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, McCarthy Reach Deal on Debt Ceiling

President Joe Biden and House Speaker Kevin McCarthy (R-Calif.) have reached a deal to avert a U.S. default on its debt obligations and suspend the debt ceiling through January 2025. The agreement – dubbed the Fiscal Responsibility Act – caps non-defense spending, keeping it roughly flat in 2024 and increasing it by just 1% in 2025. It includes a penalty if Congress fails to pass fiscal year (FY) 2024 appropriations legislation, imposing a 1% across the board cut if the bills are not passed. The compromise also expands work requirements in the Supplemental Nutrition Assistance Program from up to age 49 under current law to age 54. The more stringent work requirements would sunset in 2030 without further action by Congress.

The deal was crafted by Office of Management and Budget Director Shalanda Young, White House senior adviser Steve Ricchetti, White House legislative affairs director Louisa Terrell, Rep. Garret Graves (R-La.), Rep. Patrick McHenry (R-N.C.), and the Speaker’s chief of staff Dan Meyer. The House of Representatives will return to session during a planned Memorial Day recess. The House Rules Committee will consider the bill on Tuesday afternoon and McCarthy is expected to bring the bill for a vote on the House floor on Wednesday. Both Republican and Democratic leadership have indicated that there is enough support to pass the deal. If the package is sent to the Senate on Wednesday, the chamber could then vote on the bill as early as Saturday morning (June 3), unless members agree to advance the measure via unanimous consent. The Treasury is projected to run out of cash reserves on June 5.

In related news, the House Appropriations Committee postponed the markup of four FY 2024 appropriations bills last week, citing the then ongoing debate on the debt limit. Chair Kay Granger (R-Texas) stated that she wished to give Speaker McCarthy “maximum flexibility” as he engaged in debt ceiling negotiations with the White House. The panel was scheduled to mark up the Agriculture-Rural Development-Food and Drug Administration spending package last Wednesday. The Senate Appropriations Committee previously announced plans to consider funding bills starting in June.

House Passes WH-Endorsed Fentanyl Bill

The House of Representatives passed the HALT Fentanyl Act (H.R. 467) last week. The bill would make permanent the temporary scheduling of fentanyl-related substances (FRS) as Schedule I substances, which are subject to heighted regulatory and law enforcement. The temporary scheduling of FRS is set to expire at the end of 2024. The bill would cover those substances with a high potential for abuse and no currently accepted medical use; medical-grade fentanyl would continue to be a Schedule II substance. Seventy-four Democrats joined Republicans in support of the measure, which was also endorsed by the White House. Other Democrats, however, including House Energy and Commerce Committee Ranking Member Frank Pallone (D-N.J.), criticized the legislation and raised concerns about its potential to exacerbate inequities in the criminal justice system and the possible implications for FRS that are found that have medical applications.

E&C Advances Six Health Bills

The House Energy and Commerce Committee advanced nineteen bills last week, including legislation to overhaul the nation’s organ donation system and to reform pharmacy benefit manager (PBM) practices. The panel advanced the six following health bills out of committee:

  • H.R. 1418, the Animal Drug User Fee Amendments of 2023 was favorably reported to the House by a bipartisan vote of 49-0.
  • H.R. 2544, the Securing the U.S. Organ Procurement and Transplantation Network Act was favorably reported to the House by a bipartisan vote of 48-0.
  • H.R. 2666, the Medicaid VBPs for Patients (MVP) Act was reported favorably to the House by a bipartisan vote of 31- 19.
  • H.R. 3284, the Providers and Payers COMPETE Act was reported favorably to the House by a bipartisan vote of 49-0.
  • H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program, was favorably reported to the House by a vote of 29-22.
  • H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 was favorably reported to the House by a bipartisan vote of 49-0. The bill was amended to include H.R. 3285, the Fairness for Patient Medications Act.

Select COVID-19 Subcommittee Probes NIH Funding to Chinese Lab

House Select Subcommittee on the Coronavirus Crisis Pandemic Chairman Brad Wenstrup (R-Ohio) has sent a letter to the National Institutes of Health (NIH) requesting information on its 2020 decision to cut funding for the Wuhan Institute of Virology (WIV). According to a letter obtained by the panel, the NIH informed the University of California, Irvine in May 2020 that it would be terminating the subgrant funding to the Chinese laboratory because its research posed “serious bio-safety concerns.” Wenstrup blames the agency for publicly obscuring its support for the work of the WIV, which some suspect is the origin of the COVID-19 pandemic, while privately acknowledging the safety concerns posed by the research.

CBO Releases Latest Health Coverage Projections

The Congressional Budget Office (CBO) released updated projections last week of health insurance coverage for people under age 65 over the next decade. The share of Americans under age 65 who are uninsured is currently at a historic low of 8.3%, which CBO attributes to temporary policies instituted in response to the COVID-19 pandemic, including continuous coverage provisions in state Medicaid programs and enhanced premium subsidies in the Affordable Care Act’s individual marketplace. CBO’s analysis indicates that more than six million people will lose their health insurance coverage following the end of these COVID-era policies. While the nation’s uninsured rate will remain below pre-pandemic levels, it is expected to rise from 8.3% to 10.1% in 2033.

Longtime Delaware Senator Carper to Retire in 2024

Sen. Tom Carper (D-Del.), 76, announced last week that he will not run for reelection in 2024. Carper has served for over 20 years in the Senate. Prior to this time, he served as the governor of Delaware and as the state’s sole representative in the U.S. House for five terms. He currently sits on the Enviornment and Public Works, Finance, and Homeland Security and Governmental Affairs committees. He is the fourth Democratic senator – along with Dianne Feinstein (Calif.), Debbie Stabenow (Mich.), and Ben Cardin (Md.) – to announce his retirement from the chamber. Carper has endorsed Rep. Lisa Blunt Rochester (D-Del.) to succeed him. Blunt Rochester has indicated that she is interested in running for the seat but has not officially announced her candidacy.

CMS Releases Updated FAQ on PHE Unwinding

The Centers for Medicare and Medicaid Services (CMS) released an updated frequently asked questions document last week on the end of the COVID-19 public health emergency (PHE) indicating that the Medicare program will no longer cover telehealth services provided by hospital-based physical and occupational therapists and speech language pathologists beyond 2023. CMS states that it will exercise discretion through the end of this year to continue paying for outpatient therapy provided via telehealth billed from institutional providers. The agency did not specify for how long skilled nursing facilities and home health agencies could continue to bill for telehealth therapy services. The most recent omnibus spending bill delinked Medicare telehealth access from the PHE declaration, extending reimbursement for certain telehealth services through 2024.

Upcoming Congressional Hearings and Markups

House Rules Committee meeting to consider the Fiscal Responsibility Act of 2023; 3:00 p.m.; May 30

Senate Judiciary Committee Executive Session to consider S. 1080, Cooper Davis Act to amend the Controlled Substances Act to require electronic communication service providers and remote computing services to report to the Attorney General certain controlled substances violations, and S. 474, REPORT Act; 10:00 a.m.; June 1

May 30, 2023: | Page 1 Page 2



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