Congress’ 2024 health policy agenda

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

Jan 02, 2024 View in browser   By Chelsea Cirruzzo and Ben Leonard Driving The Day House Speaker Mike Johnson is in a time crunch to pass appropriation bills to avert a government shutdown. | Win McNamee/Getty Images RETURNING TO A BIG TO-DO LIST — Congress is staring down what has been a tall task post-holidays: passing two major health care spending bills and trying to tag on major health initiatives, Ben reports. Congress doesn’t return in full until Jan. 9 — and has 10 days left to pass the Agriculture-FDA spending bill, among others, to avert a partial government shutdown. It has until Feb. 2 to pass the Labor-HHS spending bill, along with funding the rest of the government, including many major domestic programs and the Pentagon. No cap yet: That’s all without an agreement on a top-line spending number. House Speaker Mike Johnson has pledged not to rely on “short-term” stopgap measures to fund the government. Although lawmakers have discussed a full-year patch, or continuing resolution, lawmakers in both parties have increasingly opposed such an idea. The spending bills could be one of the last major vehicles for legislation entering an election year after a historically unproductive 2023 for Congress. Lawmakers and advocates are eyeing the Jan. 19 vehicle — which includes several expiring health program extenders — for health transparency legislation. Pushback ahead? Lobbyists for business and consumer groups are gearing up for a busy start to the year, with many calls and meetings on the Hill planned and ad purchases being weighed. They hope to ride the wave of momentum after the House overwhelmingly passed the Lower Costs, More Transparency Act, the most substantial health legislation to move last year, last month. The measure would increase reporting requirements for insurers, hospitals and pharmacy benefit managers, which manage prescription drugs for insurers. Hospitals and PBMs have pushed back against the legislation. What to watch for: The Senate and the House must agree on a deal. A Senate aide told POLITICO that the chamber won’t move on the House legislation as a standalone measure, but both chambers will look for common ground. The two chambers diverge in their legislation, though they have the same goal of reducing health care costs. The House and the Senate HELP and Finance committees have different approaches to PBMs, and the Senate hasn’t come together on so-called site-neutral policies as the House has. Those policies intend to make payment the same for services whether at hospital outpatient facilities or independent doctors’ offices. WELCOME TO TUESDAY PULSE. Welcome back! The American College of Sports Medicine predicts that wearable technology, like smartwatches and heart rate monitors, will be the top wellness trend this year. What other health trends are you watching for 2024? Email us at ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_. At the Agencies HHS Secretary Xavier Becerra has been traveling coast to coast to discuss Medicare drug pricing. | Drew Angerer/Getty Images HHS’ 2024 FOCUS — HHS will continue to promote its efforts to reduce Medicare drug pricing through the Inflation Reduction Act this year — a policy likely to play a central role in President Joe Biden’s election push. An HHS spokesperson told Pulse that health costs, reproductive health and mental health are among its top priorities in 2024. This will be a continuation of 2023: In the last few months alone, HHS Secretary Xavier Becerra made trips to Arizona, California, Nevada, New Mexico, North Carolina, and Virginia to talk about the administration’s efforts on Medicare drug pricing. Artificial intelligence: HHS will need to make big strides in artificial intelligence this year: An October executive order requires the department to launch an AI task force by the end of January and develop guidelines on AI-enabled health tools by the end of April. Rules to watch: The Drug Enforcement Administration is expected to soon put out a new proposed rule on how telemedicine can be used to prescribe buprenorphine, used in drug-assisted treatment. A previous proposal, which drew fire from recovery advocates, sought to limit prescriptions to a 30-day initial supply. Additionally, the proposal will address other controlled substances being prescribed virtually. HHS’ Office for Civil Rights is also expected to finalize a rule in March that would bar providers and insurers from giving information to state officials to be used to investigate, sue or prosecute someone for seeking or providing a legal abortion. Mental Health REVERSING COURSE ON MENTAL HOSPITALS — A 1965 rule that banned Medicaid from paying for hospital treatment for people with mental illness and substance use could soon be struck down, POLITICO’s Carmen Paun reports. The House passed a bill in December to give states the option to treat Medicaid patients with substance use disorder for up to a month in a mental hospital on the government’s dime — and the bill has good prospects in the Senate. Why it matters: Both public health groups and lawmakers say the nearly 60-year-old rule had unintended consequences: a lack of psychiatric beds that forced vulnerable people to end up on the streets, in jail, in emergency rooms or dead. The legislation comes as many American cities face a dual drug addiction and homelessness crisis. Some states, like California and New York, are already experimenting with ways to force patients into care. Mixed feelings: While Republicans agree on the bill, Democrats are divided, wary that it could force people into institutions. New Jersey Rep. Frank Pallone, the top Democrat on the House Energy and Commerce Committee that shepherded the bill, has instead advocated for caring for people in their homes with a team of specialized health and social workers. Sen. Bill Cassidy (R-La.) has argued that a person diagnosed with mental illness and substance use disorder needs inpatient care for doctors to stabilize them. UTAH VS. SOCIAL MEDIA — Utah’s governor blamed social media for mental illness among children Sunday and defended a state law that would restrict its use among minors, POLITICO’s Kelly Garrity reports. “[Social media] is absolutely causing these terrible increases, these hockey stick-like increases that we are seeing in anxiety, depression, and self-harm amongst our youth,” Gov. Spencer Cox (R-Utah), the chair of the National Governors Association, said during an interview on NBC’s “Meet the Press.” A Utah law enacted last year that would require social media users to verify their ages when logging in to their accounts is facing legal challenges from a trade group that represents Meta, TikTok and X. First Amendment advocates have also argued the law, which is to go into effect in 2024, infringes on free speech rights. Cox said Sunday that big tech companies know their sites are harmful anyway. Colorado Gov. Jared Polis, a Democrat, agreed with Cox on the role social media plays in fueling the mental health crisis in the country. But policing social media use should be left up to parents, Polis said. “I think the responsibility belongs with parents, not the government,” Polis, the vice chair of the NGA, said during the joint interview with Cox. Artificial Intelligence THE AI WILL BILL YOU NOW — Both providers and insurers hope that artificial intelligence tools can help them with processing the $4 trillion in medical bills Americans accumulate each year, POLITICO’s Daniel Payne reports. The hopes: Some health systems said they want to reap savings by coding their bills more accurately and, therefore, reducing their liability. Others highlight the benefits of reducing the labor needed to complete administrative tasks. And nearly all providers are keenly interested in making their staff happier by reducing burnout. The drawbacks: When insurers and providers can’t agree on a bill, it’s often patients caught in the middle — or stuck on hold waiting to talk to a customer service representative. But, when AI helps insurers deny care, or amp up the fights between medical providers and health plans over bills, will patients have to mediate? Some of the biggest health insurers — including Humana and UnitedHealth — already face lawsuits claiming they’re using AI to deny care. The plaintiffs in the suits, filed this fall, argue the companies rejected doctors’ orders more often after embracing AI tools to monitor care. Humana and UnitedHealth declined to comment on the pending litigation. Both providers and insurers say they expect the AI takeover of the billing process to help patients more than it hurts them — and lawmakers, tasked with regulating the growing use of AI in health care, are just getting started on evaluating their role. WHAT WE'RE READING POLITICO’s Megan Messerly and Robert King report on Georgia’s lackluster Medicaid work requirements program. POLITICO’s Megan Messerly reports on the Mississippi attorney general’s fears about how tobacco settlement money will be handled. The Washington Post reports on the critical reception to HHS’ plan to revitalize primary care.   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 Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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