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.


Deal to Avoid a Government Shutdown Remains Elusive

Congress is fast approaching the end of the fiscal year on September 30th without a clear path to avoid a federal government shutdown. Republicans in the House of Representatives are struggling to agree upon a set of demands for cutting government spending. House Speaker Kevin McCarthy (R-Calif.) abandoned plans for a Saturday vote on a temporary funding measure that was intended to appease a small group of conservative members. The decision followed McCarthy’s third failed attempt to bring the latest defense spending bill to the floor. The chamber is instead expected to vote this week on four fiscal year 2024 (FY24) appropriations bills – including the Agriculture-Rural Development-Food and Drug Administration funding bill – which include provisions to address specific conservative priorities. The approach is an attempt to unify members behind a separate stopgap spending bill which would include immediate spending cuts while government funding negotiations for FY24 are ongoing. Democrats continue to urge McCarthy to support a bipartisan deal, an idea that already has the support of some moderate House Republicans. McCarthy, however, will risk a motion to vacate the chair from conservative members seeking to oust him as speaker should he pursue a bipartisan approach. While the House typically takes the lead in moving government funding bills, the Senate began the process of considering a potential legislative vehicle for a continuing resolution (CR) last week. A vote is expected on the measure this week. There is bipartisan support in the upper chamber for a CR that keeps funding at current levels to provide time for leadership to continue negotiating a bicameral deal for the next fiscal year.

House Appropriations Panel May Soon Complete FY24 Markups

The House Appropriations Committee is reportedly planning to consider their final two FY24 spending bills – Commerce-Justice-Science and Labor-Health and Human Services-Education – in the coming days. The markups are in response to demands from conservative Republicans pushing for more votes on spending cuts before the end of the fiscal year. Conservatives aim to cut discretionary spending to $1.526 trillion – lower than the previously agreed upon $1.59 trillion in this year’s debt ceiling agreement – but it remains unclear from where the additional $64 billion in cuts will be drawn.

House Republicans Release Budget Resolution

Republicans in the House of Representatives released a budget resolution last week dubbed “Reverse the Curse” which would balance the budget within a decade and make reforms to federal health programs. The budget includes $16 trillion in deficit cuts and calls for the creation of a bipartisan commission to address the major drivers of the federal deficit. The document would add per-capita limits to federal funding for Medicaid and stricter work requirements for Medicaid, and proposes site-neutral payments in the Medicare program. The nation’s gross national debt exceeded the $33 trillion mark for the first time ever earlier this month.

HELP Advances Primary Care, Health Care Workforce Bill

The Senate Health, Education, Labor and Pensions (HELP) Committee advanced its bipartisan primary care and health care workforce package (S. 2840) in a 14-7 vote last week. Sen. Roger Marshall (R-Kan.), who co-authored the bill with Chairman Bernie Sanders (I-Vt.), alongside Sens. Mike Braun (R-Ind.) and Lisa Murkowski (R-Alaska), joined panel Democrats in support of the measure. The Bipartisan Primary Care and Health Workforce Act includes an almost $2 billion annual increase in mandatory funding for community health centers – totaling $5.8 billion annually for three years. The bill would triple mandatory funding for the National Health Service Corps, from $310 million to $950 million annually for three years, while also providing $1.5 in mandatory funding over the next five years to the Teaching Health Centers Graduate Medical Education program. Ranking Member Bill Cassidy (R-La.) filed 67 amendments to the bill detailing his concerns with the legislation. During the markup Cassidy highlighted that the legislation includes $26 billion in mandatory spending but only includes approximately $10 billion in offsets. Sanders has stated that he is working with leadership of the Judiciary and Finance committees on additional offsets for the bill. The Judiciary and Finance panels have each advanced their own health care proposals this year, including measures to overhaul the pharmacy benefit manager industry and to reform the nation’s patent system, which could eventually be packaged together with HELP’s workforce bill.

Health Transparency Legislation Pulled from House Floor

House leadership unexpectedly canceled plans to consider the bipartisan Lower Costs, More Transparency Act (H.R. 5378) under suspension of the rules last week. The bill includes many provisions previously advanced by the Energy and Commerce, Ways and Means, and Education and the Workforce committees, drawing much from the PATIENT Act, to provide patients with timelier and more accurate information about the cost of health care procedures and services. It also increases funding for community health centers and the Teaching Health Centers Graduate Medical Education Program. While it remains unclear why the bill was pulled from the House schedule, Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-Wash.) stated that she remains “100% committed to getting this bill up for consideration on the floor, passed out of the House, and ultimately onto the president’s desk.”

Markey, Manchin Comment on FDA Evaluation of Opioid Risks

Sens. Ed Markey (D-Mass.) and Joe Manchin (D-W.Va.) have sent a letter to the Commissioner of Food and Drugs Robert Califf expressing concerns about how his agency evaluates opioids for chronic pain. They urge the Food and Drug Administration to reconsider the use of enriched enrollment randomized withdrawal (EERW) research methods to determine the efficacy and tolerability of extended-release and long-acting opioids in chronic pain patients. The letter warns that the use of EERW risks biasing findings in favor of opioid use and exposing clinical trial participants to opioid dependence and withdrawal.

VA Democrat Wexton Will Not Seek Re-Election

Rep. Jennifer Wexton (D-Va.) announced that she will not run for reelection next year. The three-term congresswoman cited her recent diagnosis with the rare neurological disorder progressive supranuclear palsy as the reason for her decision. Wexton currently serves on the House Appropriations and Budget committees.

CFPB to Propose Keeping Medical Debt Off Credit Reports

The Biden administration plans to propose that medical debt be barred from impacting individual’s credit scores. Under the planned rule, from the Consumer Financial Protection Bureau (CFPB), credit reporting companies would not be permitted to include medical debts in consumer reports and would be prohibited from using coercive collection practices more generally. The agency is also seeking to ban lenders from using medical collections information when considering a borrower’s application. The changes are a part of the agency’s effort to update the 1970 Fair Credit Reporting Act. CFPB plans to issue the proposed rulemaking in 2024.

UTSA to Offer First Dual Degree in Medicine and AI

The University of Texas Health Science Center at San Antonio will offer the first combined Doctor of Medicine and Master of Science in artificial intelligence degree in the nation. The five-year program includes three tracks in the master’s portion of the dual degree: data analytics, computer science, and intelligent and autonomous systems. Prospective dual degree students must first complete one year at the Long School of Medicine at UT Health San Antonio.

Upcoming Congressional Hearings and Markups

Senate Banking, Housing, and Urban Affairs Committee executive session to consider S. 2860, the SAFER Banking Act; 9:30 a.m.; September 27

Senate Budget Committee hearing “Medicare Forever: Protecting Seniors by Making the Wealthy Pay Their Fair Share;” 10:00 a.m.; September 27

House Education and the Workforce Subcommittee on Workforce Protections hearing “Examining the Policies and Priorities of the Occupational Safety and Health Administration;” 10:15 a.m.; September 27

September 25, 2023: | Page 1 Page 2



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