Clock is ticking for Congress’ health care bills

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Aug 02, 2023 View in browser   By Erin Schumaker and Daniel Payne Presented by With Alice Miranda Ollstein Driving the Day Senate Minority Leader Mitch McConnell (l), Senate Majority Leader Chuck Schumer (c) and House Speaker Kevin McCarthy face a Sept. 30 deadline to pass health policy legislation to avoid losing funding for critical health programs. | J. Scott Applewhite/AP Photo CONGRESS COUNTDOWN ON HEALTH BILLS — House and Senate panels have advanced more than a dozen health care bills this year, POLITICO’s Megan R. Wilson reports. The proposals are a mix of health policy reforms and reauthorizations of health programs that expire on Sept. 30. Although most have been bipartisan, differences in size and scope threaten to bog down their passage unless policymakers can reconcile their differences. And it’s all happening against the backdrop of ongoing budget negotiations needed to avert a government shutdown and other reauthorizations — amid a limited number of legislative days. Here are some highlights:  — In the House, overlapping jurisdictions among the Energy and Commerce, Ways and Means, and Education and the Workforce committees have resulted in a flurry of bills about related topics. The common theme involves requiring increased transparency for hospitals, insurers and pharmacy benefit managers, which negotiate discounts with drugmakers and decide which medicines plans will cover. But some proposals are at odds with others, including one that would require health facilities to disclose ownership changes — an effort to determine the prevalence of private equity in the system. A bipartisan Energy and Commerce Committee package contains the provision, but it was stripped from the GOP-written Ways and Means Committee bill. Meanwhile, the Ways and Means measure contains more expansive site-neutral payment policies, which ensure Medicare patients pay the same for a service regardless of where it’s performed. — The House and Senate versions of legislation to reauthorize the Pandemic All-Hazards Preparedness Act, first signed into law in 2006, also have differences. The Senate’s bill is more comprehensive than its GOP-led House counterpart. In the House, negotiations with Democrats broke down over whether to include policies to address drug shortages. Republicans argued the issue was unrelated to the bill, but the Senate’s bipartisan PAHPA reauthorization bill includes measures meant to mitigate medicine shortages. — And Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) released a drug shortage discussion draft last week. She said she hopes the proposal could be a jumping-off point that leads to bipartisan legislation. However, a spokesperson for the committee’s Democrats told Megan they hadn’t been given a peek at the draft or notified it was coming, which may worsen lingering tensions from the failed PAHPA negotiations. WELCOME TO WEDNESDAY PULSE, where we just learned that crews are battling“fire whirls” — that’s right, spinning columns of fire — in an attempt to put out a wildfire that’s crossed from California into Nevada. Send tips and feedback to eschumaker@politico.com and dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Megan Messerly talks with Megan R. Wilson and David Lim, who give an overview of the critical health policy legislation that Congress needs to pass before funding for crucial health programs runs out on Sept. 30. Listen to today’s Pulse Check podcast   A message from PhRMA: Insurance isn’t working like it should. The latest Patient Experience Survey uncovers the challenges insured Americans face affording care and how practices by health insurers and middlemen put patients at risk. Learn more.   At the Agencies Acute care hospitals can expect an increase in Medicare payments next fiscal year for inpatient services. | AP Photo A PAY HIKE FOR HOSPITALS — The Biden administration announced Tuesday a 3.1 percent bump to inpatient Medicare payments to hospitals next federal fiscal year that begins Oct. 1 — much to the chagrin of hospitals, which believe the increase is inadequate. CMS released the final Inpatient Prospective Payment System rule that oversees policy and payment rates for the fiscal year that starts in October, POLITICO’s Robert King reports. The 3.1 percent pay hike is slightly above the 2.8 percent the agency proposed in April. But the rule is likely to draw a harsh response from the industry and its affiliates, which had protested the proposed version citing higher labor costs. “Workforce shortages continue to create outsized pressures on hospitals and health systems, and workforce financial pressures are particularly challenging because labor on average accounts for about half of a hospital’s budget,” the American Hospital Association wrote in comments on the proposed rule. The final rule means acute care hospitals can expect an additional $2.2 billion in Medicare payments for inpatient services next fiscal year. However, CMS projects payments to so-called safety-net facilities will decline by nearly $1 billion because of “updated estimates and data in its projections.” Those hospitals typically serve a higher share of the uninsured and Medicaid population and rely on a Medicare disproportionate share hospital fund that’s in line for a $957 million cut.   YOUR TICKET INSIDE THE GOLDEN STATE POLITICAL ARENA: California Playbook delivers the latest intel, buzzy scoops and exclusive coverage from Sacramento and Los Angeles to Silicon Valley and across the state. Don't miss out on the daily must-read for political aficionados and professionals with an outsized interest in California politics, policy and power. Subscribe today.     Abortion USING THE CLEAN WATER ACT TO CURB PILL ACCESS — The influential anti-abortion group Students for Life launched the next phase of its campaign Wednesday to use the nation’s environmental laws to restrict the ability to terminate a pregnancy, Alice reports. In a citizen petition to the FDA — first shared with POLITICO — the group asks the agency to rescind approval of the widely used abortion drug mifepristone until officials assess whether its use contaminates recreational lakes and rivers in violation of the Clean Water Act. The group points specifically to protected bodies of water in Michigan and California, hoping to use the issue as a cudgel against the pro-abortion-rights governors of those states. It’s the fourth such petition to the FDA since Roe v. Wade was overturned that targets the pills, approved for use in the first 10 weeks of pregnancy. Previous petitions have alleged harm from the pills to drinking water and endangered species. Environmental scientists have said there’s no evidence abortion pills have any adverse effect on the environment, arguing that it’s a minuscule fraction of the total volume of pharmaceutical drugs that find their way into wastewater. Still, Students for Life’s work could have an impact. The group says it will sue the FDA if the agency ignores or dismisses the petitions, building on already pending lawsuits that threaten access to the pills nationwide. It is also working with state and federal lawmakers on legislation that would make doctors who prescribe the pills responsible for disposing of the medical waste that results from the abortion.    A message from PhRMA:   Providers DOCTOR AND SURGEON GROUPS FACE OFF OVER BILLING — The American Academy of Family Physicians and the American College of Physicians issued a joint letter to Congress on Tuesday, urging lawmakers to support the Centers for Medicare and Medicaid Services plan to include a Medicare billing code — known as G2211 — in its physician fee schedule next year. The code lets doctors bill for ongoing complex care. Without it, they say, the primary care practices would suffer. Meanwhile, nearly 20 surgical groups have come out against the billing code’s inclusion on the grounds that it will harm surgeons and result in overpayments. “The current Medicare physician payment system is pitting medical specialties against one another as payment rates become increasingly inadequate and physician practices struggle to stay afloat,” the doctor groups wrote. Congress delayed implementing the code in 2021. The moratorium on it ends in 2024. HEALTH TECH DR. AMAZON WILL SEE YOU NOW — Amazon is expanding its virtual health services nationwide, the company said Tuesday. Amazon Clinic, launched late last year, will offer around-the-clock messaging and video telehealth services for 30 common health problems, such as urinary tract infections and pink eye. Amazon Clinic doesn’t accept insurance but is HSA- and FSA-eligible. Names in the News Dr. Andrew Trister is the new chief science officer at Verily. He previously led digital health and artificial intelligence programs at the Bill & Melinda Gates Foundation.   A message from PhRMA: Insurance isn’t working like it should. 53% of insured Americans say they can’t anticipate what they’ll pay for health care services, even if those services are covered by their insurance plan. Learn more about the cost and coverage barriers Americans face.    What We're Reading Endpoints News reports on Henrietta Lacks descendants’ settling with the biotech company that used her cervical cells for research without her permission. The New York Times reports on Oregon’s experiment to curb overdoses by decriminalizing small amounts of illegal drugs. CNBC reports on Pfizer’s revenue from its Covid-19 vaccine and antiviral pill Paxlovid falling sharply in its latest earnings report.   HITTING YOUR INBOX AUGUST 14—CALIFORNIA CLIMATE: Climate change isn’t just about the weather. It's also about how we do business and create new policies, especially in California. So we have something cool for you: A brand-new California Climate newsletter. It's not just climate or science chat, it's your daily cheat sheet to understanding how the legislative landscape around climate change is shaking up industries across the Golden State. Cut through the jargon and get the latest developments in California as lawmakers and industry leaders adapt to the changing climate. Subscribe now to California Climate to keep up with the changes.       Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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