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.


Biden Administration Releases President’s FY24 Budget Proposal

The White House released the President’s fiscal year (FY) 2024 budget proposal last week. While the plan does not have any chance of being adopted by Congress, it represents the administration’s policy priorities and provides a starting point for Democratic appropriators as negotiations get underway on FY24 spending bills in the divided congress. The $6.9 trillion budget request, which seeks a 3.3% increase in defense spending and a 6.5% increase for nondefense discretionary programs, would increase taxes by $5.5 trillion and reduce the deficit by more than $2 trillion over the next 10 years. The U.S. Department of Health and Human Services would see an 11.5% increase to its overall budget. This includes $144.3 billion in discretionary and $1.7 trillion in mandatory proposed budget authority. The HHS Budget in Brief can be found here.

A main component of the budget focuses on Medicare solvency. The President proposes to increase the Medicare tax rate from 3.8% to 5% on earned and unearned income above $400,000, as well as to eliminate a tax loophole that allowed certain business owners to avoid paying Medicare taxes on some of their income. The President proposes to dedicate proceeds from the net investment income tax to Medicare’s Hospital Insurance (Part A) Trust Fund. The budget would also strengthen the Medicare program’s drug pricing negotiation authority as established by the Inflation Reduction Act by doubling the number of drugs subject to Medicare negotiation – to 20 Part D drugs in 2026, and 40-Part B and Part D drugs each subsequent year. The budget would also decrease the number of years treatments are excluded from negotiation to five years. The White house estimates that these provisions would save $200 billion over the next decade to extend the solvency of the Medicare program.

Casey, Tillis Circulate Dear Colleague on NIH Funding

Sens. Bob Casey (D-Pa.) and Thom Tillis (R-N.C.) are circulating their annual Dear Colleague letter in support of robust funding for the National Institutes of Health (NIH). The letter to Senate appropriations leadership urges them “to consider the tremendous benefits of sustained investment in the NIH and...remember our Nation’s role as a world leader in biomedical research and the impact this research has on the American people.” Casey and Tillis also ask appropriators to include the full allocation of funding for the NIH as provided by the 21st Century Cures Act. Members have until April 7th to sign on to the letter.

Bill to Declassify COVID-19 Origin Information Sent to President

The House of Representatives voted 419-0 to require Director of National Intelligence Avril Haines to declassify information about the origins of the coronavirus pandemic. Passage of the COVID-19 Origin Act (S. 619) follows a recent report from the Department of Energy which concluded with ‘low confidence’ that COVID-19 most likely originated from a lab leak in China. Director of the Federal Bureau of Investigation (FBI) Christopher Wray has separately acknowledged the FBI’s determination that the pandemic had most likely come from a laboratory incident in Wuhan. The bill, which was previously passed by the Senate on March 1, will now be sent to President Joe Biden’s desk for his signature.

Senate Confirms Head of Administration for Native Americans

The Senate confirmed Patrice H. Kunesh to serve as commissioner of the Administration for Native Americans at the U.S. Department of Health and Human Services by a vote of 57-35. Kunesh, of Standing Rock Lakota descent, is an attorney and policy advocate. During her career she has worked as a public servant at the tribal, state, and federal levels.

H.R.1, the Lower Energy Costs Act

House Speaker Kevin McCarthy (R-Calif.) announced last week that H.R. 1 for the 118th Congress will be the Lower Energy Costs Act. The bill aims to increase the production and export of American energy and reduce regulatory burdens. It includes legislation originating from the Energy and Commerce, Natural Resources, and Transportation and Infrastructure committees. Per House rules, the first ten numbers for bills are reserved for the Speaker to assign and the second ten numbers for the Minority Leader. Legislation numbered H.R. 1 to H.R. 20 typically signifies priority issues for the majority and minority parties.

E&C Health Subcommittee Advances Five Bills

The House Energy and Commerce Subcommittee on Health advanced five pieces of health-related legislation last week.

  • The Protecting Health Care for All Patients Act (H.R. 485) would prohibit the use of quality-adjusted life years (QALYs) in federal and state programs. Key lawmakers have stated that they are close to reaching a bipartisan agreement on the bill, which was introduced by Committee Chair Cathey McMorris Rodgers (R-Wash.). Ranking Member Frank Pallone (D-N.J.) has expressed concerns that the legislation could prevent the measurement of pharmaceutical cost-effectiveness in Medicare drug price negotiations, while proponents of the bill believe QALYs devalue the lives of people with disabilities. Health Subcommittee Ranking Member Anna Eshoo (D-Calif.) said during the markup that an agreement on the bill is “extremely close,” and Pallone said he is seeking input from Armed Services and Veterans Affairs policymakers on the potential impact of the measure on programs within their jurisdiction.
  • The Block, Report, and Suspend Suspicious Shipments Act (H.R. 501) would require drug manufacturers and distributors to report and block suspicious orders of controlled substances.
  • The 9-8-8 Lifeline Cybersecurity Responsibility Act (H.R. 498) would require the U.S. Department of Health and Human Services’ (HHS) to undertake efforts to protect the 9-8-8 Suicide & Crisis Lifeline from cybersecurity threats.
  • The HALT Fentanyl Act (H.R. 467) would permanently place fentanyl-related substances into Schedule I of the Controlled Substances Act.
  • The Securing the Border for Public Health Act (H.R. 801) would allow the HHS secretary to suspend persons and imports related to certain controlled substances from certain countries into the U.S.

Hassan, Braun Weigh in on Health Price Transparency Implementation

Sens. Maggie Hassan (D-N.H.) and Mike Braun (R-Ind.) are asking the White House to close certain loopholes they argue are being used by the health insurance industry to prevent health care price transparency. Both Hassan and Braun are members of the Health, Education, Labor and Pensions Committee. The lawmakers call on the Centers for Medicare and Medicaid Services (CMS) to revise the process for filing price data as required by the 2020 Transparency in Coverage Final Rule. “Americans should not struggle with opaque pricing for health care, and we respectfully ask CMS to update its rule to ensure that there is true health plan transparency and compliance,” the letter states. They suggest the agency limit file sizes, create standardized reporting, reduce the frequency of reporting, and require a clear organizational system and standardized labeling of reported health care price data. Hassan and Braun also ask CMS to increase enforcement against plans that provide low-quality data or no data at all.

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