Washington Update - July 28, 2017

On the Horizon

  • On August 1, the Senate Health, Education, Labor, and Pensions Committee will hold a hearing on various Department of Health and Human Services nominees.

Washington Update - Full Report

Download this week's report(3 page PDF).

Take Action


With the demise of the AHCA, the BCRA and Skinny Repeal, it is time to enjoy the successful defense of health coverage for millions. The work will continue, but it is important to celebrate a job well done before dusting ourselves off and continuing our advocacy.

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U.S. Congress

ACA Repeal Amendments Defeated, AAFP Reiterates Call for Bipartisan Solutions

Early on July 28, the Senate voted down 49-51 the latest proposal to repeal and replace the Affordable Care Act disappointing Republican leadership who pulled the bill from the floor. The AAFP sent a letter dated July 27 “to once again call on the United States Senate to set-aside this reckless path and seek bipartisan, meaningful, and impactful solutions that improve our health care system.”

AAFP Supports Bills to Extend Civil Rights Protection to LGBTQ People

The AAFP sent letters of support to the House and Senate sponsors of legislation that would add sexual orientation as protected classes under the Civil Rights Act. The Equality Act (HR 2282(www.congress.gov) and S 1006(www.congress.gov)) would amend the Civil Rights Act of 1964 to include sex, sexual orientation, and gender identity among the prohibited categories of discrimination or segregation in places of public accommodation, and would provide consistent and explicit non-discrimination protections for LGBTQ people across key areas of life, including employment, housing, credit, education, public spaces and services, federally funded programs, and jury service. AAFP has long had policy opposing discrimination of any kind.

Teaching Health Center GME Reauthorization Bill Introduced

On July 25, Reps. Cathy McMorris Rodgers (R-WA) and Niki Tsongas introduced the Training the Next Generation of Primary Care Doctors Act of 2017 (HR 3394(www.congress.gov)). The bill reauthorizes the THCGME program for three years, provides adequate funding for current residency slots, and supports program expansion for new rural and underserved communities. The program now supports 742 residency slots in 27 states. The bill provides $116.5 million annual funding for the current THCGME residency slots and provides monies for new expansion programs into new rural and underserved communities. Unless Congress acts, the program will expire on September 30. The AAFP submitted a letter of support for HR 3394.

Medicare Special Needs Population Program Reviewed

On July 25, the House Energy and Commerce Committee’s Health Subcommittee held a hearing(energycommerce.house.gov) to review the Medicare Special Needs Population Program (SNPs). The program is available as part of Medicare Advantage plans and provides comprehensive, coordinated care for two million individuals. Many SNP recipients are “dual eligibles,” those who qualify for both Medicare and Medicaid. During the hearing, Rep. Michael Burgess (R-TX), the subcommittee chair, shared that a draft reauthorization bill(docs.house.gov) was available for comment. Rep. Gene Green (D-TX), the subcommittee ranking member, talked about unique health issues, especially those with chronic health conditions.

House Committee Approves Seven Public Health Bills

On July 27, the House Energy and Commerce Committee approved seven public health bills including the SOAR Health and Wellness Act (HR 767), which will authorize a training program to encourage medical personnel to identify potential victims of trafficking. The AAFP supported a version of this legislation in 2016. The committee also approved the Action for Dental Health Act (HR 2422) that authorizes a U.S. Centers for Disease Control and Prevention health promotion initiative centered on oral health. Members also approved the Common-Sense Nutrition Disclosure Act (HR 772), which allows flexibility for implementing the Affordable Care Act’s Section 4205 mandated menu labeling requirement. The AAFP supports menu labeling.

Centering on the States

Bipartisan Group of 10 Governors Urge Senate to Reject ACA “Skinny Repeal”

Govs. Charles Baker (R-MA), Steve Bullock (D-MT), John Bel Edwards (D-LA), John Hickenlooper (D-CO), Larry Hogan (R-MD), John Kasich (R-OH), Terry McAuliffe (D-VA), Brian Sandoval (R-NV), Phil Scott (R-VT), and Tom Wolf (D-PA) submitted a letter(gov.louisiana.gov) on July 26 to Senate leaders urging them to reject the proposed “skinny repeal” of the Affordable Care Act (ACA). The Governors also advocated that the House-passed American Health Care Act(www.congress.gov) be set aside and Senators work with Governors “on solutions that will make health care more available and affordable for every American.”

Massachusetts Seeking Changes to APRN Scope of Practice

On July 19, Gov. Charles Baker (R) submitted legislation(malegislature.gov) that would permit Advanced Practice Registered Nurses (APRNs) to practice and prescribe independently without the clinical supervision of physicians. AAFP and Massachusetts AFP oppose this legislation as it undermines physician-led team-based care models. AAFP submitted a letter on July 24 to state leaders asking for their support in opposition of the bill.

Tobacco 21 Action

On July 21, New Jersey Gov. Chris Christie (R) signed legislation(www.njleg.state.nj.us) which will raise the minimum legal age for the sale of tobacco products from 19 to 21. Christie, who has previously vetoed the measure, cited the strain that tobacco use puts on the state’s health care system in his decision to sign the bill. New Jersey joins California and Hawaii to become the third state to pass age 21 legislation. Maine and Oregon have also recently passed similar bills that would raise the minimum age from 18 to 21. Gov. Paul LePage (R) vetoed Maine’s bill(www.mainelegislature.org) on July 25 while Oregon’s bill(olis.leg.state.or.us) is currently pending approval from Gov. Kate Brown (D).

Indiana Submits Amendment to Section 1115 Waiver Extension Application

Following a period of state and federal comment, Indiana submitted an amendment(www.in.gov) request to their Section 1115 waiver extension application on July 20. The waiver extension application, initially submitted on January 31, 2017, seeks to continue the Healthy Indiana Plan 2.0 for three years. Without extension, the waiver is set to expire January 31, 2018. The newly submitted amendment request incorporates a work requirement and adjusts the monthly contribution to health savings accounts for beneficiaries from 2% of monthly income to a tiered system based on federal poverty level (FPL). Under the amended contribution scheme, an individual at 101-138% FPL would have a monthly contribution requirement of $20. 

Executive Branch

Regulatory Briefs

  • On July 24, MedPAC released the June 2017 data book(medpac.gov) on healthcare spending and the Medicare program.
  • On July 25, CMS released(www.cms.gov) the proposed rule for the home health prospective payment system for 2018. Comments are due on this regulation on September 25.
  • On July 25, CMS issued a bulletin(www.medicaid.gov) to help states understand the process and their role in ensuring that dual eligible beneficiaries have timely, affordable, and comprehensive coverage under the Medicare Part D prescription drug benefit.
  • Recently the GAO posted a report(www.gao.gov) titled, “Medicaid Expansion: Behavioral Health Treatment Use in Selected States in 2014.”
  • On July 25, the HHS Office on Women's Health awarded(www.hhs.gov) 16 organizations about $100,000 each to help prevent opioid misuse by women and girls in underserved communities.