4.23.18 – 4.27.18 Health Wrap Up
Please find below a summary of the latest major health policy developments in Washington this week. Please let us know if you have any questions.
Scheduling note: both chambers are on recess next week. Unless activity warrants, we will send the next wrap up on May 4.
BUDGET AND APPROPRIATIONS
FY19 Appropriations
A meeting took place on Monday between Senate Majority Leader Mitch McConnell (R-KY), Senate Minority Leader Chuck Schumer (D-NY), and Appropriations Committee Chairman Richard Shelby (R-AL) and Ranking Member Patrick Leahy (D-VT) to discuss the path forward for fiscal 2019 appropriations bills in the Senate. Following the meeting, Senator Schumer announced on the Senate floor that he and McConnell have agreed on parameters to take appropriations bills to the floor and prevent extraneous amendments from blocking progress on the measures. The ambitious plan includes an open-amendment process and small batches of spending bills, rather than 12-bill omnibus.
Shelby has said he hopes to pass a handful of non-controversial bills before lawmakers leave Washington for the November midterm elections. His plan, however, would still likely require a continuing resolution funding the government at current levels to make it past the September 30 funding deadline. In order to do get bills on the floor quickly, subcommittees may start marking up bills before the committee has settled on allocations for all 12 panels, Shelby said after a closed-door committee meeting. He also said that the most difficult bills to negotiate, Defense and Labor HHS, will come last.
In the House, leaders have described small batches of FY19 spending bills as the successful path forward, with the Military Construction-VA and Energy and Water bills likely in the first batch.
Appropriators, however, still haven’t settled on 302(b) allocations for the 12 subcommittees in either the House or Senate. For the second straight year, the House Appropriations Committee is not planning to release a full set of subcommittee allocations in advance of markups and will instead divulge funding for each subcommittee one at a time.
In the House, two out of the 12 funding levels were disclosed this week when the appropriations committee unveiled its draft Military Construction-VA and Legislative Branch bills. The Military Construction-VA bill is slated to receive such a large increase, $4.2 billion of the extra $5 billion Congress has to spend on domestic programs in FY19, that other House subcommittee leaders say they are now bracing for flat funding or even a slight decrease. Labor HHS Subcommittee Chairman Tom Cole (R-OK) said that he is expecting a slight funding cut after seeing the size of the VA's increase.
The Senate is simultaneously preparing its subcommittee allocations, though Chairman Richard Shelby (R-AL) has not indicated whether he will release those figures ahead of the bill markups.
Rescission Package
White House Office of Management and Budget Director Mick Mulvaney told Republican lawmakers this week that a package of suggested spending rescissions, from the Trump administration, expected in early May, will be no more than $25 billion. House Appropriations Committee Chairman Rodney Frelinghuysen (R-NJ), who has criticized the idea of rescissions, said he has gotten no communication from the White House about the idea.
SUBSTANCE USE
OPIOIDS
Senate
On Tuesday, the Senate Health, Education, Labor and Pensions (HELP) Committee approved the Opioid Crisis Response Act (S. 2680) by a unanimous vote of 23 – 0.
In his opening remarks, Chairman Alexander (R-TN) touted the work of the Committee in developing S. 2680, which he said includes 40 different proposals from 38 different senators on both sides of the aisle. Alexander also said that while the challenge before the Committee to address the opioid misuse and overdose epidemic has been described as needing a “moonshot,” he believes that what the federal government can do is “create an environment so that everyone – judges, mayors, counselors, police officers, Drug Enforcement Administration agents, doctors, nurses, parents, pharmacists, and hospitals – can succeed in fighting the crisis.”
With the bill now favorably reported, Alexander said he will ask Leader McConnell (R-KY) for floor time so the bill may be considered this summer. He said they will continue to consider ideas between now and when the bill will go to the floor and he anticipates the work of other committees – particularly Finance and Judiciary – may be incorporated into one package when the bill is before the full Senate.
House
On Wednesday, the House Energy and Commerce Health Subcommittee approved 57 bills to address the opioid misuse and overdose epidemic; the bills are now referred to the full Committee for consideration.
7 of the 64 bills that were noticed were not considered at the markup; at 9:30pm ET Subcommittee Chairman Burgess (R-TX) said that the bills that would not be considered were worthy of discussion but not ready for the full Committee and they wanted to continue working on them rather than have them voted down. The bills that were not voted on included:
- H.R. 3545, Overdose Prevention and Patient Safety Act
- HR 3692 Addiction Treatment Access Improvement Act
- H.R. 4005, Medicaid Reentry Act
- H.R. 4998, Health Insurance for Former Foster Youth Act
- H.R. 5477, Rural DOCS Act
- H.R. 5562, To require the Secretary of Health and Human Services to develop a strategy implementing certain recommendations relating to the Protecting Our Infants Act of 2015, and for other purposes
- H.R. __, FDA Long-term Efficacy
Ranking Member Pallone asked that the bills that were not considered at the markup be considered before the other bills go to the full Committee and Chairman Burgess (R-TX) said they would consider the request.
During the opening statements, Democrats expressed dismay at the speed at which the Committee is moving on such a large number of bills with several saying they would prefer “quality over quantity.” In response to a question about the amount of time there will be to work on bills before they advance, Subcommittee Chairman Burgess said he does not anticipate the full Energy and Commerce Committee will markup for several weeks and then Floor consideration is not likely until several weeks after that. As we have previously reported, full Committee Chairman Walden has very publicly said he wants bills ready for a House floor vote before Memorial Day.
Detailed summaries of both markups are attached.
Medical Marijuana
This week, medical marijuana supporters gained support from key members of Congress. Senate Democratic Leader Chuck Schumer of New York announced his support to decriminalize marijuana at the federal level. Further, Congressman Bob Goodlatte (R-VA), who chairs the House Judiciary Committee, announced his cosponsorship of the Medical Cannabis Research Act. The bill authorizes limited production of cannabis for research purposes and protects institutions conducting the research from losing federal funding. Though Goodlatte is retiring from Congress this year, he had previously been one of Congress’s most ardent opponents of marijuana use. The support of Schumer and Goodlatte suggests a possible sea change in the perception of medical marijuana, and marijuana policy generally, in Congress and among the American people.
MEDICARE
On April 26th, the House Ways and Means Committee Health Subcommittee held a hearing on innovations in health care.
The hearing discussed how innovations being pioneered by the witnesses are disrupting the status-quo and how Congress can help expand upon these advancements. Witnesses and Subcommittee members focused on how they can help both improve and modernize the Medicare program and in turn increase its sustainability. Some of the areas touched on during the hearing included post-acute and long term care, healthcare consolidation, telehealth and substance use and mental health.
A summary of the hearing is attached.
TRUMP ADMINISTRATION
Veterans Administration
In late March, President Trump nominated his White House physician Rear Admiral Ronny Jackson to be Secretary of Veterans Affairs. His nomination was met with a degree of skepticism that he had never run a major operating unit comparable to the duties of running the VA. This week, news reports came forward citing dozens of current and former coworkers (both military and civilian) which alleged serious medical misconduct. Most concerning were reports that Jackson loosely prescribed large quantities of opiates and other drugs without reviewing patient history or filing the necessary paperwork. In addition, he was reported to drunk while on-call. Following the breaking of the news, Admiral Jackson withdrew his nomination, claiming the allegations were not true.
At a time when the VA is developing comprehensive plans to restructure its health care services, Jackson’s withdraw again delays and disrupts those important efforts. The White House is currently examining the backgrounds of potential candidates. White House officials will likely place greater scrutiny in their vetting this go-around to ensure what happened in the Jackson nomination is not repeated.
HHS Value Based Care Efforts
This week, HHS Secretary Alex Azar released a draft Inpatient Prospective Payment System (PPS) rule as part of the Secretary’s larger Value-Based-Care Agenda. The plan entails:
- Requiring hospitals to post on the internet their standard list of prices for certain services.
- Focusing the Electronic Health Record Initiative Program on promoting interoperability to allow greater patient access to their data.
- Eliminating out of date quality measures.
In addition, among other provisions, CMS projects that Long Term Care Hospital (LTCH) PPS payments would decrease by approximately 0.1 percent, or $5 million in FY 2019, which reflects the continued phase-in of the site-neutral payment system, which was recently extended through FY 2019 by the Bipartisan Budget Act of 2018.
CMS is also proposing to eliminate the 25-percent threshold policy. To ensure the policy change in implemented in a budget-neutral manner, CMS is proposing to reduce the LTCH PPS standard Federal payment rate by 0.9 percent.
HHS is soliciting stakeholder feedback on the proposal. Comments may be made here.
CMS also announced a new “Data Driven Patient Care Strategy” which included releasing Medicare Advantage Encounter Data for the first time.
Additional Links:
Katie Weyforth Vanlandingham
Van Scoyoc Associates
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Suite 800
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