News: House panel advances HHS 2025 budget

Thursday, July 11, 2024

House panel advances HHS 2025 budget

Jul 11, 2024

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With Lauren Gardner

Driving the Day

Rosa DeLauro and Robert Aderholt testify during a committee hearing.

Reps. Rosa DeLauro (left) and Robert Aderholt were at odds over an amendment that would impact abortion services during a markup of the HHS spending bill. | Francis Chung/POLITICO

HHS SPENDING PLAN MOVES AHEAD — Despite Democratic efforts to slam the brakes on Republican plans to limit abortion access and restructure the NIH, the House Appropriations Committee approved the fiscal 2025 HHS spending plan along party lines on Wednesday.

The budget proposal, unveiled last month by Republicans, includes $107 billion for HHS — a 7 percent cut. It would streamline the NIH, slash Title X family grants and increase funding for substance-use disorder prevention block grants.

Rep. Robert Aderholt (R-Ala.), who chairs the health subcommittee, said the bill would reduce federal spending as well as “reign in divisive mission-free public health agencies so that they can restore public trust by focusing on their core responsibilities of preparedness.”

Democrats, however, decried cuts to the CDC, the elimination of programs that focus on gun violence and climate change, and attempts to restrict abortion access.

Why this matters: House Republicans have argued that HHS has strayed from its intended purpose and want to strip the agency of programs and language they deem politically motivated, such as those focused on climate change and efforts on gender-affirming care.

The bill includes an amendment by Aderholt, also OK’d along party lines, that would allow individuals to sue for monetary damages if they believe a federal agency discriminated against a provider, hospital or health insurance plan that wouldn’t provide or refer abortion services. Democrats criticized it as an expansion of the Weldon Amendment, an abortion rider in prior HHS spending bills that makes it easier for providers and insurers to refuse that type of care.

“This amendment would expand … refusal of care laws by prioritizing personal beliefs above women's health,” said ranking member Rosa DeLauro (D-Conn.). Democrats were also unable to strip out the Hyde Amendment, which bans the use of federal funding for abortion, as well as reverse Title X funding cuts.

Other amendments considered included:

— An amendment by Rep. Andrew Clyde (R-Ga.) to prevent any CDC funding from going toward research into gun violence, which was adopted.

— An amendment by Rep. Barbara Lee (D-Calif.) to prevent the elimination of the HHS Office of Climate Change and Health Equity, which failed.

— An amendment by Rep. Steny Hoyer (D-Md.) to stop the integration of the Advanced Research Projects Agency for Health into the NIH as part of a larger reorganization, which failed and then withdrawn. “[ARPA-H’s] collaboration with NIH is essential, but its independence provides the flexibility to take big risks and big payoffs,” Hoyer said.

Next steps: The bill now advances out of committee but isn’t likely to be adopted in law in its current form due to Senate Democrat opposition.

WELCOME TO THURSDAY PULSE. My summer reading update: I just finished “Come and Get It” by Kiley Reid, a chilling read about a resident assistant in the year 2017 — which I can relate to. I’d highly recommend it! Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.

A message from the PBM Accountability Project:

Patients, providers, and employers deserve to pay transparent, fair prices for prescription drugs, but pharmacy benefit managers (PBMs) are gaming the system while eating up profits and driving up costs. The Wall Street Journal recently uncovered that PBM middleman “mark up prices of generics for cancer, multiple sclerosis and other complicated diseases,” particularly medications from mail-order pharmacies that PBMs own. Congress must act now and protect patients from big PBMs pigging out on patient savings. Learn more at pbmaccountability.org.

In Congress

James Comer walks out of two doors in the Capitol.

Rep. James Comer, chair of the House Oversight Committee, and other GOP committee chairs have asked federal agencies about rules that the overturning of the Chevron deference could impact. | Anna Moneymaker/Getty Images

HOUSE GOP’S CHEVRON RESPONSE — House Republican leadership on Wednesday pressed more than two dozen agencies, including HHS, the VA and the FTC, for details on rules that could be impacted by the Chevron doctrine’s demise, Ben reports.

The move comes after the Supreme Court last month overturned the so-called Chevron deference, a decades-old legal framework holding that when laws are unclear and federal agencies regulate based on a “reasonable” reading of them, judges must uphold their regulations. Republicans have long called for the end of Chevron, saying it gives too much power to unelected agency officials.

House Oversight Committee Chair James Comer (R-Ky.) and other GOP committee chairs asked agencies for a list of rules and adjudications that could be affected by the decision if challenged and a list of pending challenges, as well as all pending rules and adjudications that could have been eligible for Chevron deference before the decision.

The responses, which Republicans want by the end of the month, could aid in potential challenges to the rules. The decision has given more ammunition to potential challengers.

Rules surrounding Medicare, private insurance, the FDA’s oversight, abortion and clinical trials at the NIH could be vulnerable.

The White House didn’t immediately respond to a request for comment. Democrats and the Biden administration have slammed the ruling, arguing it gives too much power to judges who don’t have subject matter expertise that agency officials do.

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AROUND THE AGENCIES

DOCS BRACE FOR ANOTHER PAY CUT — CMS proposed a 2.8 percent cut to doctors’ Medicare reimbursements for 2025, a move expected to ignite a new lobbying action from advocacy groups, POLITICO’s Robert King reports.

The agency released its Physician Fee Schedule on Wednesday, which outlines payment rates and other policy updates for 2025. Doctors have faced payment cuts in the past several years, but Congress has given them some short-term relief.

Doctor groups slammed the proposed cut shortly after the rule’s release.

“Medicare physician reimbursement is on a dire trajectory, and these ongoing cuts continue to undermine the ability of medical practices to keep their doors open,” said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.

However, a long-term fix remains in limbo on Capitol Hill.

The Provider Reimbursement Stability Act introduced in the House last year would update the payment formulas but has yet to advance out of the Energy and Commerce Committee. The Senate Finance Committee released a white paper in May that floated several policy options.

FDA REJECTS WEEKLY INSULIN BID — The FDA has turned down an application to license the first weekly insulin injection for type 1 diabetics in the U.S., asking for more information about the product, drugmaker Novo Nordisk said Wednesday, Lauren reports.

The agency issued a response letter to the company that includes requests pertaining to the drug’s manufacturing process and its proposed indication for type 1 diabetes, Novo said. People with type 1 diabetes rely on daily injections of insulin to survive.

Independent FDA advisers found in May that the weekly insulin benefits didn’t outweigh the risks. Agency staff raised concerns about elevated cases of hypoglycemia in study participants with type 1 diabetes.

Novo said it would work with the FDA to identify the next steps for answering the agency’s questions but doesn’t expect to fulfill the requests this year.

The drug is approved in the EU, Canada and Australia for type 1 and type 2 diabetes.

A message from the PBM Accountability Project:

Telehealth

TELEHEALTH CHANGES AFTER EMERGENCY — Virtual mental health care dropped in the year following the end of the Covid-19 public health emergency, according to a study published in JAMA Network Open on Wednesday.

Researchers from Rand Corporation, Georgetown University and Brigham and Women’s Hospital called about 1,000 mental health treatment facilities before the end of the public health emergency in mid-2023 and again after the PHE was lifted to gauge their mental health services offered via telehealth.

They found that 2.6 percent fewer facilities offered telehealth after the PHE’s end — with public clinics more likely to discontinue telehealth services when compared with privately run clinics.

Among the facilities that continued to offer telehealth, services were more limited. For example, the availability of telehealth psychotherapy and medication management was limited, and there were large declines in the availability of audio-only telehealth and services for comorbid alcohol use disorders.

Why it matters: Congress is mulling over extensions to pandemic-era telehealth flexibilities, which will expire next year. A Congressional Budget Office official recently said that more research is needed on how telehealth use and offerings have changed as Covid becomes less disruptive.

Understand 2024’s big impacts with Pro’s extensive Campaign Races Dashboard, exclusive insights, and key coverage of federal- and state-level debates. Focus on policy. Learn more.

Names in the News

Dr. Stephen Ondra is now vice president for the Center for Transforming Health at MITRE and director of the CMS Alliance to Modernize Health Care. Ondra was previously MITRE’s chief medical adviser.

WHAT WE'RE READING

POLITICO's David Lim reports on the FDA funding bill that advanced out of the House Appropriations Committee Wednesday evening.

The New York Times reports on how doctors use AI to hit back at denied claims.

POLITICO’s Josh Sisco reports on FTC plans to sue PBMs over high drug costs.

A message from the PBM Accountability Project:

PBMs are pigging out on employer and patient savings while Americans struggle to afford the medicines they need.

A groundbreaking new study in Washington state uncovered several ways that big PBMs are reaping record amounts of prescription drug profits, hurting local pharmacies, employers and ultimately the patients at the pharmacy counter:

· For a subset of matched claims between the plan sponsors and the pharmacies, the average plan sponsor (employer) costs were approximately $165,000 higher (roughly 80% more) than the reimbursement provided to pharmacies (approximately $8 more per prescription).
· Plan sponsor (employer) costs increased by 30% while pharmacy reimbursement decreased by 3% between 2020-2023.
· PBM-owned mail-order pharmacies had drug markups that were more than three times higher than the markups at retail pharmacies.
· In one example, as reported by the Wall Street Journal, PBMs charged more than $6,000 for a cancer drug that costs $55.

We need Congress to put an end to the great PBM pig-out. Learn more at pbmaccountability.org.