4.16.18 – 4.20.18 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
FY19 Appropriations
On Wednesday, both House and Senate Appropriations Committee chairmen met with their committees and laid out aggressive timetables to approve all of the fiscal 2019 appropriations bills by September 30. Republican appropriators say they are committed to putting all 12 spending bills on the floor, even if it means circumventing partisan battles, like policy riders.
Also, Senate Appropriations Committee Chairman Richard Shelby (R-AL) and House Chairman Rodney Frelinghuysen (R-NJ) on Thursday discussed coordinating subcommittee funding allocations, known as 302(b)s, as much as possible. Closely coordinating 302(b)s would be a shift from last year when the House and Senate panels started with vastly different spending levels for their individual FY18 bills.
Shelby told his committee this week that he hopes to pass the first individual bills on the floor in early June. Ranking Member Patrick Leahy (D-VT) said Thursday that he has already met with Shelby about the steps forward for FY19 and that Democrats will go along with getting individual spending bills on the Senator floor in June. Shelby did admit that given the challenges of passing all 12 bills on the Senate floor by September 30, that a stopgap funding measure or some form of an omnibus may be necessary. He said he hopes to have three to four spending bills finished by August. It would be the first time that the Senate has passed an individual spending bill since 2016.
The House Appropriations Committee is also aiming to finish individual FY19 bills quickly. Chairman Frelinghuysen said Wednesday that he plans to start full-committee markups of the FY19 spending bills on May 8. Other committee members said the chairman circulated a list suggesting full-committee markup dates of May 8, May 16, May 17, May 22, May 23, June 13, and June 20. Following committee passage, Republican leaders could bundle bills into packages to expedite their passage in the House by mid-to-late July.
The pressure to put individual bills on the floor, rather than an omnibus, comes in part from the White House where President Trump, after signing the FY18 omnibus, vowed to never approve another omnibus.
Rescission Package
OMB director Mick Mulvaney said this week that he will formally propose a package of spending cuts to Congress in the "next couple of weeks," with aims of a House floor vote before July. During an appearance before the House Financial Services Appropriations Subcommittee he said that a rescissions package could target unused funding from previous spending bills, as well as money the White House disputes in last month's FY18 omnibus.
Mulvaney did not say which programs he was targeting, but he said whatever funding he proposed to cut would be frozen for 45 days, until Congress decides whether to act. He also added that the White House could send additional rescission proposals in the fall saying, "The only limitation seems to be, we cannot send you the same rescissions twice."
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 days to act on the rescission package. This means 45 legislative days, but since it is likely that Congress will just remain in session during this time, this would likely end up being 45 calendar days. If Congress doesn’t approve the President’s rescissions within 45 days, the President has to release the rescinded monies to the agencies. 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. The White House wants to send its request as early as May 1, which would start a 45-day clock on Capitol Hill.
Senate Republicans, including Appropriations Chairman Richard Shelby (R-AL) and Majority Leader Mitch McConnell (R-KY), have largely ruled out the prospect of rescinding funding from the just passed FY18 spending bill, which they point out the White House itself helped negotiate and President Trump signed into law.
OPIOIDS
On Thursday, the Senate Finance Committee held a hearing on addressing the opioid misuse and overdose epidemic in the Medicare and Medicaid programs and the House Energy and Commerce Committee Health Subcommittee held a roundtable with families who have been affected by the epidemic. Summaries of both events are attached.
Next week, two Committees will begin marking up legislation:
- On Tuesday, the Senate Health, Education, Labor and Pensions (HELP) Committee will hold a markup of S. 2680, the Opioid Crisis Response Act. The Committee may release the Chairman’s mark as early as this evening
- On Wednesday, the House Energy and Commerce Committee Health Subcommittee will hold a markup. The Committee is expected to release the list of bills that will be considered on Monday. Staff indicated that they hope to report most of the bills by voice vote and hold debate on contentious issues until the full Committee markup
Outlook
Assuming the HELP Committee reports their bill next week, it is unclear when it might be brought to the Senate floor and, assuming the Senate Finance Committee also approves a bill, if the two Committee products might be combined.
On the House side the full House Energy and Commerce Committee will likely mark up in May. Chairman Walden (R-OR) has said he wants his Committee to have completed its work in time for the full House to vote before Memorial Day, but we understand the timeline for House floor consideration could slip until the first week in June.
It is not clear if/when the other House Committees – Ways and Means, Judiciary and Education and Workforce – might consider legislation to address the opioid misuse and overdose epidemic.
TRUMP ADMINISTRATION
New head of Health Reform at HHS
This week, Secretary of Health and Human Services Alex Azar announced he was appointing James Parker to serve as the director of the Office of Health Reform. The position, which does not require Senate confirmation, was established to lead the implementing of the Affordable Care Act. In addition to ACA related functions, the office is intended to reduce healthcare costs and improve access and competition. It is among the most impactful non-confirmed positions at HHS. Parker formerly was CEO of MDWise, an Indiana Medicaid managed care organization. His experience in an MCO should give a good indication of the approach he will take toward his new position.
Amazon Pulls Plug on Hospital Drug Sales
On Monday, news leaked that Amazon is backing away from its plans to sell bulk-drug supplies to hospitals. Amazon promoted the plan as an innovative way to reduce escalating drug costs. Amazon hoped to use its bulk purchasing power and unique distribution services to remove middlemen and sell prescription drugs directly to hospitals across the country at a lower rate. Reportedly, Amazon did not have the appropriate infrastructure to handle temperature-sensitive drugs, and hospitals were more comfortable maintaining their existing drug supply networks.
4-19-18 Energy and Commerce Roundtable
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