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Congress Likely To Act On Short-Term Patch For ACA If Subsidies Ruled Illegal

The GOP-led Congress would likely act on a short-term legislative fix to the health care law that would allow federal subsidies to continue flowing through the federal exchanges up to a set date, albeit in exchange for certain concessions from Democrats in the event that the Supreme Court rules against the administration in King v. Burwell, several sources are suggesting.

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The goals CMS set Monday (Jan. 26) for moving providers to alternative pay models and value-based payments make it all the more important for physicians that Congress pass Medicare physician pay reform, provider lobbyists said, because Congress can pay doctors extra for simply participating in alternative pay models and CMS cannot.

The Congressional Budget Office's estimated 10-year cost of freezing Medicare physician pay increased in the office's latest Budget and Economic Outlook, but some following the issue say a cost increase is unlikely to have much of an affect on the current push to replace the flawed Sustainable Growth rate since lawmakers haven't been able to agree on how to pay for a replacement, regardless of the cost.

The Congressional Budget Office Monday (Jan. 26) lowered its expectations of exchange enrollment from 13 million Americans to 12 million who are projected to buy a health care plan through a state or federal marketplace in 2015.

The Medicaid program had about 4.8 million beneficiaries enrolled in the new adult group created by the ACA's Medicaid expansion by the end of the first quarter of 2014, out of which 3.2 million (or two-thirds) were “newly eligible,” and another 1.5 million were not, according to numbers released by CMS on Friday (Jan. 23).

A discussion draft of Rep. Marsha Blackburn's (R-TN) planned bipartisan bill attempts to draw a sharp line between “medical” software that would fall under FDA's jurisdiction and “health” that would not, but lawmakers are still grappling with how to ensure that software intended to be regulated is not accidentally exempted.

CMS has launched a review of its privacy policies, contracts for third-party tools and website construction following concerns raised after the Associated Press reported that Healthcare.gov has been sharing consumer information with advertising and analytic firms.

The Affordable Care Act's individual mandate and insurance market reforms make it clear that Congress intended for federal subsidies to be available to those buying insurance in both federal and state exchanges, and it would have been absurd for Congress to limit the subsidies to those enrolled through state-run exchanges as argued by the plaintiffs in King V. Burwell, the White House says in its 154-page response to the high-profile case under review by the Supreme Court.

Children’s advocate Bruce Lesley said Friday (Jan. 23) that he and his colleagues will be pushing Congress to pass by March legislation that would extend funding for the Children’s Health Insurance Program (CHIP) for four years, or through 2019.