.