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ML Strategies Health Care Preview - Week of July 15,2019

This week, the House is scheduled to vote on a repeal of the Cadillac tax, which is a forty percent tax on high-cost health plans. The Congressional Budget Office (CBO) estimates that repealing the tax would cost an estimated $193 billion over the next ten years. That said, the bill has broad bipartisan support in both chambers and moving it through the House potentially ratchets up some pressure on the Senate to consider it. While the focus may shift to the Senate, it is not a sure thing that the legislation is considered, even if the bill has 42 cosponsors. When the House passed the medical device tax repeal in 2018, another bill with bipartisan support, the Senate never took up the legislation.

We also wait for signals of what comes next following the Administration’s decision last week to withdraw the proposed rebate rule. CBO estimated that implementing the proposed rule would have increased federal spending by about $177 billion over the next decade. There has been a lot of noise in the drug pricing space from the Administration, which has signaled that additional executive action is likely, and that is only expected to increase as Congress ramps up its push to address lowering drug costs this summer.


Last Tuesday, oral arguments were heard before the Fifth U.S. Circuit Court of Appeals on whether to uphold a lower court ruling striking down the Affordable Care Act. The central question in the case is whether the requirement that people have health insurance, known as the individual mandate, is constitutional. In other words, if the individual mandate is unconstitutional, would that that render the entire law unconstitutional? The three-judge panel, comprised of two Republican-appointed and one Democratic-appointed judge, are not expected to rule on the case for several months and the ruling could take many forms. In one scenario, the Court could decide that eliminating the mandate means only certain aspects of the law are unconstitutional. Alternatively, the Court could affirm a lower court ruling striking down the Affordable Care Act. Future action before the Supreme Court seems increasingly likely.

The uncertainty by this situation will only grow as we head into the 2020 election cycle. It is a potentially galvanizing moment for Democrats who warded off efforts to repeal the law in 2017 and reclaimed the House majority in the 2018 elections. For Republicans, it sets up another opportunity to craft a replacement proposal should aspects of the law be deemed unconstitutional, which has proved challenging and could create an unwanted crisis just months before the 2020 election.

©1994-2020 Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. All Rights Reserved.National Law Review, Volume IX, Number 196


About this Author

Alexander Hecht, Vice President of Government Relations, Mintz Levin law Firm
ML Strategies - Executive Vice President & Director of Operations

Alex is Executive Vice President & Director of Operations, ML Strategies, Washington, DC. He is an attorney with more than 10 years of senior-level experience in Congress and trade associations.

Alex assists clients with their legislative and regulatory needs on a wide range of issues, including health care, telecommunications, the Telephone Consumer Protection Act (TCPA), technology, energy, and federal procurement. Prior to joining ML Strategies, Alex served for over six years as chief counsel for Senator Olympia J. Snowe (R-ME) on the US Senate Committee on Small Business...

Connie Garner ML Strategies Disability & Education Policy VP
ML Strategies - Vice President for Disability Policy & Education Policy

As Vice President for Disability Policy & Education Policy at ML Strategies, Connie leverages legislative, health care, government agency, and nonprofit and private sector consulting experience to help clients develop strategies on disability issues and education issues affecting their employees and businesses.

Connie is widely recognized as a national policy leader on disability, health care, and education issues. For 17 years, she was Policy Director for Disability and Special Populations to the US Senate Committee on Health, Education, Labor and Pensions (HELP), where she worked primarily with the late Chairman Senator Edward M. Kennedy, and subsequently with former Senators Chris Dodd and Tom Harkin.

In her role as Policy Director for the Senate HELP Committee, she led the efforts to draft and enact important federal legislation, including:

  • The CLASS Act, the major long-term care legislation that is part of the Affordable Care Act

  • The Mental Health Parity and Addiction Equity Act of 2008

  • The 2006 and 2009 reauthorization of the $2 billion Ryan White CARE Act

  • The Family Opportunity Act of 2006

  • The 2005 reauthorization of Individuals with Disabilities Education Act (IDEA)

  • The 1999 Ticket to Work and Work Incentives Improvement Act

Connie’s experience also includes high-level positions with federal agencies. She served in the US Department of Education as State Project Director for Early Intervention and Preschool programs, Director of the Federal Interagency Coordinating Council for Children with Disabilities, and as the Secretary of Education’s principal liaison to interagency health care matters.

She has also held executive positions with national nonprofits. Connie was Executive Vice President for Policy at United Cerebral Palsy and continues to contract as the Executive Director for Allies for Independence/Advance CLASS, Inc., a national organization advocating for long-term care services. In addition, Connie has practiced as a clinical nurse specialist, including as the nursing administrator for maternal-child health inpatient hospital units in the Philadelphia and Washington, DC areas. She is also certified as a Pediatric and Neonatal Nurse Practitioner.

Immediately prior to joining ML Strategies, Connie was Policy Director in the DC office of a prominent law firm’s Government Strategies Practice Group, where she consulted with clients on health care, health insurance issues, mental health, substance use disorder, disability, long-term care, and education issues.


  • George Washington University (EdS)
  • George Mason University (MSc, Nursing)
  • George Mason University (BS, Nursing)
Frank Guinta ML Strategies VP
Senior Vice President of ML Strategies/US

Frank is based in our Washington, DC office and is Senior Vice President of ML Strategies.

Prior to joining the firm, Frank represented New Hampshire’s 1st congressional district in the US House of Representatives. He served for two nonconsecutive terms, from 2011 to 2013 and from 2015 to 2017. During his time in Congress, Frank served on several House committees. During his most recent term, he was a member of the Committee on Financial Services and served on its Financial Institutions and Consumer Credit as well as its Monetary Policy and Trade sub-committees. Previously he served...

Aaron Josephson Mintz Law Firm
Senior Director

Aaron is based in our Washington, DC office and is a Senior Director of ML Strategies. He advises clients on health care policy issues related to medical devices and pharmaceuticals. 

Prior to joining ML Strategies, Aaron spent 10 years with the US Food and Drug Administration, most recently as a senior policy advisor in the Center for Devices and Radiological Health where he led legislative policy development activities related to all aspects of medical device regulation and oversight. He also apprised members of Congress and their staffs about...