The 2014 elections are complete, and we now know the makeup of the next US Congress. Even though Republicans picked up more than the 6 seats needed to take control of the Senate, it may not mean that significant healthcare changes are imminent. As the congressional landscape transforms, legislators will have to address the following issues.
The Affordable Care Act (ACA): There is little chance of seeing this act repealed or replaced with President Barack Obama still in office, as it is one of his most significant legislative achievements. He will not have an interest in repealing it, and the Senate does not have the two-thirds majority to overcome a presidential veto. We do know, however, that aspects of the law will be up for repeal or tweaking, including the medical device excise tax (2.3% of the sales price on certain medical devices); the employer mandate to offer qualified, affordable health coverage; and the 30-hours-per-week definition for a full-time employee. The bottom line is that even if Republicans control Congress, it is expected the ACA will remain largely intact.
The real future of the ACA likely lies with the US Supreme Court. Earlier this year, conflicting rulings came from the Appeals Courts on the legality of the ability of federally run exchanges to offer premium assistance, as the law only allows subsidies for citizens signing up for insurance through state-based exchanges. The Supreme Court’s ruling that is expected in June 2015 could have enormous implications for the success of the law with the federal marketplace in 36 states.
Another area that may see movement is the 21st Century Cures initiative: In 2014 the US House of Representatives Energy & Commerce Committee hosted hearings and roundtables to study issues that affect healthcare and innovation. In early 2015, the committee plans to introduce a bill that will address numerous issues, including one that touches on clinical trials.
The following issues largely have bipartisan support, so the makeup of Congress is not as important for these issues as are the methods decided upon to pay for them. Both houses of Congress have indicated they will prioritize legislation that has bipartisan support; the challenge will be finding ways to offset the cost.
- The Sustainable Growth Rate (SGR): The best opportunity to permanently repeal SGR occurred this year. A bipartisan bill on this matter had broad support, but Congress could not come together to determine how to pay for the cost of a fix ($130 billion). Instead, Congress passed another short-term patch that will expire in March 2015, which prevented roughly a 24% cut in Medicare physician reimbursement rates for 12 months. In keeping with previous fixes, Congress cut healthcare expenditures to pay for the extension. It also extended Medicare sequestration-mandated cuts by 2 more years. If Congress is to try to pass another long-term SGR fix in 2015, they will still run into issues with cost. Although it is likely the new Congress will bring up a long-term fix, do not be surprised if another short-term fix is the solution.
- Sequestration: For more than 18 months providers have faced sequester-mandated cuts to Medicare payments, and more than 10 years remain of the 2% Medicare claims reduction. This year, H.R. 1416, a bill that halts the cuts on reimbursement for cancer drugs, garnered some support, but not enough to pass in either chamber of Congress. Many advocacy organizations will push to have the bill reintroduced, but H.R. 1416 will be difficult to pass as part of any stand-alone healthcare bill. The best chance for a solution will be to attach some kind of fix to a larger bill, such as SGR reform.