4.9.18 – 4.13.18 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
This week, Republicans ratified the selection of Senator Richard Shelby (R-AL) to replace retired Senator Thad Cochran (R-MS) as chairman of the full Appropriations Committee. Shelby was also selected to replace Cochran as chairman of the Defense Subcommittee. It was also announced that Senator Cindy Hyde-Smith (R-MS), the new Senator from Mississippi who was sworn in this week to replace Senator Cochran, will join the Senate Appropriations Committee and the Labor HHS Subcommittee. A list reflecting the changes to subcommittee chairmanships and membership for the remainder of the 115th Congress is attached.
Balanced Budget Amendment
On Thursday, a proposed constitutional amendment to require balanced budgets, unless Congress votes to allow certain exceptions including in time of war, fell short (233-184) of the necessary two-thirds threshold to pass the House. House Republican leaders had promised conservatives a vote on the measure as part of their effort to secure support for last year's budget resolution, which allowed Republicans to pass the tax bill.
On Wednesday, the House Labor, HHS, and Education Subcommittee on Appropriations held a hearing with the National Institutes of Health to examine its FY2019 budget request. A summary of the hearing is attached. Members of the subcommittee acknowledge that NIH has the largest budget in the agency’s history, and want to ensure it is spent wisely. Areas of interest among committee members were focused on efforts to combat opioid addiction, improving maternal health, and innovating early detection of cancer. NIH Director Francis Collins outlined the agency’s plans. His primary goals are:
- Stable support after decade long freeze in funding.
- Vibrant workforce behind new funding.
- Harnessing computational power
- New technology and new facilities.
- Scientific inspiration
Fiscal 2018 Rescission Package
Since signing the recent FY18 omnibus spending bill into law, President Trump has been expressing regret and wants to roll back spending in the bill by sending Congress a rescissions package. Given that the President does not have line item veto authority, the White House is seeking to use a 1974 law that allows the president to propose Congress rescind certain budget authority. Under the law, Congress has 45 days to pass a law codifying the cuts or the spending remains in effect.
The Senate can pass a rescission resolution with a simple majority, rather than the 60 votes usually needed for a motion to proceed and to end debate on a bill, but garnering even 51 votes may be difficult given that many members have spoken out against such a package and Republicans only hold a 51-49 majority.
Some Republicans have preemptively warned the White House not to try to re-open the omnibus bill, including House and Senate Appropriations Chairmen Senator Richard Shelby (R-AL) and Rep. Rodney Frelinghuysen (R-NJ). Frelinghuysen is among more than a half-dozen appropriators who have voiced skepticism about the Trump administration's proposal, with nearly all saying they fear that it could erode the GOP's bargaining power in future budget talks. Shelby has expressed reservations about anything that would mean going back on agreements he had already made in the omnibus, and on Wednesday told Trump during a meeting at the White House that he may not have the votes for a rescission package in the Senate. House Labor HHS Chairman Rep. Tom Cole (R-OK) said the idea is "unrealistic and dangerous."
The White House, however, appears to be ignoring any warnings from the Hill and said this week that they plan to move ahead with plans to cut billions of dollars from the omnibus spending bill that Congress passed in late March. Administration officials anticipate the White House could propose slashing anywhere from $30 billion to $60 billion dollars from the $1.3 trillion-dollar spending bill passed for this fiscal year. The White House has not reached the point yet of circulating a list of areas to cut, though the anticipated suggestions will likely involve cuts to foreign aid and non-discretionary domestic programs targeted in the President's FY19 budget. OMB Director Mick Mulvaney, a former member of the House Freedom Caucus, is reportedly taking the lead on developing the proposal and the White House expects to release it around May 1.
Most are doubtful that a rescission package will even land on the floor for a vote, but the Trump administration has until mid-June to submit its request, after which it would be up to the House Appropriations Committee to turn the package into legislative language. That work would have to be done at the same time the Appropriations panels are drafting bills for fiscal 2019, throwing even more doubt on the possibility of such a package moving forward.
Trump has threatened not to support another omnibus going forward, but given the upcoming midterm elections, it is likely that Congress will pass a continuing resolution before the end of current fiscal year on September 30, funding the government through the election, followed by another omnibus at the end of the year.
As Congress returned to Washington this week after the 2-week recess, activity to address the opioid misuse and overdose epidemic is ramping up. A summary of activities at several committees is below. While it is not clear how the work of the various committees may or may not be ultimately combined into a legislative package, at least the Senate Health, Education, Labor and Pensions (HELP) and House Energy and Commerce Committees are on tight timelines with HELP announcing they will mark up on April 24 and Energy and Commerce setting a goal of completing action by Memorial Day.
Senate HELP Committee
On Wednesday, the Senate HELP Committee held a legislative hearing on the discussion draft that was released during the recess (click here for the text of the discussion draft, and here for a summary). A summary of the hearing is attached.
As referenced above, the Committee will hold a markup on April 24. We anticipate several members of the Committee will introduce bills in the next week and there will be significant advocacy to get their bills and/or make other refinements to the legislation prior to the markup.
Senate Finance Committee
On April 19th, the Finance Committee will hold a hearing on how to improve Medicare and Medicaid’s response to the opioid misuse and overdose epidemic. Witnesses will include:
- ADM Brett P. Giroir, M.D., Assistant Secretary for Health, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services
- Kim Brandt, Principal Deputy Administrator for Operations, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
Senate Judiciary Committee
On Wednesday, the Senate Committee on the Judiciary, Subcommittee on Crime and Terrorism held a hearing titled, “Defeating Fentanyl: Addressing the Deadliest Drugs Fueling the Opioid Crisis.” The hearing discussed the increasing number of opioid-related deaths attributable to fentanyl and its analogs, how fentanyl is testing law enforcement methods and straining resources in communities and emergency departments, and if mandatory minimum penalties are necessary for dealers of fentanyl. A summary of the hearing is attached.
House Energy and Commerce Committee
This week, the House Energy and Commerce Committee held a 2-day hearing on a record 34 bills and discussion drafts related to Medicare and Medicaid to address the opioid misuse and overdose epidemic. Summaries of both days of the hearing are attached.
This week’s hearing marked the third and final hearing the Committee will hold before moving to markup. While Chairman Walden (R-OR) had previously said he wants the Committee to complete its work in order to allow for the full House to vote before Memorial Day, we heard this week that given the very large number of bills under consideration and competition for Floor time, the vote on the House floor could slip until the first week in June (right after Memorial Day).
Democrats on the Committee expressed concerns at this week’s hearing about the speed at which the Committee is moving on such a large number of bills and the risk of unintended negative consequences to the Medicaid program.
The House Energy and Commerce Committee Oversight Subcommittee also announced this week that they will hold a hearing on May 8 on the “dumping” of opioid pills into West Virginia.
House Ways and Means Discussion Draft
This week the House Ways and Means Committee released a bipartisan discussion draft that summarized feedback they received from stakeholders on solutions to the opioid misuse and overdose epidemic. Recommendations from stakeholders included:
- Improving treatment and reimbursements, including increasing access to Medication Assisted Treatment, utilization and access to non-opioid treatments of pain, as well as modernizing reimbursement and quality measures;
- Utilizing tools to prevent overprescribing and abuse, including Part D lock-in, limiting prescriptions, and better data tracking; and
- Enhancing screening for opioid use disorders, provider education and communication, and patient education
House Oversight and Government Reform Hearing
On Wednesday, the House Committee on Oversight and Government Reform, Subcommittee on Healthcare, Benefits, and Administrative Rules held a hearing titled, “Local Responses and Resources to Curtail the Opioid Crisis.” A summary of the hearing is attached.
House Armed Services Committee Hearing
On April 19th the House Armed Services Committee Subcommittee on Military Personnel will be holding a hearing titled, “Military Health System Reform: Pain Management, Opioids Prescription Management and Reporting Transparency.” Witnesses will include:
- Navy Vice Adm. Raquel C. Bono, director of the Defense Health Agency
- Navy Capt. Mike Colston, director of mental health policy and oversight in the Office of the Assistant Defense Secretary for Health Affairs
CMS Exchange Rule
This week CMS released the final rule on Benefit and Payment Parameters for 2019. The final rule is similar to the proposed rule the Administration released in October. Patient advocacy and other groups had expressed concerns with the proposed rule and particularly with its provisions that give states the more flexibility in defining their Essential Health Benefits. A CMS fact sheet about the rule is available here. Additionally, a Health Affairs blog summarizing the rule is available here.
In a decision which had been rumored for several months, on Wednesday Speaker of the House Paul Ryan (R-WI) announced he would not seek reelection, though will remain Speaker through the duration of the 115th Congress. Citing his desire to spend more time with his family, he says he leaves with a career of successful accomplishment, including tax reform and changing the discussion of entitlements. In 2015, when Ryan was elected Speaker mid-term, his biggest asset was his ability to bridge the gaps between establishment Republicans, the conservative Republican Study Committee, and some moderate groups. With his departure, those divisions within the Republican Conference will be more pronounced, and many wonder in what direction the party may go.
The announcement ignited much jockeying among Republicans looking to take his place. The leading candidates are Majority Leader Kevin McCarthy of California and Majority Whip Steve Scalise of Louisiana. McCarthy’s biggest asset is his close relationship with President Trump. Scalise’s biggest asset is his more conservative approach which fits more easily with most House Republicans. In addition, House Freedom Caucus founder Rep. Jim Jordan of Ohio has announced he is considering a run. Though much of the campaigning will take place in the coming months, the final vote will not be made until after the November elections. At that time, Republicans must assess which candidate is best suited for the entirely different roles of Speaker of the House and Minority Leader, as they face the possibility of becoming the minority party.
|Katie Weyforth Vanlandingham
Van Scoyoc Associates
800 Maine Ave SW
Washington, DC 20024