2.11.19 – 2.15.19 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 will be on recess next week. Unless activity warrants, we will send the next wrap up on March 1.
BUDGET AND APPROPRIATIONS
House and Senate negotiators late Wednesday night unveiled text of a roughly $333 billion conference report covering seven outstanding fiscal 2019 appropriations bills, including the Homeland Security measure which for months held up a deal and sparked a 35-day partial government shutdown. In addition to the Homeland Security bill, the omnibus package contains the Agriculture, Commerce-Justice-Science, Financial Services, Interior-Environment, State-Foreign Operations and Transportation-HUD measures.
On Thursday, the Senate (83-16) and House (300-128) passed the measure. The Senate took action after Majority Leader Mitch McConnell (R-KY) announced that President Trump would sign the bill and also declare a national emergency to fund his border wall.
While Trump’s decision to sign the bill will avert a government shutdown tonight at midnight, it will also immediately fueling a fierce battle in the courts and on Capitol Hill. Trump has the legal authority to declare an emergency in at least some cases under the National Emergencies Act, but that law also gives Congress the ability to end the emergency by passing a joint resolution. If one chamber passes the resolution, the other must also take it up, voting on it within a total of 18 days.
Many in both parties worry that a national emergency declaration will set a dangerous precedent and Democrats appear ready to challenge the action by forcing a vote on a “resolution of disapproval.” Speaker Nancy Pelosi (D-CA) on Thursday criticized the decision to declare an emergency and didn’t rule out any options to stop it, including forcing a vote, or a lawsuit over the legality of the declaration.
HEALTH POLICY LEGISLATION
Affordable Care Act
This week, the House Energy and Commerce Committee Health Subcommittee held a legislative hearing on four bills intended to rescind or reverse some of the Administration’s changes to the Affordable Care Act (ACA). Similar to other ACA-related hearings, most of the debate broke along party lines with Democrats continuing their messaging that the Administration is “sabotaging” the health law while Republicans argue that the law drove up costs and forced consumers into expensive health insurance plans.
The bills that were considered at the hearing included:
- H.R. 986, the “Protecting Americans with Preexisting Conditions Act of 2019,” the legislation was introduced by Rep. Kuster (D-NH) and would require the Administration to rescind the Section 1332 guidance of the ACA promulgated in October of 2018;
- H.R. 987, the “Marketing and Outreach Restoration to Empower Health Education Act of 2019” or the “MORE Health Education Act,” the bill was introduced by Rep. Blunt Rochester (D-DE) and would restore outreach and enrollment funding to assist consumers in signing up for health care, which has been reduced by the Trump Administration; and
- H.R. 1010, To provide that the rule entitled “Short-Term, Limited Duration Insurance” shall have no force or effect, the bill was introduced by Rep. Castor (D-FL) and would reverse the Trump Administration’s expansion of short-term, limited-duration insurance plans.
- H.R. 1143, the “Educating Consumers on the Risks of Short-Term Plans Act of 2019,” the bill was introduced by Chairwoman Eshoo (D-CA) and would require short-term, limited duration insurance (STLDI) to disclose the risks of STLDI to prospective consumers, including disclosure that STLDI may not cover preexisting conditions, may not cover the costs of medical services, and that coverage may be rescinded if the individual seeks treatment for a preexisting condition.
As of press time, no future actions have been announced but Democrats may notice the bills for a full Committee hearing and/or markup after the President’s Day recess. Should the bills pass the House, the prospects for passage in the Senate seem less likely.
On Tuesday, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on “Managing Pain During the Opioid Crisis.” A summary of the hearing is attached.
On Tuesday, the House Ways and Means Committee held a hearing titled “The Cost of Rising Prescription Drug Prices”. It was the first hearing on drug pricing under newly appointed Chairman Richard Neal (D-MA). Members continued many similar themes we have seen at other hearings on drug pricing. There was some bipartisan consensus. Most members provided a story of the challenges some of their constituents face in paying for basic necessities or prescription drugs needed to survive. Both parties advocated for increased enforcement of anti-competition laws to go after bad actors in the industry. Members of both parties frequently asked questions about the cost of insulin, and why a 100 year old drug could rise in price so quickly. There seemed to be bipartisan consensus that the Part B average sales price plus 6% fee is not working. Most members suggested Congress needs to rewrite laws regarding PBMs and their incentives, though all were hung up on how to measure a drug’s “value”. And, unlike other drug pricing hearings, 340B drug discount program was not mentioned at all.
During the hearing, Democrats were critical that drug companies on average spend much more on advertising than research and development. Members proposed eliminating the tax credit for marketing expenses for pharmaceutical companies, banning direct-to-consumer pharmaceutical advertisements, or at the least, requiring advertisements to include greater information about the drug in question. Democrats also were pretty uniform in their support for giving Medicare authority to negotiate drug prices. And committee Democrats discussed potential changes to intellectual property laws to limit patents and exclusivity periods for prescription drugs, after such time the government could take more direct steps to influence the price of drugs.
Republicans also followed some similar themes as prior hearings. They were very concerned policies reducing drug prices could inadvertently limit access to those drugs, and they think it is a slippery slope to price controls and market intervention. Republicans regularly criticized the Affordable Care Act as being a major cause of rising drug costs.
UPCOMING HEARINGS AND EVENTS
The following upcoming health care hearings of note have been announced as of press time:
- February 26
o Senate Finance Committee hearing with pharmaceutical company CEOs
o House Judiciary Hearing on “Oversight of the Trump Administration’s Family Separation Policy” (rescheduled from February 12)
- February 27
o House Energy and Commerce Committee Oversight and Investigations Subcommittee hearing on the measles outbreak
- March 5
o Senate HELP Committee hearing on the measles outbreak
USDA Grants Prioritizing Investments in Telemedicine to Address Opioid Crisis in Rural America
On Thursday, Assistant to the Secretary for Rural Development Anne Hazlett announced that the United States Department of Agriculture (USDA) is giving funding priority in a key grant program for applications to address opioid misuse in rural communities. USDA may award up to 30 special consideration points for Distance Learning and Telemedicine (DLT) program applications for projects that provide opioid treatment services in 220 at-risk counties identified by the Centers for Disease Control and Prevention. The deadline for these applications is April 15, 2019.
In addition, USDA may award 10 special consideration points for opioid-related DLT projects or for those that provide Science, Technology, Engineering and Math (STEM) education as their primary purpose. The application deadline for these projects is May 15, 2019.
|Katie Weyforth Vanlandingham
Van Scoyoc Associates
800 Maine Ave SW
Washington, DC 20024