Healthcare Modernization Act of 2017 (The More Things Changed)

Healthcare Modernization Act of 2017

Full title	Healthcare Modernization Act of 2017
Acronym	HMA
Colloquial name(s)	Revision and Renewal Murray-Jindal
Enacted by the	115th United States Congress
Citations
Legislative history

The Healthcare Modernization Act of 2017 was signed into law on October 15th, 2017. It was proposed and passed in the 115th United States Congress, where it was introduced by Patty Murray (D-WA) and Bobby Jindal (R-LA) in the Senate on April 25, 2017.

It is the most significant healthcare legislation passed into law in the United States since 2010's Patient Protection and Affordable Care Act.

Background

Following the passing of the Patient Protection and Affordable Care Act in 2009, members of both the Democratic and Republican parties have advocated for changes to the law.

Both Senator Murray and Senator Jindal have, during their careers, pushed for differing versions of healthcare reform. Both serve on the Healthcare, Employment, Labor, and Pensions (HELP) Committee, and Jindal had previously served as Assistant Secretary of Health and Human Services during the George W. Bush administration.

Overview

The Healthcare Modernization Act of 2017 provides for revisions to the Affordable Care Act, as well as changes to Medicare, Medigap, and incentives for wellness.

Current Provisions

Title I - Changes to the Affordable Care Act

Title I provides for revisions and elimination of aspects of the Patient Protection and Affordable Care Act.

Subtitle A - Repealing Provisions of the ACA

• Repeals the tax on medical devices.
• Repeals the prohibition on the use of funds from Health Savings Accounts to purchase over-the-counter medication non-prescription medication

Subtitle B - Revising Provisions of the ACA

• Revises the ACA’s employer mandate to cover companies with more than 500 400 employees, rather than 50
• Health Savings Account funds are allowed to be used to purchase health care plans from any insurer
• Affordability is to be gauged by examining what it would cost a worker to cover their family, if they have one, instead of just the worker as an individual

Subtitle C - New Establishments

• Establishes federal guidelines on how states can take advantage of waivers from coverage rules

Title II - Medigap Reform

• Prohibits first-dollar Medigap coverage
• Applies a premium surcharge of 10% on Part B premiums
• Requires Medigap plans to include a deductible of at least $250, cover no more than 50% of beneficiaries copayments and coinsurance, and provide an annual out-of-pocket limit no lower than $2,000

Title III - Medicare Reform

Subtitle A - Care for Seniors

• Starting in 2022, seniors are given a greater choice of plans and greater premium support, including a choice among Medicare-approved private plans
• Wealthier seniors would see this program assistance reduced
• Seniors receive specialized information: about the plan in which they are currently enrolled, the projected cost of the plan, what other plans in the area are offered, and what the federal premium support would be

Subtitle B - Eligibility

• The eligibility age to participate in Medicare is gradually increased to 67, starting in 2022.
• States may be granted waivers by the Secretary of Health and Human Services to raise or lower the Medicare eligibility age, if recommended by the chief health officer of that state.

Subtitle C - Further Revisions

• More healthcare providers will be eligible for telehealth reimbursement under Medicare and other programs, including health clinics and centers
• Medicare is allowed to negotiate drug and biologic prices and demand higher rebates for prescription drugs in Medicare
• All health plans that participate in the Medicare Exchange would be required to offer benefits that are at least the actuarial equivalent of those provided by a traditional Medicare plan

Title IV - Transparency and Fraud Protection

• Price data from hospitals is required to be published online and available in print
• The “pay and chase” fraud prevention model is moved to a "5 Cs" model
• Greater fines and penalties are imposed on those who profit from or traffic in personal health information

Title V - Wellness Incentives

• Provides for premium variations up to 35%, increased from 20%, to reward participation in wellness programs, or are certified by their primary doctor to be making significant strides towards wellness
• Provides employers financial incentives on a tax-free basis, placing the money in new Wellness Accounts

Title VI - Research and Innovation

• Provides for an additional ten billion USD in loans and grants to both universities and private ventures for medical research and development

Title VII - Expanding Critical Services

Subtitle A - Addressing Physician Shortages

• Establishes a federal cap of $50 million $20 million on malpractice lawsuits
• Explicitly allows states to lower the cap on malpractice lawsuits to no less than one million USD
• Requires malpractice insurance to cover greater benefits

Subtitle B - Expanding Local Care

• Provides for doubling the National Health Service Corps by 2020
• Provides for a 50% increase in funding for community health centers

Subtitle C - Expanding Child Care

• A funding extension for the Children's Health Insurance Program is granted through 2020.

[Subtitle C was replaced by a separate bill to extend the Children's Health Insurance Program, September 26th, 2017]

Title VIII - Alzheimer's Prevention and Care

• Reauthorizes the Missing Alzheimer’s Disease Patient Alert Program
• Requires Medicare to cover Alzheimer’s care-planning sessions
• Provides an additional two billion USD in funding for Alzheimer's research and development

Legislative History

Introduction and Passage

The HMA was first introduced in the Senate by Patty Murray (D-WA) and Bobby Jindal (R-LA) on April 25th, 2017, following months of negotiations between Murray, Jindal, other members of Congress, and representatives of the Hillary Clinton administration, including Secretary of Health and Human Services Tanden Neera.

On July 28th, 2017 the Senate passed the bill in a 61-38 vote.

Following the traditional August recess, the House has taken up the bill and has begun amending it. In recent weeks, however, Congressional attention has been focused on the response to Hurricanes Harvey, Irma, and Maria.

Th HMA was cleared by the House in a 235-191 vote on Monday, October 15th. It was signed into law the same day by President Hillary Clinton.

Medicare Eligibility

Rep. Tom Price (R-GA) has proposed raising the Medicare eligibility age to 67 by 2020, as a way of offsetting costs. Although missing from his original bill in the Senate, Bobby Jindal has endorsed the provision.

In contrast, Rep. Ted Deutch (D-FL) and other Democratic co-sponsors have proposed an amendment to lower the eligibility age to 55, also by 2020.

In early October, a compromise was reached - states would be eligible to raise or lower their eligibility ages for Medicare, by two years, if granted a waiver by the Secretary of Health and Human Services, starting in 2020. four years after an initial waiver is granted, it may be granted once more, after a review by the state's chief medical officer and the Department of Health and Human Services.

Planned Parenthood Funding

In 2017, the United States House Committee on Oversight and Government Reform has no clear party majority, with Republicans and Democrats each having twenty members seated on the committee, joined by Libertarians Justin Amash (MI-3rd), Mark Sanford (SC-1st), and Martha Rainville (VT). In September, the Committee looked at a proposal by Rod Blum (IA-1st) to add an amendment to the HMA that would eliminate federal funding for Planned Parenthood.

All Democrats voted against the proposal, joined by Republican Greg Walden (OR-2nd), while the remaining Republicans voted for the proposal, joined by Libertarians Amash and Sanford. Rep. Rainville sided with Walden and the Democrats, killing the proposed amendment and keeping federal Planed Parenthood funding intact.

Response

In the Senate, the legislation has been generally praised by both Democrats and Republicans, with both Murray and Jindal arguing for it within their respective caucuses.

Elizabeth Warren (D-MA) has applauded the repeal of the medical device tax, while Lisa Murkowski (R-AK) - who had authored the Trickett Wendler Right to Try Act - said “My hope is this bill will provide additional support to not only the individuals with illness, but also to their families and loved ones seeking answers to their struggle.”

However, the bill has faced criticism from both the left and the right: Representatives Bernie Sanders (I-NY) and Chuy Garcia (D-IL) have criticized the bill as "inadequate" and advocate for a further shift towards a single-payer healthcare system, proposing the Medicare-for-All Act as an alternative. Meanwhile, conservatives like Representative Blake Farenthold (R-TX) have continued their call for a complete repeal of the Affordable Care Act, and termed the HMA "absolutely repugnant."

Congressional Libertarians have staunchly condemned the bill. Representative Mark Sanford (L-SC) has called the bill "unpalatable" while Senator Joe Miller (L-AK) said "This bill will not work and will likely make our medical system worse."