Summary
We have a new Speaker of the House! Last Wednesday the House Republican Caucus elected Rep. Mike Johnson (R-LA) to be the new Speaker of the House. After weeks of drama and several failed attempts by other members, Rep. Johnson was elected Speaker with every single Republican voting in his favor. Speaker Johnson was elected to Congress in 2017, after serving two years in the Louisiana State House. He is best known for his role in contesting the results of the 2020 presidential election. He served as chair of the Republican Study Committee, and most recently was the vice chair of the House Republican Conference. He is a very conservative Republican, particularly on social issues, as he supported bills that would institute a nationwide ban on abortion and advocated in favor of overturning the Supreme Court decision that allowed same-sex couples to legally marry.
Speaker Johnson has laid out an aggressive timeline to move all the remaining FY 2024 appropriations bills off the floor before the current Continuing Resolution (CR) expires on November 17. Last week the House approved the 5th of 12 Appropriations bills and is planning to bring up three more this week. The Speaker has also suggested that to allow time to negotiate with the Senate on a final spending bill, Congress will need to pass another CR through either January 15 or April 15, whichever date can reach consensus within the Republican conference. While such a suggestion would have been met with outrage from members of the House Freedom Caucus just a month ago, several hardliners have indicated an initial willingness to agree to a short-term CR under Speaker Johnson’s leadership. Finding compromise with the Senate on the timing of a CR, much less an end of the year spending package as well as a supplemental spending package to help our foreign allies will remain a very difficult task and will test Speaker Johnson’s leadership within his conference.
The House will come into session on Wednesday afternoon, with a busy agenda. In addition to three appropriations bills, the House will consider several bills related to antisemitism and the war in Gaza this week, a measure that would expel New York Congressman George Santos, and dueling measures that would censure Rep. Marjorie Taylor Greene (R-GA) and Rep. Rashida Tlaib (D-MI).
The Senate is scheduled to come into session this afternoon. They will vote on several nominations, including potentially confirming Jack Lew as Ambassador to Israel. The Senate will also continue to vote on amendments, and then hopefully pass, their first minibus appropriations bill. The bill contains three of the 12 appropriations bills passed by the Appropriations Committee this summer. Finally, the Senate Appropriations Committee is scheduled to hold a hearing on Tuesday to discuss the Administration’s $105 billion national security supplemental funding request.
Marketplace Open Enrollment
The Marketplace Open Enrollment period begins Wednesday, November 1 and runs through January 16 (since January 15 is a federal holiday). Due in part to the availability of enhanced premium tax credits, four in five HealthCare.gov customers have access to coverage for $10 or less per month for PY 2024 after subsidies. The benchmark plan premium increased 4 percent from PY 2023, which is consistent with the increase from PY 2022 to PY 2023. Additional details on PY 2024 are available here (fact sheet).
Updates to the Marketplace for PY 2024 include:
- Automatic re-enrollment process: Certain income-based cost-sharing reduction (CSR)-eligible enrollees who would otherwise be automatically re-enrolled in a Bronze plan will be enrolled into a Silver plan, if (1) the consumer does not make an active plan selection on or before the December 15; and (2) only if a Silver plan is available in the same product type with the same provider network and with a monthly premium after subsidies than that of the Bronze plan. As in previous years, other consumers who do not actively select a plan by December 15 will be automatically re-enrolled into their 2023 plan or a suggested alternate plan for 2024.
- Non-standardized plan option limits: Issuers offering plans through the Marketplace will be limited to offering four non-standardized plan option per product network type, metal level, inclusion of dental and/or vision benefit coverage, and service area in plan year 2024. This change aims to streamline plan option selection and encourage consumers to select a standardized plan.
- Optional collection of sexual orientation and gender identity data: The new optional questions regarding sex assigned at birth, sexual orientation, and gender identity will be collected to improve the Marketplace consumer experience.
- Cost-sharing information: Plan summaries on HealthCare.gov will specify whether a benefit’s cost-sharing is subject to the deductible or whether the consumer can access the benefit “from day 1” for primary care, specialist care, urgent care, and outpatient mental health services. During the shopping experience, consumers will be given estimates of total yearly costs (premiums, copays, co-insurance, and other out-of-pocket costs) to help understand their health care costs over the course of a year.
Regulatory Update
The Office of Management and Budget (OMB) completed reviewing the final rule for the Medicare CY 2024 physician fee schedule; and the proposed rules for the CY 2025 Policy and Technical Changes to Medicare Advantage and Part D.
OMB is also reviewing:
Medicare, Medicaid, or Both:
- CMS Enforcement of State Compliance with Medicaid Reporting and Renewal Requirements –The interim final rule would establish rules regarding CMS enforcement of states’ compliance with reporting requirements and renewal requirements during the period that begins on July 1, 2023 and ends on June 30, 2024. The interim final rule may codify existing guidance and provide more details on how CMS may enforce the requirements. The interim final rule was not included in the Spring 2023 Unified Agenda.
- Annual CY 204 Medicare Payment Updates – Final rules for home health and hospital outpatient and ambulatory surgical centers.
- 340B Program – Final rule on the Hospital Outpatient Prospective Payment System: Remedy for 340B-Acquired Drugs Purchased in Cost Years 2018-2022.
- Culturally Competent Care – Proposed rule to establish culturally competent and person-centered requirements for all provider and supplier types that participate in Medicare and Medicaid programs.
- Skilled Nursing Facilities – Final rule to require the disclosure of certain ownership, managerial, and other information regarding Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities.
Commercial Insurance:
- Annual Rulemaking for Commercial Insurers – Proposed rules for the CY 2025 Notice of Benefit and Payment Parameters
Other Topics:
- Conscience Rights in Health Care – Final rule to safeguard the rights of federal conscience and religious nondiscrimination while protecting access to care, including abortion.
- Health Data Interoperability – Final rule to implement certain provisions of the 21st Century Cures Act and make several enhancements to the ONC Health IT Certification Program to advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information.