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 GOP Releases Debt Ceiling Proposal

House GOP leadership released their legislative proposal to lift the nation’s $34.1 trillion debt limit by $1.5 trillion or until March 31, 2024, whichever comes first, in exchange for $130 billion in proposed budget cuts. The Limit, Save, Grow Act of 2023 would achieve these cuts by freezing discretionary spending at fiscal year (FY) 2022 levels - $1.47 trillion. Any future spending increases would be capped at 1% annually for the next decade, reaching $1.61 trillion in FY 2033. The bill would permit new budget authority only for certain activities, including health care fraud and abuse prevention. The legislation also includes provisions to claw back unspent and unobligated COVID-19 funding and to institute work requirements for social safety net programs. House Speaker Kevin McCarthy (R-Calif.) estimated that the bill would cut budget deficits by $4.5 trillion over the next ten years.

The proposal has been rejected by Democrats in favor of a clean increase to the debt limit. Both the White House and congressional Democrats have also expressed strong opposition to the health provisions of the proposal, which would require Medicaid recipients to work, look for work, or participate in community engagement for 80 hours a month, exempting those with dependent children and those who are “physically or mentally unfit”, enrolled in an educational program, under 19 years old, or over 56 years old. Senate Majority Leader Chuck Schumer (D-N.Y.) stated that the GOP bill has no chance of moving through the Senate, where Sen. Joe Manchin (D-W.Va.) is the only Democrat who is not calling for Congress to move a clean debt ceiling increase. Manchin has praised Speaker McCarthy for putting forth a debt ceiling proposal and criticized President Biden for refusing to negotiate with Republicans on the debt limit.

The House GOP plans to hold a vote on the measure this week, but it remains unclear whether Republicans have the necessary support within their own caucus to pass the legislation. The GOP can afford to lose only four votes given unified Democratic opposition to the proposal. Several Republican members, including Reps. Tim Burchett (R-Tenn.), Victoria Spartz (R-Ind.), and Brian Fitzpatrick (R-Pa.), have stated that they remain undecided on the bill. Without an increase or suspension of the debt ceiling the nation could default on its payment obligations as early as June.

HELP, Finance Hope to Advance Bipartisan Health Care, PBM Legislation in Coming Weeks

Bipartisan leadership of the Senate Health, Education, Labor and Pensions (HELP) Committee and Senate Finance Committee have begun previewing their plans to advance health care related legislation in the coming weeks. The HELP Committee is expected to soon schedule a markup of a legislative package that could contain policies focused on pharmacy benefit managers (PBMs), strengthening generic drug and biosimilar competition, supporting the health care workforce, and capping the cost of insulin for individuals with private health insurance. The panel has also scheduled a hearing for May 10 in which the nation’s three main manufacturers of insulin products have agreed to testify alongside representatives from the country’s major PBMs. The CEOs of Eli Lilly and Company, Novo Nordisk, and Sanofi – which control 90% of the insulin market - will be in attendance. PBM industry executives from CVS Health, Express Scripts, and OptumRx will also testify. Chairman Bernie Sanders (I-Vt.) highlighted the hearing as the latest step in his push to make insulin more affordable and to lower the price of all prescription drugs.

While HELP has jurisdiction over the commercial health insurance market, the Finance Committee manages policies impacting federal health programs. Chairman Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho) released their proposed framework for legislation that aims to “modernize and enhance” federal prescription drug programs while reducing drug costs for patients and taxpayers last week. The framework identifies the following challenges facing the nation’s prescription drug programs: misaligned incentives that drive up prices and costs, insufficient transparency that distorts the market, hurdles to pharmacy access, and behind-the-scenes practices that impede competition and increase costs. Their proposal includes the following potential policy solutions:

  • Delinking PBM compensation from drug prices;
  • Enhancing PBM accountability to health plan clients;
  • Ensuring discounts negotiated by PBMs produce meaningful savings for seniors;
  • Addressing and mitigating practices that unfairly inflate the prices patients and government programs pay for prescription drugs;
  • Modernizing Medicare’s “Any Willing Pharmacy” requirements; and
  • Increasing transparency around how financial flows across the prescription drug supply chain impact government health care programs.
According to recent reports, the emerging health care packages from HELP and Finance have the potential to be combined with bipartisan drug patent legislation advanced by the Senate Commerce and Judiciary committees earlier this year.

Constituents Call for Feinstein Resignation Amidst Extended Absence from Senate

Acoalition of more than 60 progressive grassroots organizations representing more than 100,000 Californians have sent a letter to Sen. Dianne Feinstein (D-Calif.) urging her to resign. Her resignation would allow California Governor Gavin Newsom to appoint an interim senator to serve through the 2024 election. The groups argue that Feinstein’s extended absence from the Senate following her shingles diagnosis in February and subsequent hospitalization have impeded the Democratic Senate majority from advancing the President’s agenda. Democrats currently hold a 51-49 majority in the Senate, and Feinstein’s vote may soon be necessary to confirm Julie Su as secretary of the Department of Labor and to raise or suspend the debt limit. Her absence has also deadlocked the Judiciary Committee and impacted the panel’s ability to consider the President’s judicial nominations and subpoena hearing witnesses. Republicans blocked an attempt by Senate Majority Leader Chuck Schumer (D-N.Y.) to allow Sen. Ben Cardin (D-Md.) to temporarily fill Feinstein’s position on the Judiciary Committee last week. Feinstein is also a member of the Senate Appropriations Committee, and her absence could impact markups of fiscal year 2024 spending legislation. Feinstein’s office has not provided an estimated return date for the 89-year-old senator.

President Expected to Announce NIH Nominee This Week

President Joe Biden is expected to announce his nomination of National Cancer Institute (NCI) Director Monica Bertagnolli to serve as Director of the National Institutes of Health (NIH) this week. Dr. Bertagnolli is a cancer surgeon and researcher. If confirmed, she would be only the second woman to lead the NIH as permanent director. Prior to starting as NCI’s first female director last year, Bertagnolli worked as the Richard E. Wilson Professor of Surgery in the field of surgical oncology at Brigham and Women’s Hospital in Boston. She has led NCI since October 2022 while undergoing her own treatment for early-stage breast cancer diagnosed in November.

E&C Republicans Probe NIH Leadership Vacancies, EPA Regulation of HFCs

Republican leadership of the House Energy and Commerce Committee have launched an investigation into leadership vacancies at the National Institutes of Health (NIH). The probe, announced by Chair Cathy McMorris Rodgers (R-Wash.), Health Subcommittee Chair Brett Guthrie (R-Ky.), and Oversight and Investigations Chair Morgan Griffith (R-Va.), focuses on the current lack of directors at the National Institute of Allergy and Infectious Diseases and the Fogarty International Center. The lawmakers request that U.S. Department of Health and Human Services Secretary Xavier Becerra respond to questions regarding his involvement in the appointment and reappointment of vacant director positions. They argue that his involvement is necessary to comply with the Appointments Clause of the Constitution, but that information provided by the NIH in response to questions from the committee last year indicate that the NIH Director has been the individual solely responsible for making appointments or reappointments.

Chair Rodgers, alongside Health Subcommittee Chair Guthrie and Environment, Manufacturing, & Critical Materials Subcommittee Chair Bill Johnson (R-Ohio), have also sent a letter to the Environmental Protection Agency (EPA) regarding the regulation of the reclaiming and reuse of hydrofluorocarbons (HFCs). The lawmakers express concern that the agency’s delay of reclaim and reuse provisions will negatively impact the availability and affordability of meter dose inhalers (MDIs). “We are worried that forcing albuterol MDI manufacturers to rely upon constrained and increasingly expensive options to satisfy the market’s needs jeopardizes the supply of essential public health devices and endangers drug access, availability, and affordability for Americans,” the letter states.

Sen. Patty Murray Casts 10,000th Vote

Sen. Patty Murray (D-Wash.) became the first woman in the Senate’s history to cast 10,000 votes last week. The vote came on a proposed amendment to the Fire Grants and Safety Act (S. 870), which would extend federal funding for programs supporting the nation’s local fire departments. The milestone was recognized on the Senate floor and applauded by Democrats and Republicans alike. Only 32 individuals – including Mitch McConnell, Chuck Grassley, and Joe Biden – have cast more than 10,000 votes in the chamber’s history. Murray, who was first elected to the Senate in 1993, was selected as the first woman to serve as Senate president pro tempore earlier this year.

VA Delays EHR Modernization Effort Indefinitely

The Department of Veterans Affairs (VA) has decided to further delay the implementation of its electronic health records (EHR) modernization project for an indefinite period of time. While the project was initially slated to be completed over 10 years, the VA had already decided to pause its roll-out to new sites until June. The system upgrade has faced significant issues both in terms of projected costs and patient safety. The VA’s contract with its vendor Oracle Cerner expires in May, and the two parties are currently in negotiations about the next five-year contract period.

Medscape Releases 2023 Physician Compensation Report

Anew report from Medscape reveals that the number of physicians who accept Medicare and Medicaid patients is at an all-time low. According to the 2023 Physician Compensation Report, only 65% of physicians surveyed indicated that they would continue treating current Medicare or Medicaid patients and take on new ones. Eight percent stated that they would not take on new Medicare patients, while 5% stated they would not take on new Medicaid patients. Four percent plan to stop treating all or some of their current Medicare patients, while 3% will stop treating all or some of their current Medicaid patients altogether. Approximately 22% of respondents had not decided their plans for accepting Medicare and Medicaid beneficiaries. The report is based on responses from 10,011 physicians across more than 29 specialties collected between October 2022 and January 2023.

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