POLICY BRIEFINGS

CBO Scores HELP Health Care Costs Bill


The Congressional Budget Office (CBO) estimates that the Senate Health, Education, Labor, and Pensions (HELP) Committee’s package to reduce health care costs would save $7.6 billion over the next decade. The savings would largely be the result of the bill’s provisions to address surprise insurance gaps. CBO estimates that Title I of the bill (related to surprise out-of-network care) would save $25 billion as a result of lowering marketplace and employer-sponsored insurance premiums. Title II of the legislation, which includes measures to lower prescription drug costs, would save $4.6 billion over 10 years. Title III, to improve health care transparency, would increase federal revenues by $2.7 billion. The bill’s provisions to prohibit anti-tiering and anti-steering clauses would reduce premiums and increase revenues by $1.1 billion, while new requirements for pharmacy benefit managers (PBMs) would decrease plan spending on drugs and also decrease premiums. Title IV of the bill would fund community health centers and other public health programs and would increase the federal deficit by $24.3 billion.

Committee Chairman Lamar Alexander (R-Tenn.) has stated that his package is ready for a Senate floor vote. However, when Alexander hotlined the bill last week, he met opposition from some lawmakers who continue to urge the inclusion of an independent dispute resolution (IDR) process alongside the bill’s benchmark solution to addressing reimbursement disputes between providers and payers. Sen. Bill Cassidy (R-La.) continues to negotiate with the Chairman on his proposal, which would allow providers and issuers to combine multiple charges to reach a certain threshold to begin IDR. Under the House’s version of the bill, providers and payers cannot move to IDR unless a single charge reaches $1,250, a policy which Cassidy argues could lead to artificially inflated rates.


Update on Congressional Drug Pricing Negotiations


Democrats in the House have not yet reached an agreement on a proposal to allow Medicare to negotiate drug prices, and according to Energy and Commerce Health Subcommittee Chairwoman Anna Eshoo (D-Calif.), no such measure will be considered before the August recess. House Majority Leader Steny Hoyer (D-Md.) confirmed that there is still no agreement between Democratic leadership and more progressive lawmakers on how to structure the legislation, which is being worked on in both the Ways and Means and Energy and Commerce committees.

Medicare price negotiation is not expected to be included in the forthcoming drug pricing measure being drafted by the Senate Finance Committee. Panel Republicans met with officials from CBO last week, but no firm decisions about the legislation were made. CBO reportedly told the lawmakers that the package would reduce out-of-pocket costs for beneficiaries and save federal dollars but did not provide any specific estimates. Chairman Chuck Grassley (R-Iowa) has stated that a bill could be marked up as early as this week if a CBO score has been made available.

Twelve members of the New Democrat Coalition have written to House Democratic leadership requesting a vote on three drug pricing bills this week. The CREATES Act (H.R. 965), the Protecting Consumer Access to Generic Drugs Act (H.R. 1499), and the BLOCKING Act (H.R. 938) had previously been considered and passed by the chamber as a part of the Strengthening Health Care and Lowering Prescription Drug Costs Act (H.R. 987), which also included provisions to strengthen the ACA. The lawmakers argue that considering the drug pricing legislation separately would prompt the Senate to also consider and pass the bills. The letter was signed by Reps. Kur Schrader (D-Ore.), Kim Schrier (D-Wash.), Angie Craig (D-Minn.), Greg Stanton (D-Ariz.), Derek Kilmer (D-Wash.), Suzan DelBene (D-Wash.), Terri Sewell (D-Ala.), Ami Bera (D-Calif.), Chrissy Houlahan (D-Pa.), Lizzie Fletcher (D-Texas), Donna Shalala (D-Fla.), and Scott Peters (D-Calif.).


Budget, Debt Ceiling Negotiations Stretch into the Weekend


The White House sent House Speaker Nancy Pelosi (D-Calif.) a list of proposed spending cuts and reforms to consider as negotiations continue on a budget agreement that would include a deal to raise the debt ceiling. The policies proposed by the administration would produce savings to offset the cost of a two-year budget caps agreement. Lawmakers and White House officials insist that they are close to an agreement that would set spending level ceilings for the next two years and be moved with a debt limit fix. An agreement has apparently been reached on top-line defense and non-defense spending figures, while offsets remain as the final outstanding issue to be addressed. Pelosi has indicated her hopes to file a bill this week to set up a House vote on the package before the chamber adjourns for the six-week August recess.


GAO Makes Determination on WH Waiver Guidance


The GAO has determined that Congress can overturn recent changes made by the administration to state innovation waivers. The July 15 guidance states that Section 1332 waivers fall under the boundaries of the Congressional Review Act, which allows lawmakers to reverse federal regulations by passing a resolution disapproving of the rule by simple majority in each chamber. The White House policy loosens current restrictions around state use of federal funding to pay for health insurance, such as association and short-term, limited-duration plans, that do not comply with all of the ACA patient protections like those for pre-existing conditions. No states have applied for or been approved for a waiver since the regulation was released.


Finance Republicans Request Increased HHS Puerto Rico Oversight


Several Republicans on the Senate Finance Committee have sent a letter to HHS Secretary Alex Azar requesting increased transparency on how Puerto Rico spends its Medicaid funding. The letter was sent following recent allegations of widespread corruption amongst former Puerto Rico agency officials. The lawmakers ask the Secretary to develop new measures to reduce waste, fraud and abuse. They also request an implementation timeline for such measures.



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