How a looming shutdown impacts public health

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

Sep 06, 2023 View in browser   By Ben Leonard and Chelsea Cirruzzo Presented by Driving the Day The Senate is back in town, with the House returning next week, and gearing up to avoid a government shutdown. | Sarah Silbiger/Getty Images THE CLOCK IS TICKING — Congress is trickling back into town with an important item on its agenda: Pass a spending deal by Sept. 30 to avert a government shutdown. With just 24 days to go, the White House urged Congress last week to pass a continuing resolution — a short-term funding fix — that would keep the government open and punt larger spending decisions to later this year. The Biden administration wants the continuing resolution to include $3.7 billion for CMS to assist with eligibility verifications of Medicaid and marketplace programs and keep the marketplace up and running. It also asks for $1.9 billion in funding for HHS’ Office of Refugee Resettlement, noting that certain health programs, including community health centers and the Medicaid Disproportionate Share Hospital program, must also be extended. But, passing any funding deal at all looks to be an uphill battle, made more difficult by the House Freedom Caucus’ demands. The group of roughly three dozen Republicans said it won’t support a continuing resolution unless certain of its priorities are met. Those include passing a sweeping GOP border bill and opposing a “blank check” for Ukraine aid. Shutdown impact: During a government shutdown, essential services remain running, so Medicare and Social Security checks would still go out the door. The exchanges would also remain open. But, as the U.S. heads into respiratory infection season and the administration prepares for a fall vaccination campaign, a shutdown would hamper efforts to tamp down outbreaks. In 2018, for example, health experts and the public raised concerns that the CDC’s flu surveillance system would shut down until officials promised to preserve it. Emergency funds: According to HHS’ contingency plan, certain Covid-19 activities, like vaccine development and authorization and clinical trials, would continue using emergency funding appropriations from 2020 and 2021. Monitoring for disease outbreaks — though the plan doesn’t specifically mention flu or Covid — would continue. The CDC’s contingency plan also promises to keep the Vaccines for Children program going while continuing to monitor public health threats. HHS expects to furlough about 40 percent of its workforce if the government shuts down. Staff that work on Medicare, Medicaid and other mandatory health programs would be retained. Will the past predict the future? However, as past shutdowns have shown, the health programs that remain open can vary depending on how essential they’re deemed to be at the time. During the 2013 shutdown, the NIH briefly closed its portal to register new clinical trials and couldn’t enroll new patients, according to a GAO report. CMS also lost discretionary funding for waste, fraud and abuse, and states were forced to use their own money for formula grant programs like Temporary Assistance for Needy Families. And during the 1995–1996 shutdown, new Medicare enrollees were turned away daily in alarming numbers. Health policy experts said that’s unlikely to happen again. WELCOME TO WEDNESDAY PULSE. I will be insufferable about Duke football’s huge win against Clemson for the rest of the week, and possibly the rest of the year. Or longer. As we get ready for a busy fall, reach us with news tips, feedback and scoops at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, host Daniel Payne talks with POLITICO health care reporter Alice Miranda Ollstein, who explains why abortion disputes threaten the reauthorization of PEPFAR, a law governing the United States’ global HIV/AIDS relief work. Listen to today’s Pulse Check podcast   A message from PhRMA: Middlemen can profit from where patients fill their prescriptions. Because insurance companies and PBMs own pharmacies, too.   In Congress LOOKING AHEAD — The House Energy and Commerce Committee has teed up several health care hearings for September, including one on implementing the Inflation Reduction Act, according to a schedule obtained by POLITICO. The Oversight and Investigations subcommittee is set to hold the IRA hearing on Sept. 20. Expect Republicans to scrutinize the law’s drug-pricing negotiation provisions now that the Biden administration has released the names of the first 10 drugs set for negotiation with Medicare. The other health-related hearings are Health Subcommittee legislative hearings on drug shortages on Sept. 14 and Medicare innovation on Sept. 19. A committee spokesperson declined to confirm the schedule. Sen. Bill Cassidy wants to rein in the use of artificial intelligence in health care by regulating AI by sector. | Francis Chung/POLITICO FIRST IN PULSE: CASSIDY WEIGHS IN ON HEALTH AI — Sen. Bill Cassidy, the Health, Education, Labor and Pension Committee’s ranking member, is floating changes to how artificial intelligence in health care is regulated. The framework from the Louisiana Republican, first obtained by POLITICO, is the most substantial proposal from Congress thus far to rein in AI in health care. In his report, Cassidy, who is also a gastroenterologist, suggested that artificial intelligence regulation should be sector-specific, saying that “top-down” methods could benefit incumbent firms because they prevent competition. When using AI to diagnose and treat diseases, Cassidy said, Congress might need to weigh “targeted updates” to medical device regulations to ensure safety and effectiveness while retaining flexibility. The bigger picture: Health care providers use AI to assist with diagnoses and treatment decisions, but AI hasn’t yet transformed care amid bureaucratic hurdles and a lack of trust in the technology. Elsewhere in Congress: Overall, lawmakers are getting acquainted with the technology and its implications. Sen. Ron Wyden (D-Ore.) has raised concerns about insurers using AI to deny claims, and Senate Majority Leader Chuck Schumer is developing a general “comprehensive AI framework,” though details are scant. What’s next: Cassidy is taking feedback on the framework until Sept. 22. A HELP Committee GOP aide said the feedback is needed to craft any potential legislation.   DOWNLOAD THE POLITICO APP: Stay in the know with the POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need. DOWNLOAD FOR iOS – DOWNLOAD FOR ANDROID.     Eye on Insurers MEDPAC TAKES ON MA — The Medicare Payment Advisory Commission is meeting Thursday and Friday to discuss Medicare Advantage, the hospital at home program and ambulatory surgical centers. MedPAC is devoting the bulk of its schedule to Medicare Advantage, with its focus on examining standardized benefits in the plans and rising coding intensity as compared to traditional Medicare, meaning MA beneficiaries seem sicker than Medicare ones. “We will continue to examine … plan enrollment and availability, access and quality, benefit standardization, risk adjustment and coding intensity, favorable selection, trends in the market for dual-eligible special needs plans, and the completeness of encounter data,” the advisory panel to Congress said in its agenda. The discussion comes as Democratic lawmakers have scrutinized the plans, looking at overpayments and reports of using algorithms to deny claims that should have been approved. The panel will also delve into:  — Medicare's Acute Care Hospital at Home program, which Congress extended through the end of 2024 — A slowing shift of surgeries from outpatient departments to ambulatory surgical centers NEW STATE PAYER MODEL — The Center for Medicare & Medicaid Innovation announced a voluntary payment model Tuesday that caps payments to doctors and hospitals in a state in exchange for loosening rules governing how care is provided, POLITICO’s Robert King reports. The model would cap Medicare and/or Medicaid payments to eight as-yet-to-be-chosen states but offer them more flexibility to coordinate care between a hospital and the doctor’s office. CMMI hopes to replicate similar experiments done in Maryland and Vermont. Under the model, the states would agree to give hospitals a fixed amount of money each year — a so-called global budget — to account for traditional, fee-for-service Medicare and Medicaid payments. Each state will get an overall spending target based on projections of future Medicare spending. The goal is to encourage states to “control unnecessary spending” by moving care away from hospitals to less expensive settings, according to a release.   A message from PhRMA:   Names in the News Niall Brennan is now senior adviser to the director of the CDC. He most recently was chief analytics and privacy officer at Clarify Health Solutions and is a CMS alum. Jeff Hild is now acting assistant secretary and principal deputy assistant secretary at the HHS’ Administration for Children and Families. Jacob Thaysen has been appointed CEO of Illumina. He was previously senior vice president of Agilent Technologies. Ryann Hill is joining the Federation of American Hospitals as vice president of legislation. She was previously senior director of federal and state affairs at SCAN Health Plan.   DON’T MISS POLITICO’S TECH & AI SUMMIT: America’s ability to lead and champion emerging innovations in technology like generative AI will shape our industries, manufacturing base and future economy. Do we have the right policies in place to secure that future? How will the U.S. retain its status as the global tech leader? Join POLITICO on Sept. 27 for our Tech & AI Summit to hear what the public and private sectors need to do to sharpen our competitive edge amidst rising global competitors and rapidly evolving disruptive technologies. REGISTER HERE.     What We're Reading Insider reports on issues at a weight loss startup tied to layoffs and understaffing. The Washington Post reports on a study that links screen time for 1-year-olds to developmental delays.   A message from PhRMA: Insurance companies and pharmacy benefit managers (PBMs) are putting their profits before your health. That’s because the largest PBMs own or are owned by the largest insurance companies, and they own pharmacies, too. First the PBM can deny coverage for your medicine in favor of one that makes them more money. Then, they steer you to the pharmacy they own. Without you ever knowing why it all happens this way. See what else they do.     Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo 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 Evan Peng @thepngfile Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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