2.26.18 – 3.2.18 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 had a shortened work week due to the lying in state of the late Rev. Billy Graham.  Additionally, the federal government was closed today due to high winds in the DC area and this update is abbreviated as a result.


Appropriators are still working to get an omnibus bill written and passed before all current funding expires on March 23.

While some other appropriations bills are moving quickly, the Labor-HHS negotiations have reportedly been challenging, partly because of a dispute over how much money to free up to boost discretionary programs. Although the overall discretionary spending limits were settled by the recent budget agreement, lawmakers can boost that funding on the margins by canceling or delaying spending in so-called mandatory, or entitlement, programs. Congress has long relied on making changes to mandatory programs, known as CHIMPs, to find extra money for legislative priorities. Appropriators, however, have yet to agree on how many of those CHIMPs should be allowed this year. Democrats are pushing to use all $17 billion allowed under the fiscal 2018 budget resolution, while Republicans have held the line at $14 billion. Canceling or delaying spending in mandatory programs provides a paper offset that appropriators use to raise discretionary spending above caps, but Republicans argue that the savings is illusive because CHIMPs often involve money that was not really going to be spent.

Subcommittees have been meeting this week to try to iron out differences in the 12 FY18 spending bills and in both the House and Senate the subcommittee chairs have been asked to bring any unresolved issues to the appropriations chairmen by the end of this week. House Speaker Paul Ryan (R-WI) and Majority Leader Mitch McConnell (R-KY) say they want the omnibus to be negotiated and finalized by March 9, filed in the House by March 12, on the House floor by March 14 and passed by March 16 in order to give the Senate the week of March 19 to debate and pass the bill before the current CR expires at the end of the day on March 23.

Lawmakers are also looking to attach other provisions to the omnibus, including an effort to include a bipartisan plan from by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) to help stabilize the Affordable Care Act. It is not clear, however, if the House will accept their plan, which would provide cost-sharing reduction payments to insurers.

Additionally, several lawmakers are encouraging leadership to include in the Omnibus Appropriations bill smaller health provisions which have bipartisan support. Many large employer organizations and advocacy groups are pushing for inclusion of Health Saving Account (HSA) reforms.  Among the proposals being offered are bills which would increase the maximum contribution to an HSA. Others would expand services which would qualify as eligible under HSA laws.


CARA 2.0

This week, the Senate Health, Education, Labor and Pensions (HELP) Committee and House Energy and Commerce Health Subcommittee held hearings on the opioid misuse and overdose epidemic.  Summaries of both hearings are attached.

Energy and Commerce Committee Chair Walden (R-OR) said that the epidemic is a top Committee priority and he wants to complete the Committee’s work on bills by Memorial Day.  This week’s Health Subcommittee hearing was the first of three the Committee has announced it will hold; Wednesday’s hearing focused on law enforcement and the next two hearings will cover public health and Medicare/Medicaid.

On the Senate side, HELP Committee Chair Alexander (R-TN) has said his Committee may mark up legislation as early as late March.  On Thursday March 8th, the Committee will hold a hearing with Governors on the opioid misuse and overdose epidemic.

Additionally, this week Senators Portman (R-OH) and Whitehouse (D-RI) introduced the CARA 2.0 Act of 2018 (S. 2456).  Senators Capito (R-WV), Klobuchar (D-MN), Sullivan (R-AK), Hassan (D-NH), Cassidy (R-LA), Cantwell (D-WA), Manchin (D-WV), and Brown (D-OH) are cosponsors of the legislation.  A section-by-section summary, one page summary and the legislative text are attached.  The bill, or at least pieces of it, could be included in the legislation reported by the HELP Committee later this month.

White House Summit

Yesterday, the White House held a summit on the opioid misuse and overdose epidemic. A detailed summary of the event is attached.

Following remarks by the First Lady, Administration officials and pre-selected audience members, President Trump made an appearance and offered brief remarks.  He introduced his friend Steve Witkoff, who lost his son to overdose, and emphasized the need to punish drug pushers and dealers and penalize opioid companies.  He said that he will be rolling out a policy plan to address these issues in the next three weeks. As of press time, the 3-week timeline for the release of new Administration policy announcements on the opioid epidemic could not be confirmed by agency representatives.

A transcript of President Trump’s remarks is available here and an archived webcast can be viewed here.


On Thursday, President Trump announced his intention to use national security authority in the Trade Promotion Act to place tariffs on imported steel and aluminum.  Reportedly, imported steel will have a 25% tariff and imported aluminum will have a 10% aluminum.  However, until the many agencies with jurisdiction over tariffs put forth official regulations next week, we do not know to what degree the tariffs will apply to raw or processed steel and aluminum, or which alloys with steel and aluminum would be affected.

Near term concerns for the health industry is the potential escalation of costs for durable medical equipment and medical devices. Long-term concerns focus on possible retaliation by Asian and European trading partners.

Many are skeptical that the Administration will follow through on the tariff announcement, given the impact the announcement had on the stock market on day one.  However, the president seems intent on fulfilling his campaign promise to restore domestic metal producers by placing tariffs on imports.  By next week we will have a better idea on the full picture on the implications.


CARA 2.0 section-by-section

CARA 2.0 one-pager

3-1-18 White House Summit

2-28-18 Energy and Commerce Hearing

2-27-18 HELP Hearing

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