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.


Movement on Bipartisan Infrastructure Framework Expected This Week

The group of 22 senators charged with negotiating the bipartisan$579 billion infrastructure bill have made progress in recent days on settling the final aspects of the legislation. Recent discussions have focused on various pay fors, including unspent COVID-19 relief funding and further delaying the Trump- era Medicare rebate rule. While there are still unspent funds in the Provider Relief Fund (PRF), those funds are likely not pay fors for this package. The drug pricing regulation would eliminate the rebates made by drug manufacturers to pharmacy benefit managers (PBMs) under Medicare Part D. Negotiators have confirmed that the rule would be delayed for less than a decade but have not specified the exact length of the delay. The Biden administration had already delayed the rule until 2023 following a court order. While agreement appears to have been reached on how to pay for the deal, senators are still waiting on a formal score from the Congressional Budget Office (CBO). Senate Majority Leader Chuck Schumer (D-N.Y.) attempted to start debate on the bill last week with a procedural vote, but was blocked by Republicans, who argued that they needed to see the final deal. According to a Senate negotiator, the legislative text of the agreement could be released as early as today. The Majority Leader has already stated that the chamber will remain in session beyond its scheduled recess date of August 9 to pass both the bipartisan infrastructure framework and the fiscal year (FY) 2022 budget resolution with reconciliation instructions. While Schumer had set a deadline of last Wednesday for reaching an agreement on the $3.5 trillion budget blueprint, Democrats have yet to achieve a consensus on top-line spending levels.

Yarmuth Comments on Inclusion of Medicaid Funding in Reconciliation Bill

House Budget Committee Chairman John Yarmuth (D-Ky.) stated that the House of Representatives may change the Senate’s fiscal year (FY) 2022 budget resolution to include funding for Puerto Rico’s Medicaid program. A temporary increase to territories’ federal block grant funding for Medicaid expires September 30. Democrats plan to advance the $3.5 trillion budget reconciliation package this fall. Last week, the House Energy and Commerce Committee advanced a five-year extension (H.R. 4406) for Puerto Rico’s Medicaid program and an eight-year extension for programs in American Samoa, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands.

House to Vote on Appropriations Minibus This Week

The House of Representatives plans to vote on a fiscal year (FY) 2022 minibus spending bill this week. The seven- bill package will use the Labor-Health and Human Services-Education legislation (H.R. 4502) as the vehicle, and will include the Agriculture-Food and Drug Administration (FDA), Energy and Water, Financial Services, Interior- Environment, Military Construction-Veterans Affairs, and Transportation-Housing and Urban Development (HUD) measures. Three separate appropriations bills — Commerce-Justice-Science (H.R. 4505), Legislative Branch (H.R. 4346), and State-Foreign Operations (H.R. 4373) — could also be considered on the floor this week. While Senate appropriators could begin their work on the Agriculture-FDA, Energy and Water, Military Construction-Veterans Affairs, and potentially Transportation-HUD measures prior to August recess, a continuing resolution (CR) is still expected to be necessary to avoid a government shutdown at the end of the fiscal year on September 30.

Approaching Deadline to Increase or Suspend Debt Limit

Treasury Secretary Janet Yellen has sent a letter to lawmakers warning that unless Congress acts to suspend or increase the debt limit by August 2, the Treasury will need to take extraordinary measures to prevent the U.S. from defaulting on its obligations, which “would cause irreparable harm to the U.S. economy and the livelihoods of all Americans.” She goes on to explain that the period of time that extraordinary measures may last is subject to “considerable uncertainty,” but that there are scenarios in which they could be exhausted soon after Congress returns from its August recess. A Congressional Budget Office (CBO) report issued last week estimated that lawmakers will likely have until October or November to raise or suspend the debt limit. The debt limit has been on a two-year hold that expires on July 31. Senate Republicans have expressed opposition to a clean debt increase or suspension, with Budget Committee Ranking Member Lindsey Graham (R-S.C.) proposing to tie the debt limit measure to the creation of a body to address the financial sustainability of the Social Security and Medicare programs.

Breakthrough COVID-19 Cases Amongst Fully-Vaccinated in White House, Congress

Amidst the nationwide surge in the Delta variant, several fully-vaccinated White House and congressional lawmakers and staff have tested positive for COVID-19. Reports have indicated that the individuals are asymptomatic or experiencing mild, flu-like symptoms. Two positive cases have been reported on the House side, and one Senate staffer has tested positive for COVID-19. Rep. Vern Buchanan (R-Fla.) has also contracted the virus. According to a report from Politico, the Capitol attending physician is considering a return to the recommendation that people wear masks inside the House and Senate.

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