POLICY BRIEFINGS

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.


THIS WEEK'S BRIEFING - NOVEMBER 1, 2021

House of Representatives Hopes to Pass Build Back Better, BIF This Week


Negotiations on the scaled-back $1.75 trillion reconciliation package containing the President’s Build Back Better agenda continued over the weekend, with House Democratic leadership pushing to finalize and pass the bill this week. President Joe Biden presented congressional Democrats with a framework for the updated reconciliation package on Thursday. The outline included the creation of a Medicare hearing benefit, an extension of expanded Affordable Care Act (ACA) insurance subsidies, the creation of subsidized insurance plans for individuals residing in states that have not yet expanded their Medicaid programs, and an expansion of home and community-based care. The bill would be offset by tax increases and other revenue increases that total approximately $2 trillion. The framework has been formally endorsed by the Congressional Progressive Caucus, “in principle” pending legislative text that can be agreed on by all parties including “all 50 Senators.” This endorsement from the Progressives comes despite the Build Back Better framework being significantly smaller than the initially proposed $3.5 trillion package and the lack of progressive priorities like Medicare dental and vision benefits, paid leave, and higher corporate income tax rates. While the framework calls for the repeal of the Trump-era drug rebate regulation, it excludes mention of the Democrats’ signature drug pricing legislation, H.R.3, which would have established international reference pricing. Latest reports indicate that the bill could apply government negotiation to drugs in Medicare Parts B and D for which exclusivity has expired, with an exclusion for small biotech companies, and may drop the previously proposed excise tax to compel pharmaceutical manufacturers to participate.

House Democratic leadership had targeted Sunday for completing the process of drafting the $1.75 trillion Build Back Better tax and spending package, with the goal of voting on the reconciliation bill and the $550 billion bipartisan infrastructure framework (BIF) early in the week. Congress recently passed legislation to reauthorize surface transportation programs through December 3, as progressives continue to stand by their commitment to moving the reconciliation and infrastructure bills together.

The House Rules Committee is expected to meet on Monday, with floor votes on both the Build Back Better and the infrastructure plans expected on Tuesday. Sen. Bernie Sanders (I-Vt.) has stated that he would prefer for the House to first reach a deal with Senate Democrats on what to include in the package, securing an endorsement from potential holdouts Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.) before putting reconciliation to a vote in the House.


Appropriators to Begin Discussions on FY22 Omnibus


House and Senate appropriators will begin meeting this week to discuss a fiscal year (FY) 2022 omnibus spending package. The discussion, scheduled for Tuesday, will take place between House Appropriations Chair Rosa DeLauro (D-Conn.) and Ranking Member Kay Granger (R-Texas) and Senate Appropriations Chair Patrick Leahy (D-Vt.) and Ranking Member Richard Shelby (R-Ala.). The current continuing resolution (CR) expires on December 3. Lawmakers have yet to reach an agreement on topline figures, with Democrats pushing for more social spending and Republicans in support of additional defense funds.


Senate Confirms WH Drug Czar


The Senate confirmed Rahul Gupta as Director of the Office of National Drug Control Policy (ONDCP) by voice vote last week. Gupta, a practicing primary care doctor of 25 years, will be the first physician to serve in the role of White House drug czar. He most recently served as the Chief Medical and Health Officer, Interim Chief Science Officer and Senior Vice President at March of Dimes. His focus at ONDCP will be on addressing the opioid epidemic.


Bipartisan Senators Urge CMS to Review MA Prior Authorization Process


Sens. Sherrod Brown (D-Ohio) and John Thune (R-S.D.) led a letter to the Centers for Medicare and Medicaid Services (CMS) urging the administration to reform the Medicare Advantage (MA) prior authorization process. They request an update on CMS’ “recommended next steps for improving and streamlining prior authorization processes in a manner that benefits providers, health plans, and taxpayers, but especially beneficiaries – including MA enrollees,” and ask the agency to use its regulatory authority to improve prior authorization across health plans in line with their Improving Seniors’ Timely Access to Care Act. The bill would make changes to prior authorization in the MA program by establishing an electronic prior authorization process, minimizing the use of prior authorization for services that are routinely approved, requiring plans to report on the extent of their use of prior authorization and the rate of delays and denials, ensuring prior authorization requests are reviewed by qualified medical personnel, and ensuring that plans adhere to evidence-based medicine guidelines. The letter was signed by a bipartisan group of 27 other senators.


Coronavirus Subcommittee Presses FTC on Sites Pushing Misinformation


The House Select Subcommittee on the Coronavirus Crisis has sent a letter to the Federal Trade Commission (FTC) requesting an investigation into whether certain companies like America’s Frontline Doctors and SpeakWithAnMD. com are violating the FTC Act, COVID-19 Consumer Protection Act, and other relevant statutes in spreading COVID-19 misinformation related to disproven treatments such as hydroxychloroquine and ivermectin. “Misinformation endangers public health and fuels vaccine hesitancy by promoting the false ideas that coronavirus vaccines are unsafe and ineffective and that alternative drugs can prevent or cure coronavirus infections. Exploiting these falsehoods for financial gain puts American lives at risk and sets back our nation’s efforts to combat the spread of the coronavirus,” the letter states. Chairman Jim Clyburn (D-S.C.) urges the FTC to open an investigation into these matters and appropriately exercise its enforcement authority.


IL Rep. Kinzinger to Retire


Rep. Adam Kinzinger (R-Ill.) has announced that he will not seek re-election. Kinzinger is a member of the House committees on Energy and Commerce and Foreign Affairs. Kinzinger was one of 10 House Republicans who voted to impeach former President Donald Trump, and he currently sits on the House panel investigating the January 6 insurrection. His retirement comes in the wake of the Illinois Legislature’s approval of a new Congressional redistricting map for the state’s delegation. The new map places Kinzinger in the same district as fellow Republican Congressman Darin LaHood.



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