12.3.18 – 12.7.18 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: the House was not in session this week due to the funeral services for former President H.W. Bush and the Senate only held votes on Wednesday and Thursday.
BUDGET AND APPROPRIATIONS
On Thursday, Congress passed, and this morning President Trump signed, another Continuing Resolution (CR) to avoid a partial government shutdown and fund agencies under seven appropriations bills from December 8 through December 21. As you know, the current CR was scheduled to expire tonight at midnight.
This week Senate Appropriations Committee Chairman Richard Shelby (R-AL) said that six of the seven remaining FY19 bills can be finished quickly. The Homeland Security bill is holding up spending talks due to funding for the border wall and it was reported that discussions about a final spending deal have stalled and there is still no deal over how much money to provide for a border wall and fencing. Shelby said he hopes to meet with Trump to discuss the issue next week, and likely incoming House Speaker Nancy Pelosi (D-CA) and Senate Minority Leader Schumer (D-NY) are scheduled to meet with President Trump on Tuesday to discuss a spending deal. A meeting was originally scheduled to take place this week, but was postponed due to the state funeral of former President George H.W. Bush.
On another note, current Labor HHS Subcommittee Chairman Tom Cole (R-OK) has requested to be the ranking member of the subcommittee in the 116th Congress according to his office. His spokeswoman said he wants to continue championing issues such as funding for Alzheimer’s disease research at the National Institutes of Health and college readiness programs like GEAR UP and TRiO.
HEALTH CARE LEGISLATION IN THE LAME DUCK SESSION
Public Health Legislation
As of press time, it remains unclear how much, if any, health and/or tax policy legislation may hitch a ride on the omnibus appropriations bill referenced above.
As we reported last week, two bills that we have heard as contenders for lame duck action are still held up by holds. Senators Burr (R-NC) and Isakson (R-GA) have holds on each other’s health care bills. Burr has a hold on Isakson’s Over-the-Counter Drug Safety, Innovation and Reform Act (S. 2315) and Isakson has a hold on Burr’s Pandemic and All-Hazards Preparedness Act (S. 2852). While Senate Health, Education, Labor and Pensions (HELP) staff indicated to us earlier this week that they were hopeful the standoff could be resolved in order to allow the bills to move forward before the end of the year, Sen Burr told reporters that it’s “doubtful” that they will be able to get to an agreement during the lame duck. If the bills are not passed this year, the will need to be re-introduced in 2019.
We also understand negotiations are still ongoing at the Senate HELP Committee in an effort to reach an agreement on modifications to 42 CFR Part 2 addiction treatment privacy protections. As you will recall, HR 6 ultimately did not include changes to the privacy statute and, if an agreement can be reached quickly, reforms could be included in the end-of-year package.
Senator Thune (R-SD), a member of the Finance Committee, told reporters that Senators are working on a “skinny version” of Chairman Brady’s (R-TX) tax package and the “skinny version” might extend temporary tax extenders and include some retirement provisions. Thune said, “We’re just trying to figure out what can get 60 in the Senate;” under the current makeup, Republicans need 9 Democratic votes to get to the 60 vote threshold. Whether or not Democrats would support the measure remains unclear and when asked on December 5th what provisions might be attached to the spending bill, Senator Durbin (D-IL) told reporters “as of this state, none.”
Drug Pricing Rebate Legislation
Next week the House may vote on legislation intended to punish drug manufacturers that attempt to game the Medicaid drug rebate system. Senators Grassley (R-IA) and Wyden (R-OR), who will be the chair and ranking member of the Senate Finance Committee next year, introduced legislation, the Right Rebate Act of 2018, earlier this week that would allow the federal government to impose fines against pharmaceutical companies that intentionally misclassify their product in order to avoid higher rebates. In a floor statement following introduction, Grassley specifically named actions taken by Mylan to misrepresent EpiPen as a generic in order to potentially save the company millions on Medicaid rebates.
TRUMP ADMINISTRATION
Medicare Advantage Oversight
The Centers for Medicare and Medicaid Services (CMS) recently released a report on the Agency’s review of the accuracy of Medicare Advantage plan’s online directories. In the report, CMS found that nearly half of the Medicare Advantage plans it reviewed had at least one directory error. A Washington Post article on the report said this is not the first time CMS has found inaccuracies and failed to take action against plans. The article suggested that, “The Trump administration is holding off on punishing Medicare Advantage plans for error-ridden doctor directories — further evidence the conservative-led Centers for Medicare and Medicaid Services is showing special favor to the alternative program over traditional Medicare offerings.”
Health Care Competition Report
In October of 2017, President Trump issued Executive Order 13813 requesting HHS conduct a comprehensive study to assess the health care system and provide recommendations to achieve improved competition, better quality and lower prices. On Monday, HHS Secretary Alex Azar, Treasury Secretary Steve Mnuchin, and Labor Secretary Alex Acosta announced a joint report pursuant to that executive order. The report lays out a wide ranging explanation of what the Administration believes hinder health care quality and competition. The report provides dozens of recommendations to federal agencies and state governments. Among the 21 areas of recommendations are:
- Address potential Antitrust and Provider Consolidation
- Broaden Scope of Practice
- Improve Workforce Mobility
- Facilitate Telehealth to Improve Patient Access
- Ease Restrictions on Foreign-Trained Doctors
- Streamline Federal Funding of Medical Education
- Repeal or Scale Back CON and COPA Requirements
- Amend Federal Trade Commission Jurisdiction Over Nonprofits
- Scrutinize Non-Compete Clauses and Other Restrictive Covenants
- Scrutinize Any-Willing-Provider Laws
- Loosen Network Adequacy Requirements
- Loosen Insurance Rules and Mandates
- Replace Restrictions on Physician Owned Hospitals
- Reconsider Section 1557 of the ACA
- Realign Incentives
- Delivery System Reforms
- Positively Realign Incentives through Payment Reform
- Quality Improvement and the Measurement and Reporting of Quality
- Facilitate Price Transparency
- Using Choice to Bring a Longer-Term View of Healthcare
- Improve Health IT
Prescription Drug Prices Czar
On Thursday, HHS Secretary Alex Azar announced he was appointing John O’Brien to serve as Senior Advisor for Drug Pricing Reform. The position has been empowered by HHS and the White House to lead internal efforts to reform prescription drug policy to reduce prices. O’Brien has been closely involved in current prescription drug price proposals from HHS and the White House. He formerly served on Azar’s staff as senior advisor. Previously, O’Brien worked at CMS and later was vice president at CareFirst Blue Cross Blue Shield. He is a doctor of pharmacy. The position is not required to be confirmed by the Senate.
Washington Post Forum
This morning, the Washington Post held a forum on opioids with Surgeon General Jerome Adams. Some of Adams’ key points including making naloxone widely available and incorporating mental health treatment into primary care. A summary of the discussion is attached.
| Katie Weyforth Vanlandingham
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