Health Care Checkup: February 9, 2024

Health Care Checkup

February 9, 2023

THE BIG PICTURE: KEY CONGRESSIONAL & EXECUTIVE BRANCH DEVELOPMENTS

On Thursday, the Senate filed cloture on the legislative vehicle for the national security supplemental (H.R. 815), with border provisions stripped out, in a 67-32 vote after failing to pass a procedural motion on the package on Wednesday that included both foreign aid and border provisions. Seventeen Senate Republicans, including Republican Leader McConnell, voted to proceed with the bill. The Senate is expected to take another procedural vote in relation to the bill this evening, with Leader Schumer threatening to keep the Senate in session through the weekend if necessary to debate and pass the measure.

On Tuesday, the House failed to pass its own Republican-drafted version of a $17.6 billion supplemental funding package providing aid to Israel in a 250 -180 vote.

On Tuesday, the House the House Oversight and Accountability Committee advanced the Delinking Revenue from Unfair Gouging (DRUG) Act (H.R. 6283), in a 29-11 vote, which would prohibit pharmacy benefit managers (PBMs) from spread pricing.

What to Expect Next Week:

The House returns to session on Tuesday. On Wednesday, the House Energy and Commerce Subcommittee on Health will hold a hearing to discuss 19 legislative proposals supporting patients and caregivers.

The Senate is scheduled to be out of session for the next two weeks and returns on February 26.

DEEP DIVE

Congressional:

House Passes Bill Banning QALYs in Federal Health Programs

On Wednesday, the Protecting Health Care for All Patients Act of 2023 (H.R. 485), a bill banning the use of the metric quality-adjusted life years (QALYs) and ‘similar measures”, passed the House in a 211 – 208 vote. The bill would apply to payment determinations and coverage in Medicaid, the Children's Health Insurance Program, Medicaid, managed care organizations, Medicare Advantage, and Medicare Part D. QALYs have been controversial, and the Centers for Medicare and Medicaid (CMS) have said they will not use the metric as part of its landmark drug price negotiations. The legislation advanced out of committee in March, with no Democrats voting for it. The bill is offset by reducing available funds from the Affordable Care Act’s Prevention and Public Health Fund. The Congressional Budget Office estimated the bill would increase direct spending by $1.1 billion over a 10-year period, especially in the Medicaid program. Read the bill here.

House Oversight and Accountability Committee Advances Bill on PBMs, Federal Health Plans

On Tuesday, the House the House Oversight and Accountability Committee advanced the Delinking Revenue from Unfair Gouging (DRUG) Act (H.R. 6283), in a 29-11 vote. The bill would prohibit pharmacy benefit managers (PBMs) from charging federal employee health plans more for drugs than it charges pharmacies, a practice known as spread pricing. It would also ban PBMs from steering patients to pharmacies it owns and allow the Office of Personnel Management to collect penalties for noncompliance. The committee adopted an amendment by voice vote from Rep. Stephen Lynch (D-MA), requiring PBMs to provide contracts to the Office of Personnel Management between the PBMs, insurance carriers, and drug companies that include information about rebates and other cost information. The committee also, by voice vote, adopted an amendment from Rep. Raja Krishnamoorthi (D-IL) requiring the director of the Office of Personnel Management to publish on a public website a wide range of information about PBM charges, fees, and revenues. Read more on the markup here.

House Budget Committee Advances Legislation on CBO Scoring of Preventative Health Care

On Tuesday, the House Budget Committee advanced several bipartisan bills intended to improve budget forecasting. One of the bills, the Preventive Health Savings Act (H.R. 766), advanced in a 30-0 vote, would enable the Congressional Budget Office (CBO) to produce longer-range forecasts of the impact of preventive health care measures. The bill, sponsored by Reps. Michael Burgess (R-TX) and Diana DeGette (D-CO) would require the CBO to determine if a health care bill would save money over a two-decade “out-year” period if requested by the chairs and ranking members of the Budget Committee and the primary committee of jurisdiction. Under a substitute amendment adopted by unanimous consent, the panel added language stipulating that the CBO’s estimate of the savings could only be used as a “supplement,” not to determine compliance with budget laws or rules for enforcement purposes. Read more on the markup here.

House Ways and Means Committee Holds Hearing on Drug Shortages

On Tuesday, the House Ways and Means Committee held a hearing on the topic of chronic drug shortages. Interest in addressing the factors of drug shortages was led by Chair Jason Smith (R-MO), with bipartisan agreement on the need to reduce reliance on foreign drug manufacturing from China and India and incentivize domestic or nearshore production of both active pharmaceutical ingredients and finished drugs. Policy solutions such as requiring a stockpile or buffer inventory of drugs, establishing more transparency in the supply chain, increasing payments for generic sterile injectable drugs to enhance quality, promoting innovative and cheaper manufacturing techniques, and restoring domestic manufacturing were discussed by both members and witnesses. The hearing follows on the heels of the Senate Finance Committee hearing in early December on drug shortages. Read Mehlman’s hearing summary here.

Senate HELP Committee Questions Drug Company CEOs During Drug Pricing Hearing

On Thursday, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on drug prices in the US, questioning some of the nation’s largest pharmaceutical company CEOs on their drug pricing practices. The three pharmaceutical company leaders who testified were Johnson & Johnson’s CEO Joaquin Duato, Merck & Co. Inc’s CEO Robert Davis, and Bristol Myers Squibb’s CEO Chris Boerner. The hearing focused on why drug prices are higher in the U.S. than in other wealthy countries, with the pharmaceutical CEOs stating that it was due to foreign governments limiting innovation and patient access. The CEOs also pointed to research showing that drug spending accounts for a similar share of overall health costs compared to other countries. HELP Committee Chair Bernie Sanders (I-VT) denounced the companies' profits, executive compensation, stock buybacks, and money the companies spent on advertising and lobbying. The CEOs urged Congress to "delink" revenue for pharmacy benefit managers (PBMs) from the drug's list price. Read more on the hearing here.

Senate Finance Committee Holds Hearing on AI in Healthcare

On Thursday, the Senate Finance Committee held a hearing to discuss the impact of artificial intelligence and algorithms in healthcare. During the hearing, members and witnesses focused on the Medicare reimbursement pathway for AI tools, responsible use, and transparency with AI algorithms. Members also discussed the need for AI algorithms to be equitable while protecting people from harmful impacts, including bias and being denied care, particularly with the use of algorithms in Medicare Advantage. There was bipartisan support for the responsible use of AI to lower healthcare costs and spending. Read Mehlman’s hearing summary here.

Rep. Doggett and Senators King, Warren Lead Coalition of Members Urging Biden Administration to Strengthen March-In Rights

On Wednesday, Representative Lloyd Doggett (D-TX) and Senators Angus King (I-ME) and Elizabeth Warren (D-MA), along with 75 colleagues, led a joint effort in urging the Biden Administration to strengthen and finalize its guidance to protect taxpayers and lower prescription drug prices. The members submitted a public comment calling for changes to the “Interagency Guidance Framework for Considering the Exercise of March-In Rights” to ensure increased transparency, oversight, and accessibility of medical products invented through taxpayer-funded research and development. The FTC this week also backed the proposal. Read the press release here and the letter here.

House E&C Health Subcommittee Announces Hearing on Slate of Health Care Bills

On Wednesday, the House Energy and Commerce Subcommittee on Health announced they will hold a hearing on Wednesday, February 14, 2024, at 10 am, on legislative proposals to support patients and caregivers. The hearing will focus on the following legislation:

H.R. 6160, To amend the Public Health Service Act to reauthorize a lifespan respite care program (Reps. Molinaro and Cárdenas)
H.R. 7208, To reauthorize the Traumatic Brain Injury program (Reps. Pascrell and Bacon)
H.R. 7251, To amend the Public Health Service Act to reauthorize certain poison control programs (Reps. Chavez-DeRemer, D. Joyce, Davis, and Cherfilus-McCormick)
H.R. 7153, To reauthorize the Dr. Lorna Breen Health Care Provider Protection Act, and for other purposes (Reps. Wild and Kiggans)
H.R. 6960, Emergency Medical Services for Children Reauthorization Act of 2024 (Reps. Carter and Castor)
H.R. 4646, SIREN Reauthorization Act (Reps. D. Joyce and Dingell)
H.R. 7213, Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act of 2024 (Reps. C. Smith and Cueller)
H.R. 7189, Congenital Heart Futures Reauthorization Act of 2024 (Reps. Bilirakis, Soto, Carter, Schiff, Salazar, and Cárdenas)
H.R. 7218, Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act of 2024 (Reps. Guthrie, Tonko, C. Smith, and Waters)
H.R. 2706, Charlotte Woodward Organ Transplant Discrimination Prevention Act (Reps. Cammack and Dingell)
H.R. 620, Alzheimer’s Accountability and Investment Act (Reps. C. Smith, Tonko, and Waters)
H.R. 619, NAPA Reauthorization Act (Reps. Tonko, C. Smith, and Waters)
H.R. 6829, Cardiomyopathy Health Education, Awareness, Research, and Training in the Schools (HEARTS) Act of 2023 (Reps. Pallone and A. Kim)
H.R. 7224, To amend the Public Health Service Act to reauthorize the Stop, Observe, Ask, and Respond to Health and Wellness Training Program (Reps. Cohen, Wagner, Cárdenas, and Carter)
H.R. 7300, Reauthorization of the Family-to-Family Health Information Centers (Reps. Sherrill and De La Cruz)
H.R. 7268, DeOndra Dixon INCLUDE Project Act of 2024 (Reps. McMorris Rodgers, DeGette, Cole, and Holmes Norton)
H.R. 5012, SHINE for Autumn Act of 2023 (Reps. Y. Kim, Castor, D. Joyce, and Kelly)
H.R. 3916, SCREENS for Cancer Act of 2023 (Reps. Morelle and Fitzpatrick)
H.R. 4534, Women and Lung Cancer Research and Preventive Services Act of 2023 (Reps. Boyle and Fitzpatrick)

Notable Bills Introduced:

Senators Rubio, King Colleagues Introduce Bill to Protect U.S. Health Care Systems from Hackers

On Thursday, Senators Marco Rubio (R-FL), Angus King (I-ME), and colleagues introduced the Strengthening Cybersecurity in Health Care Act to require HHS to perform consistent evaluations of its cybersecurity systems and report their findings to Congress. Read the press release here and the bill here.

Senators Durbin, Young Introduce Congenital Heart Futures Reauthorization Act

On Wednesday, Senate Majority Whip Dick Durbin (D-IL) and Senator Todd Young (R-IN) today introduced their Congenital Heart Futures Reauthorization Act, legislation that extends funding for public health efforts at the Centers for Disease Control and Prevention (CDC) to improve childhood survival rates, prevent premature death and disability, and increase quality of life for the two-and-a-half million Americans living with congenital heart disease (CHD). The bipartisan legislation builds upon the law Durbin and Young passed in 2018 to expand CDC’s research and awareness efforts for CHD. Read the press release here and the bill here.

Senators Rubio, Carper Introduce Bill to Extend and Expand At-Home Care

On Thursday, Senators Marco Rubio (R-FL) and Tom Carper (D-DE) introduced the At Home Observation and Medical Evaluation (HOME) Services Act to establish a hospital-at-home pilot program that would test expanding the acute hospital-at-home program to include observation status patients. The legislation seeks to create a pilot program on the feasibility of including observational status patients in a hospital-at-home program. The hospital-at-home program currently functions under a Centers for Medicare and Medicaid Services (CMS) waiver that expires at the end of 2024. Read the press release here and the bill here.

Sens. Ossoff, Collins, Thune Introduce Bipartisan Bill to Help Veterans in Rural Areas Access VA Health Care

On Wednesday, Senators Jon Ossoff (D-GA), Susan Collins (R-ME), and John Thune (R-SD) introduced the Rural Veterans Transportation to Care Act. The bipartisan bill would expand eligibility to the VA’s Highly Rural Transportation Grant Program (HRTG), which provides grant funding for Veteran Service Organizations and State Veterans Service Agencies to provide veterans transportation in eligible counties. The bill would also increase the maximum amount of funding grant recipients are eligible for from $50,000 to $60,000, or up to $80,000 for grantees to purchase an ADA compliant vehicle. Read the press release here and the bill here.

Rep. Wenstrup Releases Draft Legislation to Secure Domestic Manufacturing of Critical Battlefield Medicines & Devices

On Tuesday, Rep. Brad Wenstrup (R-OH) released a discussion draft of legislation to incentivize greater domestic manufacturing of critical battlefield medicines and devices in the U.S. The bill would (1) lower the tax rate on the income from the domestic manufacturing and sales of essential drugs, biologics, medical devices, countermeasures, and active pharmaceutical ingredients, (2) provide an investment tax credit for new investments in advanced manufacturing equipment or machinery used in the U.S. to manufacture critical health products, and (3) provide a credit for equipment needed to comply with EPA requirements, so that our manufacturers can meet high environmental standards while still remaining cost competitive with China. Read the press release here and the discussion draft here.

Reps. Miller, Kuster Introduce the Community Training, Education, and Access for Medical Students Act

On Tuesday, Reps. Carol Miller (R-WV) and Congresswoman Annie Kuster (D-NH) introduced the Community Training, Education, and Access for Medical Students (TEAMS) Act. The Community TEAMS Act creates a Health Resources and Services Administration (HRSA) grant program to provide community-based training for medical students in rural and medically underserved communities. Read the press release here and the bill here.

Reps. Buchanan, Thompson Introduce Bill to Lower Costs for Caregivers

On Wednesday, Reps. Vern Buchanan, Vice Chairman of the House Ways and Means Committee and Chairman of the Healthcare Subcommittee, and Mike Thompson (D-CA) introduced the Lowering Costs for Caregivers Act (H.R. 7222). The bipartisan legislation would lower costs for caregivers by allowing individuals to use tax-free health savings accounts and flexible spending accounts on medical expenses for their parents and loved ones. Currently, caregivers cannot take advantage of these tax-free accounts unless their parents are classified as dependents for tax purposes. Read the press release here and the bill here.

Senators Hickenlooper, Blackburn, Murray Introduce Bipartisan Bill to Expand Health Care for Energy Workers

On Monday, Senators John Hickenlooper (D-CO), Marsha Blackburn (R-TN), and Patty Murray (D-WA) introduced the bipartisan Health Care for Energy Workers Act, to expand health care access for current and former energy workers. The legislation would update the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), which provides compensation and medical benefits to employees who work or have worked in the nuclear weapons industry, to provide needed flexibility for more health care providers to serve beneficiaries. Read the press release here and the bill here.

Executive Branch:

HHS and CDC Release National Plan to Prevent the Spread of Vector-Borne Diseases

On Monday, the Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC) released a National Public Health Strategy to Prevent and Control Vector-Borne Diseases in People on Monday, a plan directed by the 2019 Kay Hagan Tick Act (PL 116-94). The HHS and the CDC conducted a four-year process working with other agencies to identify federal priorities to detect, prevent, and control vector-borne diseases and conditions, including Lyme diseases, Zika virus, West Nile virus, dengue, malaria, Rocky Mountain spotted fever, and others. The national strategy outlines steps for government agencies to try to meet ambitious goals by 2035, including reducing laboratory-confirmed cases of Lyme disease by 25 percent, eliminating sustained local spread of dengue, eliminating deaths from Rocky Mountain spotted fever in Arizona tribal communities by 2025, and reducing annual numbers of West Nile virus neuroinvasive diseases to fewer than 500. Read the report here.

HHS Releases Final Rule to Update Regulations for Older Americans Act Programs

On Tuesday, the Administration for Community Living (ACL) released a final rule to update regulations for implementing its Older Americans Act (OAA) programs. The rule is the first substantial update to most OAA program regulations since 1988, and aligns regulations to the current statute, addresses issues that have emerged since the last update and clarifies a number of requirements. The rule aims to better support the national aging network that delivers OAA services and improve program implementation, strengthens requirements for the programs to prioritize people with the greatest social needs, specifies who can receive services and establishes expectations for legal assistance to prevent elder abuse. It also updates the requirements for nutrition programs, such as extending eased pandemic-era regulations that allowed for carry-out meals in some programs. The rule goes into effect on March 15, but affected entities have until Oct. 1 to fully comply. Read the press release here.