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 Build Back Better Reconciliation Bill

The House of Representatives passed the Build Back Better Act (H.R. 5376) on Friday morning by a vote of 220-213. All but one Democrat – Jared Golden (D-Maine) – voted for the bill and all Republicans voted against it. The $1.85 trillion tax and social spending package includes several major health reforms, including a short-term fix to the Medicaid coverage gap, an extension of enhanced Affordable Care Act (ACA) tax credits, the addition of a hearing benefit to the Medicare program, and $150 billion for home health care. The bill also includes drug pricing-related provisions, including a new authority for the Medicare program to negotiate the prices of some of the highest-cost drugs and an annual cap on beneficiaries’ out-of-pocket drug spending.

A vote on the bill had been delayed because several moderate Democrats insisted on waiting for the release of the Congressional Budget Office’s (CBO) score of the legislation. CBO estimated that the bill would increase the deficit by $367 billion between fiscal year (FY) 2022 through 2031 – with $1.64 trillion in spending increases offset by $1.27 trillion in additional revenue. Tax enforcement funding would raise an additional $207 billion. While CBO’s analysis was largely in keeping with earlier estimates by lawmakers and the White House, the budget agency estimated that the Medicare drug price negotiation proposal would save $79 billion instead of $100 billion, and that the permanent extension of the Children’s Health Insurance Program (CHIP) would ultimately save $1 billion instead of costing money.

The reconciliation package is expected to be modified when it reaches the Senate, both to comply with the Senate’s rules for the reconciliation process and to gain the necessary support of every Senate Democrat. Sen. Joe Manchin (D-W. Va.) has already expressed reservations about some of the key provisions of the bill and has called for slowing the pace of negotiations. The revised bill would then be sent back to the House for another vote before being sent to the President’s desk for his signature. According to Senate Majority Leader Chuck Schumer (D-N.Y.), the Senate will first complete work on the National Defense Authorization Act before turning to the reconciliation bill, which he hopes to complete before the Christmas holiday.

Congress’ attention will also be focused on funding the government before current appropriations expire on December 3. A second stopgap spending measure will likely be necessary to avoid a shutdown in early December, but House Appropriations Chair Rosa DeLauro (D-Conn.) says she hopes to reach a bipartisan deal on topline spending figures next month rather than delaying government funding talks until 2022. Negotiations in the Senate on government funding are currently stalled on policy disagreements, including restrictions on abortion funding.

DeGette, Upton Introduce Cures 2.0

Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) have officially introduced the Cures 2.0 Act (H.R. 6000), which aims to build upon their previous landmark 21st Century Cures Act. The 173-page bill would authorize $6.5 billion to establish the Advanced Research Projects Agency for Health (ARPA-H), a medical research agency housed within the National Institutes of Health (NIH) responsible for accelerating new medical breakthroughs. ARPA-H was first proposed by President Joe Biden in his budget. The bill also includes provisions to speed Medicare coverage of innovative treatments, increase access to telehealth services, provide training and education for at-home caregivers, encourage innovative antimicrobial drug development, and improve clinical trial diversity. Cures 2.0 requires the U.S. Department of Health and Human Services (HHS) to conduct a nationwide study on the implications of long COVID and to develop a nationwide testing and vaccine distribution strategy to be used in future pandemics. While the bill’s sponsors are working to drum up support amongst their Senate colleagues for fast tracking the legislation, they have also acknowledged that Cures 2.0 is unlikely to reach the President’s desk by the end of the year as they had initially hoped. Many expect next year’s Food and Drug Administration (FDA) user fee reauthorization to serve as a vehicle for Cures 2.0 passage given lawmakers’ current focus on the Build Back Better reconciliation package, government funding, and the debt ceiling.

Leahey, Speier, Butterfield to Retire

Senate President Pro Tempore and Appropriations Chair Patrick Leahy (D-Vt.) has announced that he will not seek reelection in 2022. Leahy is the chamber’s longest-serving member, having first been elected in 1974. In addition to leading the appropriations panel, Leahy serves on the Judiciary and Agricultural committees. The names of several potential Democratic contenders have been floated, including Rep. Peter Welch (D-Vt.), state Senate President Pro Tempore Becca Balint, state Sen. Kesha Ram-Hinsdale, and Lt. Gov. Molly Gray. The next Democrat in line to serve as president pro tempore is Sen. Dianne Feinstein (D-Calif.), followed by Sen. Patty Murray (D-Wash.).

Leahy’s retirement could have a ripple effect on the leadership of Senate committees with health care jurisdiction. Sen. Patty Murray, current chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, would be in line to replace Leahy as Democratic leader of the Appropriations Committee. If she chooses to do so, she may leave an opening at the helm of the Labor-Health and Human Services-Education Subcommittee, with Sens. Jeanne Shaheen (D-N.H.) and Jeff Merkley (D-Ore.) next in line for that position. Sen. Bernie Sanders (I-Vt.) would be eligible for the position of top Democrat on the HELP Committee if Murray assumes the senior appropriations post. This would leave a vacancy at the head of the Senate Budget Committee.

Democratic Reps. Jackie Speier (D-Calif.) and G.K. Butterfield (D-N.C.) also announced that they will not seek reelection next year. Butterfield was first elected in 2004 and is a member of the House Energy and Commerce Committee. Speier was first elected to national office in 2008. She currently serves on the House Committee on Oversight and Reform.

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