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 Passes Stopgap Spending Bill, Debt Limit Suspension

The House of Representatives passed a stopgap spending bill to fund the federal government beyond the end of the fiscal year (FY) on September 30 along with a debt limit suspension to avoid the U.S. government defaulting on its debts. The bill was approved in a 220-211 party-line vote. It would provide government funding through December 3, 2021 and suspend the debt ceiling through December 16, 2022. Also included were several emergency provisions, such as $28.6 billion in emergency relief for states responding to recent hurricanes and wildfires and $6.3 billion to support the resettling of Afghan refugees. The bill would also extend current restrictions on fentanyl analogues through January 28, 2022. The government’s authority to prosecute illegal possession of such substances is currently set to expire on October 22. The Senate will likely vote this week to proceed to consideration of this legislation. Senate Republicans, however, have pledged to block the measure because of their opposition to a clean debt limit suspension or increase. Former Treasury secretaries Henry Paulson, Robert Rubin, Timothy Geithner, and Larry Summers, who served under both democratic and republican presidents, sent a letter to House Speaker Nancy Pelosi (D-Calif.) last week urging lawmakers to raise the debt limit. “Failing to address the debt limit, and allowing an unprecedented default, could cause serious economic and national security harm,” the letter argues. They also warn that postponing action to raise the debt limit until too close to the deadline “undermines confidence in our political system at home and abroad.”

House Expected to Vote on BIF, Build Back Better This Week

House Speaker Nancy Pelosi (D-Calif.) has pledged that the chamber will pass the $550 billion bipartisan infrastructure framework (BIF) this week. The bill could be brought before the House of Representatives for consideration as early as today. Progressive Democrats continue to insist that the Build Back Better reconciliation bill be moved in tandem with or prior to the infrastructure package, and Speaker Pelosi stated her intention to pass both bills this week.

The House Budget Committee advanced the reconciliation bill on Saturday, assembling the 13 individual committee measures into a single 2,465 page piece of legislation, a necessary step before the legislation can be brought for a floor vote. The panel voted 20-17 to send the bill to the Rules Committee, with Rep. Scott Peters (D-Calif.) joining Republicans in opposition to the measure. Peters has been vocal in his opposition to the inclusion of the Medicare drug price negotiation provision. The reconciliation process precluded any substantive changes from being made to the package by the Budget Committee. Pelosi has indicated that she expects the reconciliation bill, which currently stands at $3.5 trillion, to be scaled back. House Budget Committee Chairman John Yarmuth (D-Ky.) has made similar remarks, stating that he expects the Senate to make changes to the bill that will necessitate another House vote at a later date.

Senate Majority Leader Chuck Schumer (D-N.Y.) announced that the White House and congressional Democrats have reached an agreement on a framework to pay for the economic and social spending measure but did not provide any further details on the plan. It is nevertheless clear that intraparty disagreements remain between the moderate and progressive wings of the Democratic Party. Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.) continue to raise concerns about the total size of the President’s tax and spending plan, with Manchin recently stating that he also opposes the expansion of Medicare benefits without first addressing the program’s long-term solvency. It also is unknown whether the bill’s drug pricing provisions – which would produce $600 billion in funds to pay for the package – have enough Democratic support for inclusion. The proposals were opposed by four House moderates during committee markup and have also been criticized by Sen. Sinema.

Sanders Proposes Voucher Cards to Expand Medicare Benefits

Sen. Bernie Sanders (I-Vt.) is proposing a voucher system for the provision of dental, hearing, and vision coverage to Medicare beneficiaries. Under his proposal, individuals making less than $75,000 per year and families with incomes below $150,000 would receive $1,000 debit cards to be used for the purchase of dental visits, hearing aids, or eyeglasses. Sanders’ proposal, which he is seeking to add on to the reconciliation package currently under negotiation, would allow seniors to access these services earlier than is currently provided for in the reconciliation bill. Under the House Build Back Better plan, vision coverage would begin in 2022, hearing coverage would begin in 2023, and dental coverage would begin starting in 2028.

FDA, CDC Sign-off on Booster Shot Recommendations

The Food and Drug Administration (FDA) has amended the emergency use authorization (EUA) for the Pfizer- BioNTech COVID-19 vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series in:

  • individuals 65 years of age and older;
  • individuals 18 through 64 years of age at high risk of severe COVID-19; and
  • individuals 18 through 64 years of age whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19 including severe COVID-19.

Director for the Centers for Disease Control and Prevention (CDC) Rochelle Walensky broke with the recommendations of her agency’s advisory committee in her decision to endorse the Pfizer booster shot for people at risk of contracting COVID-19 because of on-the-job exposure. The CDC is recommending:
  • people 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • people aged 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • people aged 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks, and
  • people aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

The CDC’s Advisory Committee on Immunization Practices (ACIP) had previously endorsed the Pfizer-BioNTech booster shot for people 65 and older, nursing home residents, and those with underlying medical conditions at risk of developing severe disease. Last week, ACIP’s interim recommendations rejected a booster campaign for health care workers and others who may be at increased risk of contracting their virus through their jobs or an institutional setting. In overruling the advisers, Walensky noted that the CDC’s recommendations for booster use will align with the FDA’s authorization. The booster shot rollout will likely rely on a system of self-attestation.

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