News : Cole curbs abortion rider enthusiasm

Tuesday, April 16, 2024

Cole curbs abortion rider enthusiasm

Apr 16, 2024

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By Chelsea Cirruzzo and Ben Leonard

With help from Daniel Payne

Driving The Day

Representative Tom Cole arrives for a House Republican Conference meeting at the U.S. Capitol on October 9, 2023.

As the new chair of the House Appropriations Committee, Rep. Tom Cole is downplaying the chances of getting any abortion-related riders attached to bills. | Francis Chung/POLITICO

(NOT SO) GREAT EXPECTATIONS — Rep. Tom Cole, the new House Appropriations Committee chair, is giving House Republican conservatives pushing for abortion-related riders in the appropriations process a reality check, Ben reports.

The Oklahoma Republican said Monday he’ll “work hard from a pro-life position,” but he also lowered expectations.

“The bills are going to have to be bipartisan,” Cole told POLITICO when asked about abortion-related riders. “It’s very difficult to force riders.”

He said the Hyde Amendment preventing federal funding for abortions will stay in spending bills, and he’ll look at “other things.”

“But at the end of the day, the functioning of the government has to go on,” Cole said.

Cole was named committee chair last week after former chair Rep. Kay Granger (R-Texas) stepped down from her post.

During the 2024 fiscal appropriations process, House Republicans worked with outside conservative groups to add new abortion restrictions in many corners of the appropriations process.

Their bid complicated negotiations and was ultimately unsuccessful. House Republicans have a narrow margin in the chamber and must reach a deal with the Democratic-led Senate.

Cole under fire: Cole’s taking heat from anti-abortion advocates for his stance.

“Tom Cole has always run as a pro-life Republican but also made it clear he would not fight for the issue,” Tom McClusky, director of government affairs at conservative nonprofit Catholic Vote, told Pulse. “We in the movement definitely will have our work cut out for us to change his mind and strengthen his spine.”

Others struck a different tone. Cole has an A+ rating from Susan B. Anthony Pro-Life America based on his voting record on abortion.

SBA Pro-Life is “confident he will continue to fight unapologetically to protect the unborn throughout the government funding bills.”

Jesse Southerland, federal policy director of Americans United for Life, said he believes Cole and House Republicans are defenders of existing statutes and riders.

Other appropriations updates: After lawmakers wrapped up fiscal year appropriations nearly six months late last month, Cole said there isn’t a top-line spending number yet. Government funding runs out Sept. 30.

Lawmakers will likely have to resort to a temporary funding patch, punting a spending deal until after the November elections.

“It’s going to be extraordinarily difficult. Every day closer to the election, the more reluctant Congress is to do anything,” Cole said.

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In Congress

Ron Wyden speaks with reporters at the U.S. Capitol.

Sen. Ron Wyden expects to schedule a Senate Finance Committee hearing on cybersecurity in the health sector “very shortly.” | Francis Chung/POLITICO

THE LOWDOWN FROM WYDEN — Senate Finance Committee Chair Ron Wyden (D-Ore.) said Monday that a hearing examining the Change Healthcare cyberattack will be scheduled “very shortly,” Ben reports.

The hearing would examine cybersecurity in the health sector and mark the first time the company’s senior executives would testify before Congress after the massive ransomware attack that disrupted claims processing. It could help build momentum for federal minimum cybersecurity standards — something Wyden pushed for Monday at the American Hospital Association’s annual meeting in Washington.

“It’s clear nobody was ready for this,” Wyden said.

UnitedHealth Group CEO Andrew Witty will appear before the panel, a company spokesperson told POLITICO last month. The U.S. should have a system that “uniformly” takes on measures to secure data from hackers, Wyden said.

Wyden also touched on several other topics:

PBMs: Wyden touted legislation to change the business practices of pharmacy benefit managers, which act as middlemen between insurers and drugmakers to negotiate drug prices, but didn’t specify how to proceed after negotiations stalled earlier this year.

Artificial intelligence: Wyden hopes AI regulation will be based on his Algorithmic Accountability Act, which would require firms to assess the impact of automated decision-making and reporting to the FTC.

IN OTHER CHANGE HEALTHCARE NEWS — Bipartisan leaders on the House Energy and Commerce Committee wrote to Witty on Monday, requesting information about what UnitedHealth knew about the breach when it occurred, how it responded and what it has done since to improve its cybersecurity. Their letter asks for answers by the end of the month.

The committee’s Health Subcommittee will hold a hearing today with cybersecurity experts and a policy adviser from the American Hospital Association to discuss cybersecurity within the health sector.

PHARMA WATCH

STATES REGULATE PBMS — Some states that regulate PBMs say such broad regulatory authority has been effective in tackling issues with them without the need for new legislation, according to a GAO report out Monday.

The report looked at five states — Arkansas, California, Louisiana, Maine and New York — with laws that allow them to regulate PBMs. The states regulate how PBMs set drug prices and pay pharmacies, including limiting their use of manufacturing rebates and their ability to pay pharmacies less than what they charge health plans.

Why it matters: Despite bipartisan support, a national PBM reform has floundered on Capitol Hill. In 2021, prescription drug spending by private health plans reached nearly $152 billion, an 18 percent increase from 2016, according to the GAO. The plans generally rely on PBMs for services, including processing claims and negotiating rebates with drugmakers.

However, concerns about how PBMs retain shares of rebates have left states to regulate PBMs on their own. All 50 states have at least one law regulating PBMs, the report said.

The five states analyzed by the GAO have imposed laws including:

— Instituting a duty of care on PBMs, meaning they must act in the best interest of the health plans they work with

— Requiring state licensing or registration for PBMs

— Limiting patient co-pays charged by PBMs

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Around the Agencies

PRIOR AUTH COMEBACK? The Biden administration might not be done with prior authorization policy, CMS Administrator Chiquita Brooks-LaSure suggested Monday, Daniel reports.

At the American Hospital Association conference, Brooks-LaSure said she has been hearing a lot about prior authorization requirements for prescription drugs.

“That’s an area that we have been asked to look at — and we are open to do that,” she said.

It’s uncertain what — if any — new action CMS will take on prior authorization, in which doctors must justify certain treatments before insurers agree to pay for them.

But the administration has tackled this issue before, with CMS finalizing a rule earlier this year that would limit the use of prior authorization in Medicare Advantage, Medicaid managed care and children’s health insurance plans.

Providers have long argued the process is used to delay or deny patient care, urging government-mandated reforms. Insurers say the process helps keep care costs down and protects patients from inappropriate care, though they sometimes have supported new rules for prior authorization.

But Brooks-LaSure’s comments suggest doctors and hospitals are gaining traction.

“The volume of frustration that I hear about prior authorization has just exploded,” Brooks-LaSure said, adding the practice is exacerbating health workforce shortages “in a way that is extremely problematic.”

CMS HITS PAUSE — The Centers for Medicare and Medicaid is delaying until next year the implementation of a controversial policy that’s upset academics.

The agency said earlier this year it would stop giving researchers physical copies of data extracts because of data breaches and security concerns. Instead, researchers would be required to use a virtual center to access data. However, academics have raised concerns that this would raise costs and impede high-quality analysis.

On Monday, CMS said it would delay implementation, initially planned for August, until next year to allow time to answer concerns and questions received via its request for information on the policy.

The RFI remains open until May 15.

Names in the News

Rebecca Mandell is the director of federal affairs for drugmaker Takeda. She previously launched the federal government relations operations at pharmaceutical company Organon.

WHAT WE'RE READING

The New York Times reports on congressional scrutiny of a Chinese drugmaker with ties to the Chinese government.

Reuters reports on an expected increase in medical costs for UnitedHealth Group ahead of its earnings call today.

STAT reports on telehealth company Cerebral facing a $7 million fine for charges that it disclosed personal health information to third parties for ads.

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