News: Health policy goals, must-pass bills and gridlock

Monday, July 10, 2023

Health policy goals, must-pass bills and gridlock

Jul 10, 2023

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By Megan R. Wilson and Daniel Payne

Presented by

With Robert King

Driving the Day

The U.S. Capitol Dome is seen.

Congress has a busy post-recess agenda, which includes reauthorizing the Community Health Center Fund and the Pandemic and All-Hazards Preparedness Act. | Anna Moneymaker/Getty Images

HEY, WELCOME BACK FROM RECESS … HERE’S A TO-DO LIST — The combination of high policy aspirations, partisan gridlock and looming deadlines for must-pass legislation plague lawmakers as they return from July recess — only 12 legislative days from the next congressional break.

Senate Majority Leader Chuck Schumer vowed to move forward on a number of efforts — including advancing bills that would lower the cost of insulin and prescription drugs, a nod to a long-rumored drug pricing package he’s been putting together for months.

In a "Dear Colleague" letter sent Sunday, Schumer also mentioned the need to “promote community health.” Congress must reauthorize the Community Health Center Fund, which represents about 70 percent of the federal funding for community health centers, by Sept. 30.

While a House panel advanced a package that included a community health center reauthorization in May, Sen. Bernie Sanders (I-Vt.), chair of the Health, Education, Labor and Pensions Committee, is requesting a massive increase in the fund that has screeched action on the issue to a halt.

Advocates say that health centers are under financial pressures and hope the House version — in a larger bill that also includes price transparency measures and other health reauthorizations — receives a floor vote thisnth to push the Senate to act.

Congress must also revamp the nation’s pandemic and emergency preparedness law before many of its programs expire on Sept. 30. This week, the House Energy and Commerce Committee is barreling toward a subcommittee markup of its version of the bill, which would reauthorize the Pandemic and All-Hazards Preparedness Act, despite lingering differences between Republicans and Democrats over its scope.

Top Democrats, including ranking member Frank Pallone (D-N.J.), have been pushing to include policies meant to address shortages that have impacted antibiotics, ADHD medication and cancer drugs. Rep. Anna Eshoo (D-Calif.) has been negotiating with Rep. Richard Hudson (R-N.C.) for weeks, but it’s unclear whether an agreement will be reached by Thursday’s expected markup — which hasn't been officially announced.

The Senate dropped its draft bill text last week, which has its own partisan points of contention between Sanders and ranking member Bill Cassidy (R-La.).

WELCOME TO MONDAY PULSE. Are you putting Schumer’s drug pricing package together? Send me the deets at mwilson@politico.com, and don’t forget to tip dpayne@politico.com.

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Robert King, who walks listeners through President Joe Biden's bid to crack down on short-term health coverage in an effort to safeguard consumers and strengthen the Obamacare exchange by reining in what the president calls “junk insurance” plans.

Listen to today’s Pulse Check podcast

A message from PhRMA:

Research and development of cancer medicines after their initial FDA approval can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. Read the new report.

Providers

A doctor and patient look at an x-ray of a colon.

An uptick in late-stage cancers could be the result of missed or delayed screenings during the pandemic. | American Cancer Society/Getty Images

PROVIDERS PLAY CATCH-UP — Surgeons are grappling with Covid-19’s effects on other kinds of care, such as missed or delayed screenings and elective procedures, according to Patricia Turner, who leads the American College of Surgeons.

She spoke with Daniel about the group’s top priorities, including Covid-19’s impact on cancer care, health equity, physician payment reform and workforce shortages.

“We are now reflecting: What is the best way to take care of those patients with later-stage cancer? What is the best way to get people back into the routine of doing their proper screenings?” she said.

The group has a multiyear campaign to improve post-pandemic care, expanding its program to measure quality care nationwide. It also wants to use a larger data set to identify and reduce health disparities that have become more apparent through the pandemic.

“We recognize that health equity is still an aspirational goal,” she said. “As we reflect on how we actually move the needle on that, it requires the data-driven evidence-based approach.”

Though patient volume has largely returned to pre-pandemic levels, Turner said, the workforce needed to care for them hasn’t.

And the race is on to get more money from Medicare, too. Turner said the group is looking at short-term payment bumps along with larger reforms that could take years.

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Around the Agencies

CMS PROPOSES 340B REMEDY — The Biden administration is proposing to give certain hospitals participating in the government’s 340B discount drug program $9 billion to make up for pay cuts dating back to 2018, Robert reports.

The Centers for Medicare and Medicaid Services released a proposed rule that details plans to distribute the funds to approximately 1,600 hospitals affected by the cuts rejected as unlawful by the Supreme Court in 2022.

The pharmaceutical and hospital industries have been closely watching to see what CMS would do, with hospitals and other eligible clinics favoring a lump sum to each facility — an approach adopted by the agency. A higher payment rate for 340B hospitals in place since September 2022 should help cover the remaining $1.5 billion, the agency said.

Hospital groups said they were happy with the lump sum approach but disappointed that CMS is proposing a 0.5 percent cut to nondrug items and services for all hospitals to keep the 340B remedy budget neutral.

“The administration’s plan to cut non–drug payments to hospitals to achieve budget neutrality unnecessarily blunts the impact of the remedy by ensuring years of future underpayments,” said Bruce Siegel, who leads America’s Essential Hospitals, an industry group for so-called safety-net hospitals.

PhRMA, the leading industry group for drugmakers, said the proposed rule “is a reminder of the need to fix the 340B program to ensure it works for vulnerable patients and the safety-net rather than as a profit stream for hospitals.”

IN THE STATES

SOUTH CAROLINA RESPONDS — The South Carolina Department of Mental Health said in a statement it was “surprised” by a DOJ report alleging the state’s practices violated the Americans with Disabilities Act.

The DOJ report argued South Carolina was effectively segregating people with disabilities by incentivizing sending them to adult-care facilities instead of community-based treatment.

But the South Carolina Department of Mental Health defended its actions, saying the state has expanded housing programs, streamlined discharge processes and created a plan to continually assess the need for community services.

That plan was created after the state was sued by several patients in 2017 over similar complaints of unnecessary institutionalization.

A message from PhRMA:

Names in the News

The Federation of American Hospitals hired Charlene MacDonald to serve as executive vice president of public affairs. She comes from CareFirst Blue Cross Blue Shield, where she was chief government affairs officer. Before that, MacDonald was head of health care and life sciences at FTI Consulting and a senior policy adviser for House Democratic Whip Steny Hoyer (D-Md.).

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What We're Reading

POLITICO New York reports that a Manhattan judge has paused a plan to push retired municipal workers off existing health care plans and onto Medicare Advantage.

The New York Times reports on how substance abuse is rising among older adults.

LAist reports that changes to Medi-Cal may prompt cuts to mental health services in California.

A message from PhRMA:

A new report showcases the vital role of post-approval R&D in nine critical oncology treatments. This research can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. See how post-approval R&D in cancer is at risk.