Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


House Democrats Pick Leadership for 117th Congress

House Democrats have nominated current Speaker Nancy Pelosi (D-Calif.) to continue to lead the party for another two years. Her selection took place by voice vote. To secure the position of speaker during the 117th Congress, she will need the support of the majority of the full House come January. Majority Leader Steny Hoyer (D-Md.), Majority Whip Jim Clyburn (D-S.C.), and House Democratic Caucus Chairman Hakeem Jeffries (D-N.Y.) were also reelected to their leadership posts. Rep. Katherine Clark (D-Mass.) defeated Rep. David Cicilline (D-R.I.) in the race for assistant Speaker. She will replace Rep. Ben Ray Lujan (D-N.M.), who has been elected to the Senate. The race for Democratic Congressional Campaign Committee (DCCC) chair has been postponed until the week after Thanksgiving to give the candidates, Rep. Sean Patrick Maloney (D-N.Y.) and Rep. Tony Cardenas (D-Calif.), additional time to campaign. Current DCCC chair Cheri Bustos (D-Ill.) did not seek a second term. Please see HERE for Hart Health Strategies Inc. updated 2020 Political/Elections Overview document.

White House Objection Complicates Spending Talks

White House negotiators are demanding cuts to domestic spending ahead of the December 11 deadline to fund the federal government. Treasury Secretary Steven Mnuchin expressed objections to the proposal to exempt $12.5 billion in spending for the Department of Veterans Affairs (VA) from the budget cap established by the 2019 debt ceiling deal. The money would provide for expanded health care for veterans as required by the 2018 VA Mission Act. Efforts are currently underway to pass a full- year omnibus measure, but negotiations could be stalled by the need to find domestic spending cuts to offset the VA money, a move which is opposed by Democrats and would increase the likelihood of another short- term spending measure.

COVID Stimulus Negotiations Remain Stalled

Senate Minority Leader Chuck Schumer (D-N.Y.) called on Majority Leader Mitch McConnell (R-Ky.) last week to resume negotiations on a coronavirus stimulus package. McConnell has repeatedly dismissed the $2.4 trillion bill that Democratic leadership wish to use as a starting point for negotiations. White House Chief of Staff Mark Meadows signaled that any future talks on a COVID stimulus package will be led by Congress and not the White House. Previously, negotiations had taken place between Meadows, Treasury Secretary Steven Mnuchin, and House Speaker Nancy Pelosi (D-Calif.).

White House Releases Major Drug Pricing Regulations

The administration has released two major regulations aimed at lowering drug prices. The so-called “rebate rule” would remove safe harbor protection from antikickback law for after-sale rebates paid by manufacturers to pharmacy benefit managers (PBMs) in Medicare Part D. Instead, upfront discounts will be eligible for safe harbor protection. The rule will also allow for discounts to go directly to the patient at the pharmacy counter. The Department of Health and Human Services (HHS) had appeared to scrap the rule last year out of concerns that it would raise premiums for program beneficiaries. The PBM industry has threatened lawsuits if the administration follows through with the regulation. Meanwhile, the so-called “most favored nation” interim final rule would tie federal reimbursement for drugs administered in doctors’ offices and outpatient departments to the lowest price paid among certain other countries. The policy would be implemented over the course of seven years through a demonstration model and initially apply to 50 single-source drugs comprising a high percentage of Part B drug spending. It would also replace the current add-on percentage-based payment with a flat fee. The seven-year demo will be nationwide and mandatory, to begin in January. In the rule, the Centers for Medicare and Medicaid Services (CMS) acknowledges that it is difficult to accurately estimate the financial impact of the model, but estimates that it will save more than $85 billion over seven years, net of associated premium savings.

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