Health Care Checkup
May 10, 2024
THE BIG PICTURE: KEY CONGRESSIONAL & EXECUTIVE BRANCH DEVELOPMENTS
On Monday, the Department of the Treasury released the annual Social Security and Medicare Trustees Reports, which found that stronger-than-expected economic growth last year drove improvements to the fiscal health of the Medicare trust fund. The report found that the hospital insurance trust fund, which pays for Medicare Part A benefits, will be able to pay 100 percent of total scheduled benefits until 2036 and 89 percent of scheduled benefits beginning in 2036, five years later than the trustees reported last year.

On Wednesday, the House Ways and Means Committee marked up six health care bills related to telehealth and rural health. The six pieces of legislation included a two-year extension to telehealth flexibilities for Medicare Beneficiaries and a five-year extension of hospital-at-home, expanding criteria for participation in the Rural Emergency Hospitals program, authorizing grants for rural hospitals, and other bills related to rural health.

On Wednesday, the Congressional Budget Office (CBO) issued a report titled “Budgetary Outcomes Under Alternative Assumptions About Spending and Revenues” that found that permanently extending the Affordable Care Act (ACA) premium tax credits would cost $383 billion over ten years.

On Thursday, the Justice Department announced the formation of the Antitrust Division’s Task Force on Health Care Monopolies and Collusion (HCMC). The HCMC will guide the division’s enforcement strategy and policy approach in health care, including by facilitating policy advocacy, investigations, and, where warranted, civil and criminal enforcement in health care markets.
What to Expect Next Week:

The House Committee on Education and the Workforce will hold a hearing on Wednesday examining the policies and priorities of the Department of Health and Human Services. It is possible that the House Energy and Commerce Committee will hold a markup on telehealth bills next week.

On Thursday, the Senate Finance Committee will hold a hearing on rural health care and the Senate HELP Committee will hold a hearing on dental care access. 
DEEP DIVE
Congressional:

House Way & Means Committee Passes Six Health Care Bills Through Markup
On Wednesday, the House Ways and Means Committee marked up six health care bills related to telehealth and rural health. One bill, the Preserving Telehealth, Hospital, and Ambulance Access Act, advanced out of the committee in a 41-0 vote despite some division over several provisions. The legislation would extend through 2026 telehealth services for Medicare beneficiaries set to expire at the end of the year. The legislation also extends the hospital-at-home program through 2029. The package would be paid for by changing the way pharmacy benefit managers (PBMs) can participate in Medicare drug plans, mainly by requiring them to only accept flat service fees and pass any rebates through to plans, delaying phasing in of Medicare laboratory test payment changes, and extending hospice caps under Medicare. The other five bills, passed on partisan lines, would expand the criteria for participation in the Rural Emergency Hospitals program (Second Chances for Rural Hospitals Act), authorize grants for rural hospitals (Rural Hospital Stabilization Act), as well as other bills related to rural health (the PEAKS Act, Ensuring Seniors’ Access to Quality Care Act, and the Rural Physician Workforce Preservation Act). The House Energy and Commerce Committee is expected to markup telehealth legislation soon. Read Mehlman’s markup summary here.

CBO Report Finds ACA’s Premium Tax Credit Would Cost $383 Billion
On Wednesday, the Congressional Budget Office (CBO) issued a report titled “Budgetary Outcomes Under Alternative Assumptions About Spending and Revenues” that found that permanently extending the Affordable Care Act (ACA) premium tax credits would cost $383 billion over ten years. Key Republicans on Capitol Hill were quick to criticize the estimate. For example, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) released a statement saying in part that “Congress should stop expanding public funding to insurance companies” and instead encouraged Congress to pass the Lower Costs, More Transparency Act. Read the CBO report here and Rodgers’ press release here.

Senate Budget Committee Holds Hearing on Alleviating Administrative Burdens in Health Care
On Wednesday, the Senate Budget Committee held a hearing on alleviating administrative burdens in health care. Democrats and Republicans agreed that a “spring cleaning” was needed for the paperwork clinicians face from insurance companies or the Centers for Medicare and Medicaid Services (CMS) and the potential for significant federal savings if Congress removed inefficiencies from the current system. There was also discussion on prior authorization reform led by Budget Committee Chair Sheldon Whitehouse (D-RI), who said he wanted to direct CMS to regulate the use of prior authorization from the government. Sen. Roger Marshall (R-KS) also stated that he plans to reintroduce a bill, the Improving Seniors’ Timely Access to Care Act, which would standardize prior authorization in Medicare Advantage plans to help reduce the burden of the system on providers. Marshall stated that the bill, after tweaks, is expected to receive a Congressional Budget Office score of zero cost. Read the opening statements and witness testimonies here.

Senate Appropriations Committee Holds Hearing on FDA Budget Request, Califf Requests More Funds for Bird Flu Response
On Wednesday, the Senate Appropriations Committee held a hearing examining the Food and Drug Administration (FDA) fiscal year 2025 budget request with FDA Commissioner Robert Califf. The Administration requested $7.2 billion for the FDA’s fiscal 2025 budget, an increase of $341 million above 2024 enacted levels. During the hearing, Califf told the Committee that while humans are not currently at high risk of contracting avian flu, the agency remains worried about mutation and spread of the virus. He noted that if the virus mutates to infect human lungs, it could become fatal to one in every four people who contract the virus. Califf also told the Committee the FDA and the National Institutes of Health are working in tandem to create an mRNA vaccine to prepare for a potential widespread virus jump to humans. Read Califf’s testimony here.

Senate HELP Committee Ranking Member Cassidy Releases New Proposals to Modernize NIH
On Thursday, Senator Bill Cassidy, M.D. (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a white paper detailing proposals to improve the National Institutes of Health (NIH). In the report, Cassidy emphasized the importance of NIH maintaining a balanced portfolio. The report also examined how the United States can sustain its advantage in biomedical research, laying out several proposals to address this, including streamlining peer review of research and addressing challenges in recruiting and maintaining our biomedical workforce. Cassidy also highlighted the importance of robust collaboration between NIH, public health and health care institutions, and the private sector in identifying how NIH policies can be adapted to most effectively support potentially transformative research. Read the white paper here and the press release here. 

Notable Bills Introduced:

Sen. Marshall Introduces Bipartisan, Bicameral Bill to Restore Due Process Rights in Health Care
On Thursday, Senator Roger Marshall, M.D. (R-KS), and his colleagues, Sen. Elizabeth Warren (D-MA), Representatives Raul Ruiz, M.D. (D-CA), John Joyce, M.D. (R-PA), Katie Porter (D-CA), and Greg Murphy, M.D. (R-NC) introduced the Physician and Patient Safety Act to restore due process rights for physicians. The legislation would address due process rights not guaranteed to physicians who are contracted but not directly employed by hospitals and ensure due process rights for physicians who are employed by third-party contractors or physician staffing companies. Read the press release here and the bill here.

Sen. Blumenthal & Rep. Larson Introduce the Essential Caregivers Act
Senator Richard Blumenthal (D-CT) and Representative John Larson (D-CT), joined by U.S. Senator John Cornyn (R-TX) and Representative Claudia Tenney (R-NY), introduced the bipartisan, bicameral Essential Caregivers Act. The bill would protect the residents in long-term care facilities, giving all residents nationwide the right to have in-person access to an essential caregiver when visitations are restricted due to a declared emergency. The bipartisan bill seeks to prevent a repeat of the isolation and lack of care that long-term care residents experienced during the COVID-19 pandemic. It also requires CMS to set clear and fair guidelines for essential caregivers to protect the safety of facility staff and residents. Read the press release here and the bill here.

Warren, Baldwin, Raskin, Kuster, Trone, Pettersen, 86 Lawmakers Reintroduce Landmark Bill to Combat Substance Use Epidemic
On Wednesday, Senators Elizabeth Warren (D-MA) and Tammy Baldwin (D-WI), and Reps. Jamie Raskin (D-MD), Ann Kuster (D-NH), David Trone (D-MD), and Brittany Pettersen (D-CO) led 86 lawmakers to reintroduce the Comprehensive Addiction Resources Emergency (CARE) Act. The legislation would provide state and local governments with $125 billion in federal funding over ten years, including nearly $1 billion per year directly to tribal governments and organizations. The CARE Act is modeled directly on the Ryan White Act, supporting local decision-making and programs to expand access to evidence-based treatments and recovery support services. Read the press release here and the bill here.

Sanders, Merkley, Khanna, Tlaib Introduce Legislation to Eliminate Medical Debt for Millions of Working Class Americans
On Wednesday, Sens. Bernie Sanders (I-VT) and Jeff Merkley (D-OR), with Reps. Ro Khanna (D-CA) and Rashida Tlaib (D-MI), introduced legislation to eliminate all $220 billion in medical debt held by millions of Americans, wipe it from credit reports, and drastically limit the accrual of future medical debt. The Medical Debt Cancellation Act would amend the Fair Debt Collection Practices Act, making it illegal to collect medical debt incurred prior to the bill’s enactment and creating a private right of action for patients. It would also amend the Fair Consumer Credit Reporting Act and the Public Health Service Act to remove medical debt from credit reports and update billing and debt collection requirements to limit the potential for future debt to be incurred. Read the press release here and the bill here.
 
Reps. Wenstrup & Blumenauer Introduce Bipartisan "Hospital At Home" Extender Legislation
On Tuesday, Reps. Brad Wenstrup (R-OH) and Earl Blumenauer (D-OR) introduced the bipartisan Hospital Inpatient Services Modernization Act. The legislation includes a 5-year extension of the Acute Hospital Care at Home program to allow participating providers to continue furnishing services that enhance access to care. The legislation also includes improvements to data collection required under the program to better inform Congress on how to make this program permanent in the future. The legislation was included as a provision in the Preserving Telehealth, Hospital, and Ambulance Access Act, which passed out of the Ways and Means Committee with bipartisan support on Wednesday. Read the press release here.

Rep. Feenstra Introduces Two Bills to Protect Rural Hospitals and Preserve Access to Care for Seniors and Rural Communities
On Tuesday, Rep. Randy Feenstra (R-IA) introduced two pieces of legislation to help keep rural hospitals open and preserve access to quality care over the phone for seniors and those who lack reliable broadband. The Rural Hospital Stabilization Act would authorize the Rural Hospital Stabilization Pilot Program through 2029, allowing struggling hospitals – especially those in the most rural areas – to improve financial stability and allow them to retain healthcare services and increase service capacity. The Audio-Only Telehealth Access Act would make Medicare’s coverage of audio-only telehealth services permanent. Both bills were included in the Ways and Means markup on Wednesday and passed out of committee on partisan lines. Read the press release and bills here.

Executive Branch:

Treasury Releases Social Security and Medicare Trustees Reports
On Monday, following a meeting of the Social Security and Medicare Boards of Trustees, the Department of the Treasury released the annual Social Security and Medicare Trustees Reports, which found that stronger-than-expected economic growth last year drove improvements to the fiscal health of the Medicare trust fund, but congressional action is necessary to maintain the programs' long-term health. The report stated that the hospital insurance trust fund, which pays for Medicare Part A benefits, will be able to pay 100 percent of total scheduled benefits until 2036 and pay 89 percent of scheduled benefits beginning in 2036, five years later than was reported by the trustees last year. The trustees wrote that increasing health care costs continue to threaten the program stating, "Current law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation.” "Such legislation should be enacted sooner rather than later to minimize the impact on beneficiaries, providers and taxpayers." Read the report here and the fact sheet here.

Assistant Attorney General Jonathan Kanter Announces Task Force on Health Care Monopolies and Collusion
On Thursday, the Justice Department announced the formation of the Antitrust Division’s Task Force on Health Care Monopolies and Collusion (HCMC). The HCMC will guide the division’s enforcement strategy and policy approach in health care, including by facilitating policy advocacy, investigations, and, where warranted, civil and criminal enforcement in health care markets. The new group, led by Katrina Rouse, will draw from staff across the antitrust division, including civil and criminal prosecutors, data scientists, industry experts, and economists. The HCMC will consider widespread competition concerns shared by patients, health care professionals, businesses, and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, health care IT services, access to and misuse of health care data, and more. Read the press release here.

CMS Announces the Increasing Organ Transplant Access (IOTA) Model
On Wednesday, the Centers for Medicare & Medicaid Services (CMS) announced the Increasing Organ Transplant Access (IOTA) model, which would be implemented by the CMS Innovation Center. The proposed mandatory model would align with the HHS Organ Transplant Affinity Group’s strategy to coordinate a series of initiatives to increase transplantation access through payment, quality, and regulatory efforts. In the proposed model, participating transplant hospitals would be measured by increases in the number of transplants, improved equity in the transplant process, increased organ acceptance rates, and post-transplant outcomes. Hospitals eligible to be selected for the proposed model are non-pediatric facilities that conduct a minimum of 11 transplants each during a three-year baseline period. Out of the 257 transplant hospitals in the country, an estimated 90 would be required to participate in the proposed six-year model beginning January 1, 2025. Standard provisions are also included in the proposed rule that would be applicable to all Innovation Center model participants that begin participation in a model on or after January 1, 2025. Read the press release here and the fact sheet here.
 
HHS Issues Draft Guidance for Next Round of Medicare Direct Negotiation
Late last week, the Biden Administration released draft guidance for the next cycle of drug price negotiations. The guidance lays out the Centers for Medicare & Medicaid Services’ requirements and parameters for the second cycle of negotiations in the Medicare Drug Price Negotiation Program. Fifteen Medicare Part D drugs will be selected for the second negotiation round. The agency is expected to announce the list of Medicare Part D drugs no later than Feb. 1, 2025. Those agreed to negotiated prices will go into effect in 2027. CMS is requesting input on its newly released draft guidance for the second cycle of negotiations by July 2. CMS Administrator Chiquita Brooks-LaSure stated, “We continue to engage drug companies and the public as we build on what we are learning in the first cycle of negotiations.” Read the guidance here. 

Legal & Other:

Judge Halts US Chamber’s Suit Challenging FTC’s Noncompete Ban
On Monday, a federal judge halted the US Chamber of Commerce’s lawsuit over the Federal Trade Commission’s (FTC) noncompete ban, allowing the Chamber to join a similar case filed earlier in a separate Texas court. Business groups led by the US Chamber of Commerce sued the FTC last month in the US District Court for the Eastern District of Texas, the day after the antitrust agency finalized a rule outlawing noncompete provisions for most workers. Plaintiffs in both lawsuits allege the FTC lacks clear congressional authority to issue the noncompete rule. But the agency’s Democratic commissioners maintain the FTC does have the power to issue rules defining unfair methods of competition, arguing the authority has been upheld by courts and reaffirmed by Congress.
CONGRESSIONAL HEARINGS & EVENTS
House & Senate Hearings and Markups:

House:
 
House Committee on Veterans' Affairs, Subcommittee on Health – Field Hearing
“Iowa: A Leader in Veteran Healthcare Innovation”
Monday, May 13, at 10:00 AM

House Committee on Education and the Workforce - Hearing
“Examining the Policies and Priorities of the Department of Health and Human Services”
Wednesday, May 15, at 10:15 AM
 
Senate:

Senate Committee on Veterans' Affairs – Hearing
“Frontier Health Care, Focusing on Ensuring Veterans' Access No Matter Where They Live.”
Wednesday, May 15, at 3:30 PM
 
Senate Finance Committee – Hearing
“Rural Health Care: Supporting Lives and Improving Communities.”
Thursday, May 16, at 10:00 AM
 
Senate Health, Education, Labor and Pensions (HELP) Committee - Hearing
“Examining the Dental Care Crisis in America: How Can We Make Dental Care More Affordable and More Available?”
Thursday, May 16, at 10:00 AM
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