Health Care Checkup: August 13, 2021

Health Care Checkup

August 13, 2021

THE BIG PICTURE

Both the House and Senate will be in August recess next week. Our Health Care Checkup will take a brief hiatus through the end of August and will return in September after Labor Day.

On Tuesday, the Senate passed its bipartisan infrastructure bill in a vote of 69-30. The passage came after months of negotiation among Senators and the White House. The bill invests billions of dollars into the nation’s infrastructure, including roadways, bridges, public transit, and clean energy. After passing the infrastructure bill, the Senate kicked off the debate on the Democrats’ $3.5 trillion budget resolution. The budget resolution framework tees up Democrats’ plans for a budget reconciliation package that makes investments in human infrastructure, including extending enhanced Affordable Care Act subsidies; Medicare dental, vision, and hearing coverage; home and community-based services investments; coverage in the Medicaid gap; and lowering prescription drug costs. Following a late-night vote-a-rama, on Wednesday morning, the Senate passed the budget resolution along party lines.

On Thursday, President Biden called on Congress to address the high cost of prescription drugs. Specifically, Biden is calling on lawmakers to allow Medicare to negotiate drug prices and establish a “firm” cap on the amount that Medicare beneficiaries must pay out-of-pocket for prescription drugs each year. A fact sheet on the announcement can be found here.

Also on Thursday, the U.S. Food and Drug Administration (FDA) authorized a COVID-19 booster shot for immunocompromised individuals. The booster is for certain immunocompromised people who received two doses of either Pfizer’s or Moderna’s COVID vaccines. Specifically, the FDA said the boosters will be for “solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.”

CMS Administrator Chiquita Brooks-LaSure sent letters to health officials in Utah, Ohio, and South Carolina, stating that the Biden Administration is withdrawing approval for Medicaid work requirements in their states. The work requirements, which were originally approved during the Trump Administration, would have required adults who are eligible for Medicaid to work or volunteer to receive Medicaid benefits. Brooks-LaSure wrote that such requirements could result in “significant coverage losses and harm to beneficiaries” amid the ongoing COVID-19 pandemic.

CMS announced that more than 2.5 million people have enrolled in health coverage on HealthCare.gov and state Marketplaces during the Special Enrollment Period (SEP), which began in February and will end on August 15. The agency reports that enhanced premium tax credits from the American Rescue Plan (ARP) have saved new consumers approximately 27% on their monthly premiums. CMS’s fact sheet on the enrollment report can be viewed here.

What to Expect Next Week: Both the House and Senate are in August recess. The House will briefly come out of recess on August 23 to take up the budget resolution and H.R. 4, the John Lewis Voting Rights Act. Both chambers are expected to be back in the full swing of things after Labor Day in September.

DEEP DIVE

Senate Passes Bipartisan Infrastructure Legislation, Budget Resolution

On Tuesday, the Senate passed its bipartisan infrastructure bill in a vote of 69-30. The passage came after months of negotiation among Senators and the White House. The bill invests billions of dollars into the nation’s infrastructure, including roadways, bridges, public transit, and clean energy. After passing the infrastructure bill, the Senate kicked off the debate on the Democrats’ $3.5 trillion budget resolution. The budget resolution framework tees up Democrats’ plans for a budget reconciliation package that makes investments in human infrastructure, including extending enhanced Affordable Care Act subsidies; Medicare dental, vision and hearing coverage; home and community-based services investments; coverage in the Medicaid gap; and lowering prescription drug costs. Following a late-night vote-a-rama, on Wednesday morning, the Senate passed the budget resolution along party lines. The House is expected to come back the week of August 23 to consider the budget resolution as well as the infrastructure bill.

President Biden Calls on Congress to Lower the Cost of Prescription Drugs

On Thursday, President Biden called on Congress to address the high cost of prescription drugs. Specifically, Biden is calling on lawmakers to allow Medicare to negotiate drug prices and establish a “firm” cap on the amount that Medicare beneficiaries must pay out-of-pocket for prescription drugs each year. The Administration also noted that it will be working with states and Tribes to import “safe, lower-cost prescription drugs” from Canada. A fact sheet on the announcement can be found here.

CMS Discusses the Lessons Learned from the Past 10 Years of its Innovation Center and its Goals for the Next 10

Leaders from the Centers for Medicare and Medicaid Services (CMS) sat down with Health Affairs to discuss the lessons learned in the 10 years since the Center for Medicare and Medicaid Innovation (CMMI) was created. Those lessons include the need to make equity a centerpiece of every model, re-evaluate the financial incentives in each model to ensure provider participation, and not test too many models at once. CMMI’s vision for the next 10 years includes promoting accountable care, advancing health equity, supporting innovation, and addressing affordability. The full article can be found here.

CMS Announces that Over 2.5 Million People Enrolled in Marketplace Health Plans During the Special Enrollment Period

Biden Administration Strikes Down Trump-era Medicaid Work Requirements

This week, CMS Administrator Chiquita Brooks-LaSure sent letters to health officials in Utah, Ohio, and South Carolina, stating that the Biden Administration is withdrawing approval for Medicaid work requirements in their states. The work requirements, which were originally approved during the Trump Administration, would have required adults who are eligible for Medicaid to work or volunteer to receive Medicaid benefits. Brooks-LaSure wrote that such requirements could result in “significant coverage losses and harm to beneficiaries” amid the ongoing COVID-19 pandemic. Thus far, CMS has revoked Medicaid work requirements in six other states: Arkansas, Arizona, Indiana, Michigan, New Hampshire, and Wisconsin.

CMS Solicits Public Comment on Tennessee Medicaid Block Grant

CMS is seeking stakeholder input on Tennessee’s Medicaid block grant, which was approved in the waning days of the Trump Administration. The block grant, which was approved on January 8, 2021 for a ten-year extension, caps Medicaid funding in the state. In a letter to a Tennessee health official, CMS noted that the comment period will “provide a new opportunity for public input” on the block grant. The National Health Law Program and the Tennessee Justice Center sued the state to challenge the grant in April 2021. The suit alleges that the block grant is invalid because it was issued without adhering to proper notice-and-comment procedures.

FDA Approves COVID Booster for Immunocompromised; ACIP to Convene to Discuss COVID Booster Shots

The U.S. Food and Drug Administration (FDA) authorized a COVID-19 booster shot for immunocompromised individuals on Thursday. The booster is for certain immunocompromised people who received two doses of either Pfizer’s or Moderna’s COVID vaccines. Specifically, the FDA said the boosters will be for “solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.” The agency’s Advisory Committee on Immunization Practices (ACIP) is slated to convene on August 13 to consider booster doses of the vaccines. ACIP’s meeting agenda can be found here.