After a month of intense political jockeying, President Barack Obama signed a measure to end the weeks-long government shutdown and raise the nation's debt ceiling in legislation that left the controversial 2010 healthcare reform law
On Wednesday night, the House voted 285-144 on a Senate-approved bill that funds federal government operations at sequestration levels through Jan. 15 and lifts the nation's debt ceiling through Feb. 7, allowing the government to reopen and also avert default. It also establishes a conference committee between both chambers to negotiate broader budget reforms and reach agreement by Dec. 13. The Senate passed the bill in a vote of 81-18 earlier in the evening.
The White House released a statement around 12:30 a.m. ET Thursday that said the president
signed the bill into law.
Sylvia Mathews Burwell, director of the Office of Management and Budget, said federal employees should expect to return to work Thursday morning.
Several potential changes to the Patient Protection and Affordable Care Act—including a repeal or delay of the law's medical device tax, a yearlong postponement of the individual mandate, and a cancellation of subsidies to federal lawmakers and their staff members—had been at the center of the discussions since the start of the budget standoff but in the end were not part of the bill.
Instead, lawmakers agreed to one ACA provision intended to prevent fraud on the health insurance exchanges. The short-term spending bill requires the HHS secretary to make sure the exchanges verify that people applying for premium tax credits and reductions in cost-sharing are in fact eligible to receive them, and also submit a report to Congress by Jan. 1, 2014, that describes the procedures the exchanges will use to verify eligibility. Meanwhile, the HHS inspector general must file a report to Congress by July 1 about the effectiveness of those procedures.
Christopher Condeluci, former tax and benefits counsel on the Senate Finance Committee on the GOP side during the run-up to the healthcare reform law, said income verification was an extremely important aspect of the law when it was drafted, and that the provision in the bill was "100%" a reaction to the administration's regulation this past July that loosened verification of individuals' incomes.
"The legislation is intended to push the administration back to where the law was requiring the administration to go in the first place," said Condeluci, now an attorney with the firm Venable.
Although the Affordable Care Act was spared in this go-around of fiscal deliberations, GOP leaders in both chambers Wednesday promised their efforts to dismantle the law are far from over.
"Our drive to stop the train wreck that is the president's healthcare law will continue," House Speaker John Boehner (R-Ohio)
said in a statement hours before the lower chamber voted. "We will rely on aggressive oversight that highlights the law's massive flaws and smart, targeted strikes that split the legislative coalition the president has relied upon to force his healthcare law on the American people."
While the national spotlight has centered on the government shutdown and the country's debt obligations, there are other areas that are more relevant to healthcare business leaders, Eric Zimmerman, a partner at the law firm McDermott, Will and Emery, wrote Wednesday in an advisory to clients. For instance, the new target dates of Jan. 15 and Feb. 7 in the law likely mean there will be no Medicare legislation in 2013.
"Because entitlement program reforms- including both Medicare and Medicaid- will undoubtedly play such a large role in the conference committee deliberations, it is highly unlikely that Congress would try to separately resolve SGR and other expiring Medicare programs through a separate, earlier process," Zimmerman wrote, adding that while that's bad news for physicians, it's good news for other sectors in healthcare that would be expected to contribute heavily in any legislation that requires Medicare offsets.
Meanwhile, the conference committee the law establishes paves the way for a so-called grand bargain to reduce the nation's deficit, which again puts the healthcare industry at risk for additional reimbursement cuts.
Under a major deficit reduction scenario, Congress could look to squeeze $400 billion to $600 billion out of Medicare and $150 billion to $200 billion out of Medicaid," Zimmerman wrote. "If so, Congress will have to go deep into the list of 'payfors' that have been floated in recent years, and all segments of the health industry will be vulnerable."Follow Jessica Zigmond on Twitter: @MHjzigmond