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 Employer Health Plan Legislation

Before leaving for a two week recess, the House of Representatives passed the CHOICE Arrangement Act (H.R. 3799) by a 220-209 party-line vote. The bill would codify two Trump-era regulations intended to lower the cost of employer- sponsored health insurance. The first would allow companies to offer association health plans, and the second would allow employers to provide tax-free contributions through individual coverage health reimbursement arrangements (ICHRAs) to help employees pay for health coverage in the individual market. Democrats have argued that these policies can be used by employers to discriminate against certain classes of employees. The Congressional Budget Office (CBO) estimates that the bill would add $348 million to the federal deficit over the next decade. The bill is unlikely to be taken up by the Democratic- controlled Senate. The House and Senate will return to session the week of July 10th.

Senate Appropriators Adopt 302(b) Allocations, Two FY24 Spending Bills

Senate appropriators have adopted the top-line spending levels agreed to in this year’s bipartisan debt limit deal. The Senate Appropriations Committee agreed to the subcommittee allocations for fiscal year (FY) 2024’s twelve annual appropriations bills by a 15-13 party line vote. The figures represent a $12.2 billion cut compared to FY 2023 levels, but are consistent with the debt limit agreement signed into law earlier this month. Committee Chair Patty Murray (D-Wash.), however, has stated plans to redirect unspent funds and use emergency spending to increase total spending levels. Republicans objected to the topline figures, stating that they were not consulted in the drafting of the allocations. Their Republican counterparts in the House of Representatives have opted to adopt spending levels below the ceiling agreed to in the most recent debt limit negotiations.

Senate appropriators also advanced the Agriculture- Rural Development-Food and Drug Administration (FDA) and Military Construction-Veterans Affairs (VA) appropriations bills in two 28-0 votes last week. The Agriculture-FDA bill includes $26 billion in discretionary spending, a $513 million increase in budget authority over current levels. The FDA would see a $20 million increase. The Military Construction-VA bill includes $135.3 billion in nondefense discretionary spending, a slight increase over FY 2023. VA medical care would see a $2.3 billion increase for a total of $121 billion.

EPW Leadership Requests Comments on PFAS Discussion Draft

Leadership of the Senate Enviornment and Public Works (EPW) Committee has released a bipartisan draft bill on per- and polyfluoroalkyl substances (PFAS). The legislation seeks to improve the mitigation and remediation of PFAS contamination. The legal definition of PFAS included in the bill would exclude many types of the chemicals used by the medical device industry. The panel is requesting stakeholder comments on the draft by July 3, 2023.

RSC Releases FY2024 Budget, Includes Medicare Reforms

The Republican Study Committee (RSC) released its fiscal year 2024 budget last week. The proposal, titled “Protecting America’s Economic Security,” balances the budget in seven years, cuts spending by $16.3 trillion over the next decade, and reduces taxes by $5.1 trillion over 10 years. The budget is comprised of over 220 individual bills and initiatives from RSC members, including a Medicare premium support plan that would implement a model whereby the program’s trust funds would be merged into a single fund that would pay premium subsidies to Medicare beneficiaries. The RSC budget asserts that this type of model could reduce premiums overall by 7%.

Blunt Rochester Officially Enters DE Senate Race

As expected, Rep. Lisa Blunt Rochester (D-Del.) has filed the paperwork necessary to launch a 2024 Senate campaign. Sen. Tom Carper (D-Del.) announced earlier this year that he would not seek reelection and endorsed Blunt Rochester to succeed him. If elected, she would be the first woman and first person of color to serve the state of Delaware in the Senate.

Employers Endorse Legislation to Address “Dishonest Billing”

The ERISA Industry Committee has spearheaded a letter to members of Congress signed by other business stakeholders endorsing the Facilitating Accountability in Reimbursement (FAIR) Act (H.R. 3417), and the Site-based Invoicing and Transparency Enhancement (SITE) Act (S.1869). The letter argues that the bills will help address the problem of dishonest billing, or when hospitals “secretly reclassify a doctor’s office they own as a hospital setting in order to charge more money.” The employers argue that these practices contribute to consolidation and higher prices across the health care industry. The FAIR Act, introduced by Reps. Kevin Hern (R-Okla.) and Annie Kuster (D-N.H.), aims to harmonize billing practices by ensuring all off-campus outpatient departments have separate national provider identification (NPI) numbers. It would also direct the Centers for Medicare and Medicaid Services to prioritize auditing facilities recently converted to off campus hospital outpatient departments to ensure they are meeting remote location of a hospital facility requirements. The SITE Act, introduced by Sens. Mike Braun (R-Ind.) and Maggie Hassan (D-N.H.), would end the 2015 Bipartisan Budget Act’s site-neutral exceptions, and prevent off-campus emergency departments from charging higher rates than on-campus emergency departments when standalone emergency facilities are near a hospital campus. It would also require health systems to establish and bill using a unique NPI for every off-campus outpatient department.

Upcoming Congressional Hearings and Markups

House Small Business Subcommittee on Oversight, Investigations, and Regulations hearing “Burdensome Red Tape: Overregulation in Health Care and the Impact on Small Businesses;” 10:00 a.m.; July 19

Recently Introduced Health Legislation

H.R.4202 — To amend title 18, United States Code, to expand to all firearms the requirement that Federal firearms licensees report sales of 2 or more handguns to the same unlicensed person within 5 consecutive business days. Sponsor: Torres, Norma J. [Rep.-D-CA-35]; Committees: House – Judiciary

H.R.4201 — To amend title 18, United States Code, to require a gun lock to be provided to every firearm purchaser. Sponsor: Tlaib, Rashida [Rep.-D-MI-12]; Committees: House – Judiciary

H.R.4195 — To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to allow parental choice in the selection of primary health insurance coverage or primary coverage under a group health plan for certain dependent children. Sponsor: Davids, Sharice [Rep.-D-KS-3]; Committees: House - Energy and Commerce; Ways and Means; Education and the Workforce

H.Res.522 — Recognizing the role of father engagement in improving overall health outcomes during pregnancy, birth, and postpartum, for both the mother and baby. Sponsor: Veasey, Marc A. [Rep.-D-TX-33]; Committees: House - Energy and Commerce

S.2044 — A bill to require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs, and for other purposes; Sponsor: Merkley, Jeff [Sen.-D-OR]; Committees: Senate - Health, Education, Labor, and Pensions

S.2052 — A bill to amend title XVIII of the Social Security Act to enforce any willing pharmacy requirements and establish safeguards to ensure patient access to pharmacies in Medicare part D, and for other purposes; Sponsor: Tester, Jon [Sen.-D- MT]; Committees: Senate – Finance

S.2059 — A bill to impose sanctions with respect to pharmaceutical companies of the People’s Republic of China and certain cartels that traffic fentanyl into the United States, and for other purposes; Sponsor: Menendez, Robert [Sen.-D-NJ]; Committees: Senate - Banking, Housing, and Urban Affairs

H.R.4215 — To require the Secretary of Health and Human Services to establish reference prices for prescription drugs for purposes of Federal health programs, and for other purposes; Sponsor: Dingell, Debbie [Rep.-D-MI-6]; Committees: House - Energy and Commerce; Ways and Means; Armed Services; Veterans’ Affairs; Oversight and Accountability; Natural Resources

H.R.4223 — To establish an artificial intelligence commission, and for other purposes; Sponsor: Lieu, Ted [Rep.-D-CA-36]; Committees: House - Science, Space, and Technology

S.Res.264 — A resolution designating June 2023 as “National Post-Traumatic Stress Awareness Month” and June 27, 2023, as “National Post-Traumatic Stress Awareness Day”; Sponsor: Sullivan, Dan [Sen.-R-AK]; Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent.

S.2070 — A bill to prohibit the Secretary of Veterans Affairs from replacing physician anesthesiologists with certified registered nurse anesthetists under the health care system of the Department of Veterans Affairs, and for other purposes; Sponsor: Cantwell, Maria [Sen.-D-WA]; Committees: Senate - Veterans’ Affairs

S.2078 — A bill to direct the Secretary of Veterans Affairs to take actions necessary to ensure that certain individuals may update the burn pit registry with the cause of death of a registered individual, and for other purposes; Sponsor: Welch, Peter [Sen.-D-VT]; Committees: Senate - Veterans’ Affairs

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