Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Trump Signs Compromise Spending Bill, Declares Border Wall National Emergency

The President signed a spending package on Friday to avert another partial government shutdown and keep the government funded through Sept. 30. The conference report to H.J. Res. 31 includes $3.08 billion in discretionary funding for the Food and Drug Administration (FDA), an increase of $267 million above current levels. It also includes $5.8 billion for the Indian Health Service (IHS), an increase of $266 million, $5.7 billion for the President’s Emergency Plan for AIDS Relief (PEPFAR), an increase of $50 million, and $3.1 billion for global health programs. The measure was approved by the Senate in a 83-16 vote and the House of Representatives by a vote of 300-128 on Thursday, just one day before current funding was set to expire. The compromise reached by legislators authorized $1.375 billion to build 55 miles of new barriers along the U.S.-Mexico border, far less than the $5.7 billion demanded by the White House, prompting President Trump’s declaration of a national emergency to bypass Congress and obtain $8 billion for the construction of a border wall. While his decision to declare a national emergency was supported by conservative lawmakers and Republican leadership, members on both sides of the aisle have raised concerns that the move could set a bad precedent for future administrations. Democrats have promised to use every legislative and legal option available to overturn the declaration. House Democrats plan to quickly introduce a bill to block the declaration, and California is leading a coalition of 16 states in a lawsuit against the declaration. Congress is not scheduled to be in session this week for the President’s Day holiday.

Dems Consider Medicare for More, Medicare for All Measures

Sens. Debbie Stabenow (D-Mich.) and Tammy Baldwin (D-Wis.), alongside Reps. Brian Higgins (D-N.Y.) and Joe Courtney (D-Conn.), have introduced legislation to allow people to buy into the Medicare program starting at age 50. Under the Medicare Buy-In and Health Care Stabilization Act, Americans between the ages of 50 and 64 could buy into Medicare. The Medicare for More bill is one option being proposed as an alternative to the push for Medicare for All.

Sen. Bernie Sanders (I-Vt.) stated last week that he plans to introduce his Medicare for All bill “fairly soon.” Rep. Pramila Jayapal (D-Wash) announced that her Medicare for All bill will be introduced with at least 100 cosponsors and is likely to get its first hearing at the end of March in the Rules Committee. She had hoped to introduce legislation last week, but it is now expected to be introduced by the end of the month. Reps. Jayapal and Debbie Dingell (D-Mich.) are circulating a letter to Democratic colleagues asking for cosponsors for the Medicare for All Act of 2019. The bill will revise and update legislation formerly introduced by Congressman John Conyers as H.R. 676. It is expected to include provisions to enhance current Medicare coverage, including dental, vision, prescription drugs, women’s reproductive health services, maternity and newborn care, and long term services and supports, but will not include the tax increases necessary to pay for the measure.

In related news, Sen. Brian Schatz (D-Hawaii) and Rep. Ben Ray Lujan (D-N.M.) reintroduced the State Public Option Act (S. 489/H.R. 1277) last week, which would allow states to create a universal Medicaid buy-in program. According to the bill’s sponsors, at least 14 states are currently exploring the idea of creating a Medicaid public option within their legislatures.

Azar Meets with Finance Dems on Drug Pricing

U.S. Department of Health and Human Services (HHS) Secretary Alex Azar met with Senate Finance Committee Democrats last week to discuss the administration’s efforts to lower drug prices. The group discussed negotiations in Part D, the International Pricing Index (IPI) and reforms to Part B, and the administration’s proposal to eliminate the drug rebate system in the Medicare and Medicaid programs. Ranking Member Ron Wyden (D-Ore.) expressed skepticism that changing the rebate system would reduce drug spending for beneficiaries. He also asked Azar to support his RxCAP Act (S. 475), which would limit patients’ Part D out-of-pocket (OOP) costs to approximately $7,500. The administration has expressed support for an OOP cap but has not backed any particular piece of legislation. HHS continues to stress that all options to lower patient costs while preserving safety and protecting innovation are still on the table.

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