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.


Parliamentarian Provides Guidance on Budget Reconciliation Strategy

Senate Parliamentarian Elizabeth MacDonough has effectively ruled that Democrats can only use the budget reconciliation process one more time during 2021. MacDonough determined that a revision to the 2021 budget resolution cannot be automatically discharged from the Senate Budget Committee, requiring Democrats to secure at least one Republican vote on the panel whose members are split 11-11 along party lines. Democrats had hoped to use reconciliation to advance the President’s Build Back Better agenda – passing the American Jobs Plan, the American Families Plan, and health care reform proposals to expand the Medicare program and lower the price of prescription drugs over multiple reconciliation packages. Instead, it is likely that Democrats will only be able to use reconciliation to pass one legislative package with a simple-majority vote during the remainder of this year.

Lawmakers Push for Increased CMMI Transparency

Abipartisan group of two dozen members of the House of Representatives is requesting details from the Center for Medicare and Medicaid Innovation (CMMI) regarding the agency’s metrics for gauging the success of its health initiatives. The lawmakers argue that more transparency is needed around CMMI’s demonstration project decision making, stating that the center’s metrics are biased toward savings rather than improvements in beneficiary health or health disparities. “The Department of Health and Human Services needs to reveal the modeling which produces estimates of savings and how quality will be affected,” the lawmakers write. “Stakeholders need to know what analytics and standards are used to define a successful demonstration.” The letter was led by Reps. Terri Sewell (D-Ala.) and Adrian Smith (R-Neb.).

In related news, CMMI Director Liz Fowler recently spoke in favor of expanding mandatory payment models and re-examining current incentives in the health care system to pay for improved patient outcomes. During remarks at a National Academy of Medicine event last week, Fowler stated that the current system “can’t resist the siren song of the status quo,” and that it is too comfortable to remain in fee-for-service. She also stated plans to improve the infrastructure of CMMI’s demonstration projects to better gather data and measure outcomes and rewards.

Pascrell Requests GAO Report on Private Equity in Health Care

House Ways and Means Subcommittee on Oversight Chair Bill Pascrell (D-N.J.) is requesting that the Government Accountability Office (GAO) investigate the impact of private equity investment in the health care industry. In his letter to GAO head Gene Dodaro, Pascrell argues that private equity ownership has resulted in an increase in surprise billing, nursing home mortality rates, and bankruptcies and closures of critical health care providers. He asks that GAO complete a longitudinal analysis covering 10-15 years examining private equity investment and subsequent bankruptcies, including how many facilities or providers declared bankruptcy following private equity investments; how many facilities closed; in what industries were such bankruptcies most common; how the closure or bankruptcies rates compare to those of other facilities; whether there are geographic trends; and to what extent a closure resulted in loss of services for a community. Pascrell also requests information about the extent to which private equity buyouts are associated with providers who disproportionately serve marginalized populations.

Wyden to Investigate AbbVie Earnings

Senate Finance Committee Chairman Ron Wyden (D-Ore.) is opening an investigation into AbbVie Inc.’s country-by- country earnings and its U.S. corporate income taxes. Wyden argues that the company “has been able to successfully exploit the incentives to offshore profit” created by former President Donald Trump’s 2017 tax law. Wyden requests details about royalties for AbbVie’s rheumatoid arthritis medication Humira as well as a list of foreign entities that reported pretax earnings for sales of the drug in the U.S., received any royalties or similar payments and the amount of earnings attributable to each. He requests similar data on the company’s cancer drug Imbruvica.

Warren Seeks Gilead Testimony for Hearing on Pharmaceutical Competition

Sen. Elizabeth Warren (D-Mass.) has invited Gilead’s chief executive Daniel O’Day to testify in a hearing on pharmaceutical market competition scheduled for June 16 before the Senate Finance Subcommittee on Fiscal Responsibility and Economic Growth. Warren, chair of the subcommittee, states that the panel is interested in focusing on anti-competitive behavior that impacts consumer access, innovation, and pricing. In her letter, she states that while “Gilead has taken some steps to expand access” to lifesaving medications, the company “is set to hold on to its monopoly over its hepatitis C medications using ‘thickets’ of questionable patents.”

June 7, 2021: | Page 1 Page 2



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