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PPACA: The Battle of the H.R. 1 Amendments

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Opponents of the Affordable Care Act have used floor proceedings for H.R. 1, a continuing resolution needed to fund the government through the remainder of the fiscal year, as a vehicle for attacking the act.

Republicans have offered, and won approval for, a number of H.R. 1 amendments that could block implementation of parts or all of the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA).

In theory, the Democratic majority in the Senate can simply reject any H.R. 1 PPACA Legislative lightning defunding provisions. If Democrats form a budget resolution with significant PPACA defunding provisions, President Obama could veto it. But Republicans may have the leverage to get some amendments enacted, because the Obama administration must get a resolution through the House and signed by March 4 to keep the federal government from shutting down.

The underlying bill, H.R. 4, passed 235-189 at 4:40 a.m., with all but 3 Republicans who voted voting for the bill and all Democrats who voted voting against it.

Rep. Cathy McMorris Rodgers, R-Wash., ran into trouble with efforts to win approval for an amendment that would have “prohibited the use of funds in H.R. 1 from being used to pay any employee, contractor, or grantee of the Internal Revenue Service to implement or enforce the provisions of, or amendments made by” PPACA and HCERA.

House members blocked the McMorris Rodgers amendment from coming for a vote because of concerns that it violated budgeting rules.

House members later approved several general PPACA defunding amendments offered by Rep. Dennis Rehberg, R-Mont, and Rep. Steve King, R-Iowa.

The Rehberg amendment could prohibit the use of federal funds to “pay any employee, officer, contractor, or grantee of any department or agency to implement” PPACA or the health provisions of HCERA.

One King amendment would “prohibit the use of funds in H.R. 1 or any previous act, to be used to carry out the provisions” of PPACA, HCERA or any amendment made by either PPACA or HCERA. A second King amendment would prohibit H.R. 1 funds from being used to “pay the salary of any officer or employee of any federal department or agency” to carry out PPACA or HCERA provisions.

The Rehberg and King amendments passed with almost complete Republican support and little Democratic support. A handful of Republicans and a handful of Democrats crossed party lines on each vote.

The House also approved at least two narrower defunding measures.

One, introduced by Rep. Cory Gardner, R-Colo., would prohibit the Obama administration from using H.R. 1 funds to “pay the salary of any officer or employee of the Department of Health and Human Services” who is involved with developing the PPACA health insurance exchange coverage distribution system that is supposed to start up in 2014.

The Gardner exchange amendment attracted slightly more Democratic support than the other PPACA amendments. The overall vote was 241-184. Only 1 Republican voted against the amendment; 5 Democrats voted for it.

Another amendment, offered by Rep. Tom Price, R-Ohio, would prevent use of public h funds to implement or enforce the new PPACA medical loss ratio (MLR)

provision. The MLR provision requires health plans to spend 85% of large group revenue and 80% of individual or small group revenue on health care and quality improvement efforts.

The Price amendment won approval by a 241-185 vote, with just 3 Democrats supporting it and 2 Democrats opposing it. All Republicans who voted on the MLR amendment voted for it.

Health insurance agents and producers oppose the MLR provision, because they say it is encouraging health insurers to slash producer commissions.

The National Association of Health Underwriters (NAHU), Arlington, Va., has come out strongly in favor of the Price amendment.

NAHU Chief Executive says the MLR provision would have a devastating effect of health agents and brokers and their clients.

The MLR provision is hurting important insurer administrative operations, such as fraud prevention and claims management operations, and “the new requirements also limit the ability of insurers to offer low-cost plan alternatives,” Trautwein says. “Over time, they will reduce the number of insurers willing to write health insurance in the individual and small-group markets.”