The Month of Anti-Deadlines

As we shake off the carb-coma and make our pre-resolutions, Congress and the Administration head into a sprint to the holiday recess fraught with health policy implications. Unlike every December in recent memory, there isn’t very much Congress actually has to do. Here are the top five things you need to know to follow the fun and prepare your organization for the changes afoot. A key theme to take home is that December 2013 is a month of anti-deadlines.

The Nov. 30/Dec. 1 “fix” to was set arbitrarily and has simply teed up another pivot point for opponents to pounce. We already know the wand hasn’t tapped the electro-synapses of the site yet to make the dang thing work like it should. Expect more incremental improvements through the month and enrollment numbers to come in above current rock-bottom expectations, with a healthy chunk coming from the proud, the few … the state-based exchanges.

The Dec. 13 deadline for budget conferees to produce a joint resolution is similarly fictional and self-imposed. While there are some burgeoning reports that co-chairs Murray and Ryan might be able to agree to FY14 funding levels and potentially alleviate some of the sequester, the buzz-o-sphere in Washington still has deep doubts. Even if the two negotiators come to agreement, House and Senate leadership have the bigger challenge of getting a bipartisan deal through their chambers.

Jan. 15 is the real deadline for a budget agreement and the real goal is writing a check to fund the government through Sept. 30. A budget resolution is helpful to give appropriators time to write actual spending policy, but it can be bypassed if the end-game is a continuing resolution that keeps current funding allocations in place. (Congress hasn’t passed an actual budget resolution since Democrats controlled both chambers.) At the end of the day, we’ll be back to the all-too-familiar roundtable of congressional leaders and Obama reps hatching a last-minute deal to avert a shutdown.

With the Finance Committee marking up their Medicare physician payment reform and extenders package on Dec. 12 and Ways & Means whispering they will do the same, Congress will take its farthest step ever into the final frontier of SGR repeal. But don’t get your hopes up. Only in Washington does the $175 billion estimated price tag of the Finance/W&M package sound “cheap.” And, the recent use of the nuclear/constitutional option on appointments, not to mention the still perilous politics of health reform, makes a bipartisan agreement on paying for the bill about as likely as Jim DeMint enrolling in Obamacare. Ways & Means is rumored to be contemplating marking up a short-term doc fix alongside its long-term one to give Congress more time to reach a deal on a permanent policy. But leadership wants a 1-2 year fix, because they aren’t believers in the SGR repeal fairy and aren’t thrilled about shepherding a big bundle of Medicare and Medicaid cuts in the middle of next year anyway. For now, our crystal ball still says a one year fix will travel with the CR by January 15.

Oh yeah, back to the exchanges. If you want coverage on January 1, 2014, then the only real deadline this month is December 23. Those enrolling after that date won’t get covered until Feb. 1 or later. Expect the trajectory of enrollment to run to its first peak before likely plateauing through the end of the open enrollment period on March 31. With STILL unlikely to be working smoothly for everyone by then, also get ready for more calls to push out the open enrollment window further. The Administration would like to avoid that, though, because the dust needs to settle on the 2014 market before they, the states and insurers can start crunching numbers to prepare for 2015.

So there it is, in a nutshell. Put up your decorations and light your fire, because the good news in all of this is Congress might actually go home by the middle of December for the first time in years.

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