5.7.18 – 5.11.18 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.
BUDGET AND APPROPRIATIONS
Senate Labor HHS Azar Hearing
On Thursday, the Senate Labor HHS Appropriations Subcommittee held a hearing to examine the FY19 President’s budget request for the Department of Health and Human Services. HHS Secretary Alex Azar was the only witness. Opening statements and a webcast of the hearing can be found here.
Some of the major topics discussed at the hearing include drug pricing, the opioid epidemic and limited-duration health plans. A full summary of the hearing is attached.
Rescission Package
On Tuesday, the Trump Administration officially delivered its proposal to Capitol Hill seeking to cancel $15.4 billion across 10 federal departments in unspent previously appropriated federal funds. A copy of the rescission request and justification can be found here. Rescissions are included for (but not limited to) the following programs:
- $7 billion from the Children’s Health Insurance Program (HHS)
- $800 million from the Centers for Medicare and Medicaid Innovation (HHS)
- $220 million from "Departmental Management" expense fund (HHS)
- $252 million in “excess funds” remaining from the 2015 Ebola outbreak (USAID)
- $52 million from the Millennium Challenge Corporation (USAID)
- $107 million from Hurricane Sandy technical assistance.
The request is scaled back from the Administration’s initial goal of cutting as much as $60 billion, including an attempt to cancel money from the FY18 omnibus signed into law in March. The proposal was later downsized to $11 billion, and then back up to $15 billion, targeting only unused funding from past years.
On Thursday, a measure was introduced in the House (H.R. 3) by Majority Leader Kevin McCarthy (R-CA) that closely follows the request by the Administration. It is being reported that the measure will bypass consideration by the Appropriations Committee and go directly to the House floor. However, the package’s prospects are uncertain in the Senate where Republicans hold just a 51-49 majority. Several GOP Appropriators have cast doubt on the proposal saying they are not yet ready to bury some of the targeted programs. Senators Lisa Murkowski (R-AK) and Susan Collins (R-ME), whose votes would be necessary to pass the measure, have criticized the proposal. Several members have expressed concerns with the CHIP cuts and to the money to fight Ebola given the recent outbreak in the Democratic Republic of Congo.
Senate Appropriations Committee Chairman Richard Shelby (R-AL) said on Thursday that he has an objection to a provision rescinding transportation funds and that he is waiting to see the details of what the House sends over. He has stated, however, that he does not favor reopening the FY18 spending bill. House Appropriations Committee Chairman Rodney Frelinghuysen (R-NJ) also hasn’t given an indication of his support or opposition to the package saying he is still looking it over. He has previously stated that he strongly opposes cutting current-year spending after the fact. In addition, Democrats have expressed opposition to the proposal, particularly the rescission to the CHIP program. They believe that maintaining the contingency funds are necessary in case CHIP enrollment were to surge unexpectedly and the program, whose funding is not open ended, suddenly needed more money. The White House has defended the CHIP provision saying the funds came exclusively from accounts with expired authorization, noting that Congress reauthorized CHIP for six years in January.
Under the Budget Act of 1974, which created the rescission process, the House and Senate appropriation committees have 25 days to either approve, disapprove or amend the request. If the committees do not take action within 25 days, the measure is subject to discharge from the committee and can go to the full House and Senate for action. If either of the committees, full House or Senate disapproves the measure, the process stops. Congress overall has a total of 45 legislative days to act on the rescission package, although Congress is not required to consider President Trump’s proposal. If lawmakers have not taken any action, the funding would remain intact. In order to approve a rescission, the President needs a positive vote from Congress, and on this issue that is a simple majority vote in the House and Senate. Under the Impoundment Control Act of 1974, President Trump is able to temporarily freeze funding for impacted accounts for 45 days.
While there is currently no timeline for other rescission requests, we understand that the Administration plans to follow up this action with additional requests, including ones targeting the FY18 omnibus.
OPIOIDS
Several House Committees held hearings and a markup on legislation to address the opioid misuse and overdose epidemic this week. We understand that the first week in June following the Memorial Day break is being referred to as “Opioids Week” as House leaders are targeting that week to bring up the opioids bills as reported by the Committees. As of press time, only the Energy and Commerce Committee has marked up/noticed a mark up, but we understand the Ways and Means, Judiciary and/or Education and Workforce Committees may also consider bills in time for them to be on the floor during the first week in June.
On the Senate side, staff indicated that action may be considerably slower. As we have previously reported, if/when the full Senate should take up a package, it is expected to be a joint package that incorporates the work of the Senate Health, Education, Labor and Pensions (HELP) Committee, which has already reported a bill, and the Senate Finance and Judiciary Committees, who have not yet considered legislation. Some staffers indicated that Democrats are concerned that Senate leadership may delay floor consideration in order to keep some of the vulnerable Senate democrats who are up for re-election – such as Senators Manchin (D-WV) and Donnelly (D-IN) - from getting a “win.”
Actions taken this week by the various House Committees are briefly summarized below and in more detail in the attached.
House Energy and Commerce
The full Energy and Commerce Committee marked up 26 bills addressing the opioid misuse and overdose epidemic on Wednesday; all of the bills were reported by voice vote. As indicated by the voice votes, the markup largely lacked the partisan tensions that characterized the Health Subcommittee markup a couple weeks ago. However, the Committee will hold a second markup on May 17 on the more difficult bills and that markup will likely be longer and contentious. A detailed summary of the markup is attached.
Additionally, on Tuesday two Energy and Commerce Subcommittees held hearings:
- The Health Subcommittee held a hearing on 42 CFR Part 2 privacy regulations. A summary of the hearing and a transcript are attached.
- The Subcommittee on Oversight and Investigations held a hearing titled: Combating the Opioid Epidemic: Examining Concerns About Distribution and Diversion. A summary is attached.
House Ways and Means
The House Ways and Means Committee is planning to mark up bills to address the opioid misuse and overdose epidemic within the next couple of weeks. Today, Chairman Brady (R-TX, Ranking Member Neal (D-MA), Health Subcommittee Chair Roskam (R-IL) and Health Subcommittee Ranking Member Levin (D-MI) released bipartisan legislative proposals that the Committee will consider.
In releasing the bills, the Committee announced that they intend to mark up 4 “packages” that will include measures from additional pieces of legislation. The four main “packages” are:
H.R. 5773, “Preventing Addiction for Susceptible Seniors (PASS) Act” – Sponsored by Chairman Peter Roskam (R-IL), Rep. Terri Sewell (D-AL), Rep. Steve Knight (R-CA), and Rep. Kyrsten Sinema (D-AZ)
- H.R. 5774, “Combatting Opioid Abuse for Care in Hospitals (COACH) Act” – Sponsored by Rep. Carlos Curbelo (R-FL), Rep. Suzan DelBene (D-WA), Rep. Ted Budd (R-NC), and Rep. Ann McLane Kuster (D-NH)
- H.R. 5775, “Providing Reliable Options for Patients and Educational Resources (PROPER) Act” – Sponsored by Rep. Erik Paulsen (R-MN), Rep. Ron Kind (R-WI), Rep. Bruce Poliquin (R-ME), and Rep. Conor Lamb (D-PA)
- H.R. 5776, “Medicare and Opioid Safe Treatment (MOST) Act” – Sponsored by Ranking Member Richard Neal (D-MA), Rep. George Holding (R-NC), Rep. Scott Taylor (R-VA), and Rep. Matt Cartwright (D-PA)
A full list of the bills is available here.
House Judiciary
On Tuesday, the House Judiciary Committee held a hearing on “Challenges and Solutions to the Opioid Abuse Crisis.” A summary of the hearing is attached.
House Education and Workforce
On Tuesday, the House Education and Workforce Committee held a hearing entitled, “The Opioid Epidemic: Implications for the Federal Employees’ Compensation Act.” A summary of the hearing is attached.
House Oversight and Government Reform
This week the House Oversight and Government Reform Committee released a discussion draft of legislation to re-authorize the White House Office of National Drug Control Policy (ONDCP). Comments on the draft may be submitted here. Upon releasing the discussion draft, Chairman Gowdy (R-SC) announced that the Committee will hold a hearing on ONDCP reauthorization next week and it has been noticed for May 17.
MEDICARE & MEDICAID
Medicare Advantage
On Tuesday, the House Ways and Means Committee Health Subcommittee held a hearing on the Medicare Advantage program. Some of the issues covered during the hearing included the availability of Medicare Advantage data, consolidation in the health care sector, plan flexibility, Medicare Advantage plan star ratings, and telehealth. A summary of the hearing is attached.
Ways and Means Red Tape Relief Initiative/Post-Acute Care
On May 22, the Ways and Means Committee Health Subcommittee will hold a roundtable as part of its “Reducing Medicare Red Tape Initiative.” This roundtable will be the third in a series held by the Committee and will focus on post-acute care. While a list of panelists may not be made available by the Committee in advance, we understand representatives from the National Association of Long Term Hospitals will be among the presenters.
340B
On Tuesday May 15 the Senate Health, Education, Labor and Pensions (HELP) Committee will hold a hearing on the 340B Drug discount program. Witnesses will included:
- Ann Maxwell, Assistant Inspector General for Evaluation and Inspections, Office of the Inspector General, U.S. Department of Health and Human Services
- Debra A. Draper, Ph.D., Director, Health Care Team, U.S. Government Accountability Office
HOUSE VETERANS AFFAIRS
On Tuesday, the House Veterans’ Affairs Committee passed the VA MISSION Act (HR 5764) by a vote of 20-2. The bill would reauthorize the VA CHOICE Act, expanding access to the program to additional veterans seeking care from non-VA facilities. However, by moving VA CHOICE from a mandatory spending program to a discretionary program, it would place providers serving VA patients in a precarious position in the event of a federal shutdown. In addition, the bill streamlines the process to centralize all providers to improve the referral process.
TRUMP ADMINISTRATION
Prescription Drugs
Today, President Trump and HHS Secretary Alex Azar spoke at the White House about prescription drug reforms he calls “American Patients First.” The details of the proposal will emerge in the coming weeks, but ideas specifically mentioned today include:
- Authorize Medicare Part D officials to negotiate for lower prices.
- End rewards for drug companies under Medicare which escalate drug prices.
- End rebate payments going to prescription drug middlemen.
- End the gag rule which prohibits pharmacists from recommending to patients more affordable alternatives.
- The US Trade Representative will negotiate with foreign governments to pay higher prices for US-made drugs.
- Require prescription drug companies to disclose the cost of their medication in television advertisements.
Veterans Affairs
After President Trump’s pick to head the Department of Veteran’s Affairs recently withdrew in light of allegations of medical misconduct, the new name being discussed to lead the VA is Congressman Brian Mast of Florida. The first-term representative from the Florida Atlantic coast is an Army veteran who lost both legs in Afghanistan to an improvised explosive device. It is yet to be seen if the 37 year old with no experience leading a large organization can garner enough support to be confirmed by the Senate. Though he has not served on any committees with jurisdiction over the VA, his personal experience with the VA has been appealing.
O&I Subcom hearing May 8 Summary
May 10 Senate LHHS Azar hearing
House Judiciary Committee Hearing on Opioids 8 May 2018
5.8.18 TRANSCRIPT House E and C 42 CFR 5-9-18 E&C 5-8-18 W&M
5-8-18 House Energy and Commerce Hearing 42 CFR
5-8-18 Education and Workforce
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