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.


Senate Finance Splits on CMS Nominee Amidst TX Waiver Dispute

The Senate Finance Committee voted to report the nominations of Andrea Palm to be Deputy Secretary of Health and Human Services and Chiquita Brooks-LaSure to be Administrator of the Centers for Medicare and Medicaid Services (CMS) to the full Senate last week. The panel voted 20-8 in favor of Palm, sending the nomination to the full Senate with a recommendation for approval. Brooks-LaSure’s nomination was reported to the full Senate without a recommendation for confirmation, with panel Republicans voting against the nominee resulting in a tie (14-14) vote. The move was a protest against the Biden administration’s recent decision to revoke a 1115 Medicaid waiver extension for the state of Texas; the waiver was approved in January by the Trump administration. Many Republican members on the committee stated that they do not oppose Brook-LaSure’s nomination and praised her qualifications for the position. Finance Committee Chairman Ron Wyden (D-Ore.) had previously denied a request from Sen. John Cornyn (R-Texas) to delay a vote on the nominations until Cornyn could discuss the issue with the White House. Instead, Wyden pledged to work with Cornyn to ensure that states are able to innovate under the 1115 and 1332 waiver programs. Cornyn has also placed a hold on Brooks-LaSure’s nomination, which may further delay a confirmation vote. Because Brooks-LaSure was not advanced with a recommendation for approval, Senate leadership will have to file a discharge petition to bring the CMS nomination for a vote before the entire Senate with added debate time. If the chamber splits upon party lines, the tie-breaking vote would lie with Vice President Kamala Harris.

Lawmakers Unveil Major Drug Pricing Proposals

Democrats in the House of Representatives have reintroduced their sweeping drug pricing legislation (H.R. 3). The Elijah E. Cummings Lower Drug Costs Now Act, which was previously passed by the House in 2019, would permit Medicare to directly negotiate the cost of prescription drugs and biologics that lack competition by referencing prices in certain other countries and penalize manufacturers whose prices rise faster than the rate of inflation. In the last Congress, the Congressional Budget Office estimated that the bill would result in approximately $456 billion in savings over the next decade; some of the savings would be used for capping Medicare beneficiaries’ out-of-pocket spending on prescription drugs at $2,000 per year. The House Energy and Commerce Committee is expected to schedule a hearing on the legislation in early May. More information can be found in Hart Health Strategies Inc.’s summary of the legislation, which is included as an appendix to this newsletter.

House Republicans, led by Energy and Commerce Ranking Member Cathy McMorris Rodgers (R-Wash.), Ways and Means Ranking Member Kevin Brady (R-Texas), and Education and Labor Ranking Member Virginia Foxx (R-N.C.), released the GOP’s drug pricing proposal last week. The Lower Costs, More Cures Act (H.R. 19) aims to lower out-of-pocket health care costs for patients without negatively impacting innovation. Amongst the bill’s provisions, H.R. 19 would provide an out-of- pocket cap of $3,100 on annual drug spending for seniors and cap the out-of-pocket cost of insulin for seniors in Medicare Part D.

Details on the American Families Plan Expected this Week

President Joe Biden is expected to unveil his American Families Plan this week, ahead of the President’s first address to a joint session of Congress on April 28. The major initiative is expected to raise taxes on millionaires to fund education, childcare, and other anti-poverty proposals. Some congressional Democrats are pushing the Biden administration to include major health care reform proposals, including H.R. 3, in the second portion of the larger infrastructure package. Rep. Lauren Underwood (D-Ill.), for example, led a group of 30 House Democrats in calling on the administration to prioritize health care coverage and affordability policies in upcoming recovery legislation, including a permanent expansion of advance premium tax credits (APTCs) used to purchase marketplace plans under the Affordable Care Act (ACA). Sen. Bernie Sanders (I-Vt.) and 15 additional Democratic Senators have also written to the administration asking the White House to propose reducing the Medicare eligibility age; expanding Medicare benefits to include hearing, dental, and vision care; implementing a cap on out-of-pocket expenses under traditional Medicare; and negotiating lower drug prices as a part of the plan. The White House has signaled in recent days, however, that its forthcoming American Families Plan will not include any polarizing health care-related provisions and will instead save these proposals for a separate initiative.

Congress Considers Extension of Fentanyl Ban

The Senate and House of Representatives are working to advance competing proposals to extend the current ban on fentanyl analogues that is scheduled to expire on May 6. The House passed a six-month extension of the ban (H.R. 2630) by voice vote on Wednesday, and the Senate is scheduled to debate a bill (S. 1216) that would extend the ban until July 6, 2022. An extension would allow the government to continue to classify fentanyl-like substances as Schedule I controlled substances. Neither solution has widespread support – with many Republicans calling for the classification to be made permanent and many Democrats highlighting the civil rights implications of the policy, arguing that it is an extension of the war on drugs. In related news, the Senate passed the DUMP Opioids Act (S. 957) by unanimous consent last week. The bill would direct the Department of Veterans Affairs to ensure that certain medical facilities have locations to dispose of controlled substance medications.

Senate GOP to Keep Nonbinding Ban on Earmarks

Senate Republicans have made the decision to retain their nonbinding prohibition against congressionally-directed spending. The choice was made during an internal party meeting last Wednesday. While some GOP senators have pledged to continue abstaining from seeking earmarks, others – like Sens. Susan Collins (R-Maine), Richard Shelby (R-Ala.), Shelly Moore Capito (R-W.Va.), and Roy Blunt (R-Mo.) – have said they will join Democrats in seeking specific funding for projects in their home states.

Warren, Grassley Comment on Device Safety Tracking

Sens. Elizabeth Warren (D-Mass.) and Chuck Grassley (R-Iowa) are urging the Accredited Standards Committee (X12) to require the serial numbers of implantable devices to be included in Medicare claims forms. The policy was first proposed by X12 in October 2019; the lawmakers argue that it would make tracking devices that fail or are recalled significantly easier, and that it would aid researchers studying long-term patient outcomes. The letter requests an update on the status of X12’s formal recommendation.

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