1.2.18 – 1.5.18 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 on recess this week and the Senate’s legislative week was cut short due to the east coast snowstorm.
BUDGET AND APPROPRIATIONS
This week Congressional leaders continued their attempt to reach a budget deal to clear the way for an FY18 omnibus spending bill. On Wednesday, Speaker Paul Ryan, Senate Majority Leader Mitch McConnell, Senate Minority Leader Charles Schumer, House Minority Leader Nancy Pelosi, Office of Management and Budget Director Mick Mulvaney and White House Legislative Affairs Director Marc Short met to discuss spending and other policy issues, but no agreement was reached. Pelosi and Schumer released a statement following the meeting saying that it was “positive and productive” and all parties involved have agreed to continue discussing a path forward. In addition, McConnell said Thursday on the Senate floor that lawmakers are making progress on a deal and that he is hopeful that a spending deal can be completed by January 19, when current CR is set to expire.
One issue holding up an agreement is the fact that Republicans want to raise the cap on defense spending, while Democrats are pushing for parity saying any increase for defense should be matched with an equal increase for non-defense programs. Additionally, on Thursday, Schumer reiterated Democratic conditions for a bipartisan spending deal saying any deal must include protection for Dreamers, a "fair" disaster aid package for hurricane and wildfire victims, and health care provisions to stabilize insurance markets and fund the Children's Health Insurance Program.
Even if the leaders reach a deal to lift the spending limits in the next two weeks, however, they likely won’t have enough time to put together and pass an omnibus spending bill to carry the government through the rest of the fiscal year, so it is likely that another stopgap bill will be needed, possibly into February.
SUBSTANCE USE AND MENTAL HEALTH
HELP Committee Hearing
On January 9th, the Senate Health, Education, Labor and Pensions (HELP) Committee will hold a hearing entitled, “The Opioid Crisis: An Examination of How We Got Here and How We Move Forward.” Sam Quinones, the author of Dreamland, will be the only witness.
On Thursday, Attorney General Jeff Sessions announced the Department of Justice was making major changes to its enforcement of state marijuana laws, including for medical purposes. Existing federal law categorizes marijuana as a schedule I drug under the Controlled Substances Act, carrying substantial criminal penalties for cultivation, distribution, and possession. Despite the federal prohibition, for many years states have legalized medical marijuana. Currently, 29 states and the District of Columbia allow the use of marijuana or derivative products for medical purposes with a prescription. Under 2013 Department of Justice guidelines, the Department and its agencies would not enforce marijuana prohibitions in states which have a legal structure in place to regulate the product. DOJ would only step in in cases where marijuana was used by criminal networks, targeted minors, or was grown or possessed on federal property.
Thursday’s announcement rescinds the 2013 guidelines and restates the blanket prohibition on marijuana. Though the memo targets recreational marijuana use, the new guidance does not make any distinction between recreational and medical marijuana. Congress has banned DOJ from using federal funds to interfere with medical marijuana laws in state where it is legal. That ban is scheduled to expire January 19th; negotiations about extending the ban are ongoing as the Senate’s version of the Department of Justice spending bill extends the ban on interference for medical marijuana laws, while the House bill does not. Furthermore, DOJ guidance to its agencies and US attorneys do not carry the force of law, so US attorneys across the country would have discretion as to how they would approach the enforcement of marijuana laws after the Sessions memo.
At a minimum, Sessions’ announcement has created great uncertainty. Sen. Cory Gardner (R-CO) has said he plans to reach out to legislators from other states that have legalized recreational marijuana – Alaska, California, Massachusetts, Nevada, Oregon and Washington – about possible legislation to provide protections for the state laws. Sen. Gardner has also threatened to hold up all DOJ nominees pending a commitment from Attorney General Sessions that he will live up to assurances he made to Gardner during the confirmation process regarding federal enforcement of marijuana laws.
The Senate Finance Committee will hold a hearing on the nomination of Alex Azar to be Secretary of the Department of Health and Human Services (HHS) on January 9th.
Association Health Plans Proposed Rule
On Thursday, the Department of Labor (DOL) released a proposed rule to expand access to Association Health Plans, which are not subject to the same rules as plans covered under the Affordable Care Act (ACA). A DOL summary of the proposed rule is available here.
Critics of the proposal to expand these plans, including America’s Health Insurance Plans (AHIP) argue that, if finalized, the rule would allow insurers to sell plans that do not cover pre-existing conditions or the ACA’s essential health benefits. While the proposed rule does not allow plans to charge higher premiums for individuals with pre-existing conditions, some policy experts are concerned that plans could essentially control who enrolls by eliminating certain categories of care.
In a statement earlier this year, AHIP urged state insurance commissioners to take action to protect consumers in their states and said, “We are concerned that this could create or expand alternative, parallel markets for health coverage, which would lead to higher premiums for consumers, particularly those with pre-existing conditions.”
The DOL is characterizing the rule as a way to expand access to health coverage, particularly for small employers. DOL estimates up to 11 million individuals could be covered by these plans.
There is a 60 day comment period on the proposed rule.
CONGRESSIONAL HEALTH POLICY LEADERSHIP
On Tuesday, Senator Orrin Hatch (R-UT), Chairman of the Senate Finance Committee, announced he will be retiring from the Senate. Hatch’s retirement opens up a spot on the Finance Committee and either the Chairmanship or Ranking Member slot depending on the makeup of the Senate following the mid-term elections.
Who will replace Hatch as the top Republican on the Committee, which oversees health care and tax policy, is unclear. Sen. Grassley (R-IA), who previously served as chairman and ranking member, still has two years of chairmanship eligibility. However, in order to re-take the top slot, he would need to give up his chairmanship of the Senate Judiciary Committee. Grassley himself seemed undecided when asked which he would prefer, telling reporters to come back to him 10 months to a year from now. He added, “There's so many things that enter into that. No. 1, will we still be in the majority?" If Grassley declined, Sen. Crapo (R-ID) is next in line behind him, but he would have to give up his spot as top Republican on the Senate Banking Committee.
|Katie Weyforth Vanlandingham
Van Scoyoc Associates
Washington, DC 20024