THUNE IS PRO-FILIBUSTER — Sen. John Thune (R-S.D.), who won the race to be Senate majority leader in the next Congress Wednesday, told reporters the Senate filibuster will stay intact under his leadership. If that holds true, it could be a thorn in the side of Republicans, who would need 60 votes to pass legislation — meaning they’d need to rely on Democrats. That could include changes to the Affordable Care Act, Medicaid and more. Thune has focused on issues including the 340B drug discount program and pharmacy benefit manager reform. President-elect Donald Trump has pushed the Senate GOP to ditch the filibuster and could do so again if his priorities aren’t deemed eligible for the wonky budget reconciliation process that helps the Senate pass legislation with a simple majority. “At the end of the day, we’re going to have more limitations on what we’re able to use reconciliation for than perhaps a number of our House colleagues would like,” Thune told POLITICO’s Jennifer Scholtes and Caitlin Emma this summer. SITE-NEUTRAL UPDATE — Senate Finance Committee Chair Ron Wyden (D-Ore.) told Pulse he hasn’t yet reviewed a recent proposal from Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.) to stop Medicare from paying hospitals more for the same care provided in a doctor’s office. Wyden reiterated concerns about how site-neutrality impacts rural hospitals’ bottom lines. He has previously pledged to work with Hassan on the issue and has been open to the idea. The proposal from Cassidy and Hassan would bring hospital outpatient clinic payment in line with what independent practices get paid. Wyden’s persistent skepticism could be an obstacle to getting the legislation done this Congress despite a broad bipartisan push including House Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.), ranking member Frank Pallone (D-N.J.) and a wide array of health groups across the political spectrum. Hospital groups have been fiercely opposed to site-neutral payments. Hassan and Cassidy want to use savings to invest in rural and so-called safety-net hospitals. The House passed the Lower Costs, More Transparency Act last year, but the Senate hasn’t taken up the bill. The bill ensures older Americans pay the same out-of-pocket costs for a prescription in an off-campus outpatient department as in a doctor’s office. The Congressional Budget Office has estimated those provisions would save nearly $4 billion over a decade. Rep. Buddy Carter (R-Ga.) told Pulse that site-neutrality could be an option in a broader package next Congress through reconciliation, which allows bills to pass the Senate with a simple majority. “That’s exactly what we’re looking at,” Carter said. MAHA GOES TO THE HILL — Congressional staffers will be pitched on Robert F. Kennedy’s plans to “make America healthy again” on Wednesday, POLITICO’s Brittany Gibson and Daniel Payne report. Kennedy and his allies want to fire government regulators, crack down on pesticides and food additives, halt fluoridation of drinking water and examine the safety data for vaccines, among other far-reaching changes to the public health system. Jeff Hutt, spokesperson for the Make America Healthy Again PAC and former national field director for Kennedy’s presidential campaign, will speak with staffers on Capitol Hill following a similar briefing in September from Kennedy ally Calley Means, a former food-industry lobbyist who’s become a prominent voice in the debate about President-elect Donald Trump’s health policy platform. Why it matters: Trump told Kennedy he’d allow him to oversee the government’s health agencies. Hutt has said MAHA allies are working with the Trump transition team to vet potential nominees for the incoming administration — though the Trump team declined to comment on their involvement.
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