2023’s biggest House health care vote

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

Dec 12, 2023 View in browser   By Ben Leonard and Chelsea Cirruzzo Presented by With Megan R. Wilson and Daniel Payne  Driving The Day Democratic leadership was split on passing major health legislation, with House Minority Leader Hakeem Jeffries (left) and Minority Whip Katherine Clark supporting the bill and Rep. Pete Aguilar, chair of the House Democratic Caucus, opposing. | Anna Moneymaker/Getty Images TRANSPARENCY PACKAGE SAILS THROUGH — The House advanced on Monday one of the bipartisan bright spots in Congress this year: health care legislation called the Lower Costs, More Transparency Act, which passed in a 320-71 vote. The measure would increase reporting requirements for insurers, hospitals and pharmacy benefit managers. PBMs have been a bipartisan target in both chambers, and the passage is the most significant action lawmakers have made against them this year — now prompting the Senate to act. The bill renews a number of federal health programs and changes Medicare payment policy so that drugs administered in a hospital outpatient department are reimbursed at the same rate as a doctor's office, a policy known as site-neutral payments. Hospitals and PBMs oppose the bill and vow to continue pushing against the policies. The bill was slated to receive a vote in September but was pulled from the calendar amid questions over its support and House chaos over government spending. It passed Monday with the support of 166 Republicans and 154 Democrats, a total that could bolster House lawmakers’ negotiating leverage with the Senate. Rep. Brett Guthrie (R-Ky.), chair of the Energy and Commerce health subcommittee, told Pulse that the House is “getting back to normal” following the passage of a government funding package and the election of a new speaker. Rep. Bobby Scott (D-Va.), ranking member of the Committee on Education and the Workforce, had flipped to support the bill. A House Democratic aide told Pulse that adding more robust privacy protections was key to getting Scott on board. However, some key players opposed the bill. Rep. Richard Neal (D-Mass.), ranking member of the Ways and Means Committee, cited a lack of ownership transparency requirements that would reveal when private equity firms purchase health facilities, including nursing homes. Other Ways and Means Democrats — including Reps. Lloyd Doggett (D-Texas) and Bill Pascrell (D-N.J.) — also voted no. Democratic leadership was split, with House Minority Leader Hakeem Jeffries (D-N.Y.) and Minority Whip Katherine Clark (D-Mass.) supporting and Rep. Pete Aguilar (D-Calif.), chair of the House Democratic Caucus, opposing. The bill also authorizes increased funding for community health centers, Daniel reports. But the increase that passed Monday night — an annual 10 percent boost through calendar year 2025 — is far less than a Senate proposal. Some community health advocates hope Monday’s vote will jump-start negotiations with the Senate, where leaders have signaled they’re looking for more than what’s in the House bill, Amanda Pears Kelly, CEO of Advocates for Community Health, told Pulse. Funding expires in mid-January. WELCOME TO TUESDAY PULSE. Are you going to work on reconciling Senate and House packages? We want to hear from you. Reach us at bleonard@politico.com or ccirruzzo@politico.com. We can keep you anonymous. Follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, your host Ben talks with POLITICO health care reporter Megan Messerly about her report on a coming mining boom that brings with it industry jobs that have good health care benefits — and how that can counterintuitively damage health care access, boosting it for some while hampering it for others. Listen to today’s Pulse Check podcast   A message from PhRMA: Middlemen like PBMs are charging fees tied to the price of medicines, which means they make more money when the price of a medicine goes up. This business model allows PBM profits to soar and can lead to higher costs for patients. It’s time to lower costs by holding middlemen accountable.   In Congress HELP Committee Chair Bernie Sanders wants more done to bolster mental health and substance abuse staffing. | Francis Chung/POLITICO OPIOID LEGISLATION UP FOR HELP — More than two months after the provisions of a major 2018 opioid law expired, the Senate HELP Committee will this morning mark up the SUPPORT Act reauthorization bill, which provides grants for states to pay for prevention, treatment and recovery services for people with opioid use disorders. Sen. Bernie Sanders (I-Vt.), chair of the Health, Education, Labor and Pensions Committee, who for months didn’t see the bill as a priority, said more needs to be done in the long term to “substantially increase the number of substance abuse counselors and mental health professionals in America.” The committee will also mark up a bill expanding access to methadone, a drug used to treat people with opioid use disorder. If enacted, the legislation would allow more providers and pharmacies to prescribe and dispense it. Methadone is dispensed in specialized clinics to avoid the risk of misuse, but Sen. Ed Markey (D-Mass), who sponsored the bill with Sen. Rand Paul (R-Ky.), said in a statement that too many people are forced to travel for hours to obtain it, making it hard to stay in recovery. Yet some addiction treatment providers have opposed it, warning that more liberal access could lead to methadone overdose deaths. FIRST IN PULSE: BIPARTISAN PRESSURE ON HHS — Forty-eight members of Congress on both sides of the aisle are putting pressure on HHS to drop its appeal of a decision that struck down a rule on cost-sharing. The 2021 rule allowed insurers to avoid counting drugmaker coupons toward patients’ maximum out-of-pocket costs and deductibles, meaning patients could pay more out-of-pocket. A federal judge in September struck down the rule but HHS has decided to appeal, which the members said was disappointing. In a letter obtained by Pulse led by Reps. Buddy Carter (R-Ga.) and Nanette Diaz Barragán (D-Calif.), the lawmakers said they were “disappointed” that HHS appealed the decision. “We believe this decision is an important step in the right direction for patients who rely on manufacturer copay assistance to alleviate affordability and access challenges for their medicines,” the lawmakers wrote. The ruling was a win for patient advocate groups who brought the suit against HHS. They argued the rule contradicts the Affordable Care Act’s and HHS’ definitions of cost-sharing and can significantly raise patient costs. Insurers have pointed at drugmakers for setting high prices. HHS gave notice it was appealing the ruling late last month. An HHS spokesperson didn’t respond to a request for comment.   POLITICO AT CES® 2024: We are going ALL On at CES 2024 with a special edition of the POLITICO Digital Future Daily newsletter. The CES-focused newsletter will take you inside the most powerful tech event in the world, featuring revolutionary products that cut across verticals, and insights from industry leaders that are shaping the future of innovation. The newsletter runs from Jan. 9-12 and will focus on the public policy-related aspects of the gathering. Sign up today to receive exclusive coverage of the show.     Public Health HEAT SAFETY CONCERNS — Eugene Gates, a 66-year-old mail carrier with a 35-year career, died of heat stroke in June while delivering mail in a Dallas front yard. His death is part of a storm of allegations that the U.S. Postal Service ignored its own heat safety programs and manipulated official records to hide those actions ahead of an unrelenting summer of extreme heat that killed scores of people across the U.S., E&E News’ Ariel Wittenberg reports as part of a three-month investigation. Under its own policy, the agency is required to train letter carriers each spring to recognize the symptoms of heat illness and what to do if they feel sick. But Gates didn’t receive training, and his managers “falsified” official records before his death to hide it, according to his widow, Carla, and leaders of the National Association of Letter Carriers union involved in the grievance. He’s not the only one affected. The mounting accusations by thousands of mail carriers come as the debt-plagued USPS pushes workers to make faster deliveries amid growing competition and as temperatures catapult to heights never before recorded. USPS declined interview requests and didn’t answer questions about the allegations. But in at least three instances, Postal Service officials on dispute resolution panels have acknowledged in writing that training records were “falsified.” “The safety of our employees is a top priority, and the Postal Service has implemented a national Heat Illness Prevention Program for all employees,” USPS spokesperson Darlene Casey said in a statement.   A message from PhRMA:   HEALTH TECH TEFCA REVEAL — The Office of the National Coordinator for Health IT is set to unveil today the first batch of organizations that will officially join its major data-sharing initiative, the Trusted Exchange Framework and Common Agreement. The initiative aims to better connect providers, public health agencies, researchers and others in medicine through a nationwide network and facilitate sharing of patient information. Some groups that have participated in TEFCA’s onboarding process include electronic health records giant Epic; data-sharing trade group CommonWell Health Alliance; interoperability platforms Health Gorilla and Kno2; health information network eHealth Exchange; and KONZA, a nonprofit that supports health information exchanges. Surescripts, the health information and e-prescribing behemoth, has also applied to become a Qualified Health Information Network. It’s unclear how many organizations will become designated QHINs to share data.   SUBSCRIBE TO 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. Subscribe now to California Climate to keep up with the changes.     Names in the News Mike Tuffin has been appointed CEO of AHIP. He currently oversees advocacy for UnitedHealth Group. Peter Arduini will chair AdvaMed’s board. He’s the president and CEO of GE HealthCare. WHAT WE'RE READING The Texas Tribune reports on the Texas Supreme Court blocking an order allowing a woman to have an abortion. She left the state before the ruling to get one. CNN reports on ChatGPT struggling with medical questions.   A message from PhRMA: Middlemen like PBMs are charging fees tied to the price of medicines, which means they make more money when the price of a medicine goes up. This business model allows PBM profits to soar and can lead to higher costs for patients. It’s time to lower costs by holding middlemen accountable.     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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