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March 29, 2021

This Week in Health Policy for March 29

This Week (March 29 - April 2)

The House and Senate are on recess. There will be no This Week in Health Policy next week.

Last Week (March 22 - 26)

Health Care Highlights

Biden doubles vaccine goal. On Thursday (March 25), President Joe Biden set a new goal of administering 200 million coronavirus vaccine doses by the end of April, doubling his target for his first 100 days in office in his first formal press conference. Biden set his original goal of 100 million shots in his first 100 days in December and if continuing at its current pace the U.S. would reach just over 203 million shots by the end of Biden’s 100th full day in office. The pace of vaccines is poised to ramp up as Johnson & Johnson is set to sharply increase its shipments and Pfizer and Moderna have been steadily increasing their production. Biden previously said the U.S. will have enough vaccine for all adults by the end of May, but administration officials have said administering the shots could take longer.

Senate approves Murthy sand Levine for Biden health roles. This week, the Senate approved Dr. Vivek Murthy as surgeon general in a 57-43 vote, with seven Republicans joining Democrats to vote in his favor, and approved Rachel Levine as assistant secretary for health under Health and Human Services (HHS) Secretary Xavier Becerra in a 52-48 vote. Levine is the first openly transgender person confirmed for any cabinet post.

Senate votes to delay some Medicare cuts. On Thursday (March 25), the Senate voted 90-2 to pass a measure (H.R. 1868) to delay an automatic 2% cut to Medicare payments set to take effect in April, but stripped out a measure included in the House-passed version that would avert other cuts triggered by this year’s $1.9 trillion stimulus, including $36 billion in Medicare cuts in 2022. The 2% cut to Medicare will be bumped out to December 31, setting the stage for a year-end debate over sequestration. In 2017, when Republicans faced similar cut requirements due to their tax cuts, they attached a measure to avert the cuts to the year-end government funding measure, which have served as legislative vehicles for sequestration waivers in the past. House lawmakers will have to vote again on the amended version of the bill before it is sent to President Biden for his signature. 

Pelosi discusses including drug pricing in infrastructure package. Earlier this week, Speaker Nancy Pelosi (D-CA) said Democrats are discussing adding a provision into upcoming infrastructure legislation that would let the federal government negotiate drug prices, citing estimates from the Congressional Budget Office (CBO) for a previous bill that negotiation would save the federal government $456 billion over a decade. “We’d be missing an opportunity if we did not include lowering the cost of prescription drugs,” Pelosi said on a conference call commemorating the 11th anniversary of the Affordable Care Act by advocacy group Protect Our Care. She also noted that making permanent the higher subsidies for the Affordable Care Act (ACA) included in the $1.9 trillion COVID-19 relief was another priority, and added that “everything is on the table” when asked about issues such as expanding Medicare and opening more community health centers. Biden administration officials are also considering paying for the package in part through addressing the cost of prescriptions drugs, and also hope to make ACA subsidies permanent through this or later legislation.

Biden extends special enrollment period. HHS said on Tuesday (March 23) that consumers will now have until August 15 to sign up for health coverage through the ACA exchanges, extending the deadline from May 15 to account for the newly passed $1.9 trillion COVID-19 stimulus bill, which includes increased premium subsidies. More than 200,000 people enrolled in coverage in the first two weeks of the special enrollment period, which began on February 15 and is aimed at helping people who lost their job-based health insurance during the pandemic.


HELP hearing on prescription drugs. On Tuesday (March 23) the Senate Committee on Health, Education, Labor & Pensions (HELP) Subcommittee on Primary Health and Retirement Security held a hearing entitled, “Why Does the US Pay the Highest Prices in the World for Prescription Drugs?” Several of the Democratic witnesses expressed concerns with “government-granted monopolies” in the form of patents that allow companies to set any price they want and expressed the need for government price negotiation based on the clinical benefit that drugs provide to a patient. On the other hand, the Republican witness cautioned that Congress must protect the incentives that drive pharmaceutical innovation and should instead facilitate competition and promote the approval of innovative medicines to compete with branded drugs. Several Committee Democrats voiced their support for Medicare price negotiation as well as proposals that leverage international reference pricing, allow for the importation of drugs from Canada, and reduce perverse tax incentives such as those for direct-to-consumer marketing. Republicans on the committee, on the other hand, noted their support for proposals aimed at addressing abuses of the patent system, such as patent “thickets” and “drip feed” strategies, as well as legislation to prevent gaming of the Orphan Drug Act and increase transparency across the system.

Appropriations hearing on maternal health. On Tuesday (March 23), the House Committee on Appropriations Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies held a hearing entitled, “Addressing the Maternal Health Crisis.” Throughout the hearing, committee members expressed their bipartisan commitment to finding solutions to address the maternal health crisis. The witnesses expressed their support for several pieces of legislation aimed at reducing maternal mortality and morbidity, including the Momnibus Act, which the panel said would invest in building out the workforce and expanding cross-sector collaboration; the MOMS Act, which they said would support midwives in completing their training; the Babies Act, which would fund Medicaid demonstrations to build birth centers; and more. They stressed the need to expand Medicaid funding for 365 days post-partum, ensure mental health is included in post-natal screenings, and fund other initiatives including perinatal quality collaboratives, standardized data collection and surveillance, evidence-based guideline development and dissemination, training for providers on racial bias, and more.

Ways and Means hearing on private equity. On Thursday (March 25) the House Ways and Means Oversight Subcommittee held a hearing entitled, “Examining Private Equity’s Expanded Role in the U.S. Health Care System.” Democrats on the committee focused their questions and comments on learning more about the impact of private equity on nursing homes, along with the need for more transparency and oversight into these businesses. The witnesses expressed their desire for increased transparency into ownership, expenditures, and staffing structures in order to assess the impact on patient outcomes. Several Democrats on the committee noted their support for the Transparency in Health Care Investments Act (H.R. 5825), and Rep. Lloyd Doggett (D-TX) teased a bill establishing a multiagency taskforce to analyze quality metrics at nursing homes. Witnesses also discussed fraudulent activities that lead to up coding, increases in length of stay, and work to achieve higher star ratings to get more money out of Medicare. They also discussed concerns existing inequities are exacerbated when profits are the focus over patients. Republicans expressed their disappointment with the hearing’s focus, instead saying the focus should be on nursing home deaths during COVID-19 and accurate data collection, as well as holding accountable states and Governors who advanced policies that led to additional deaths.

HELP committee hearing on health equity. On Thursday (March 25) the Senate Committee on Health, Education, Labor & Pensions (HELP) held a hearing entitled, “Examining Out COVID-19 Response: Improving Health Equity and Outcomes by Addressing Health Disparities,” where bipartisan committee members expressed their commitment to advancing policies to improve equity across the health care system. In the context of COVID-19, the panel discussed how minority communities are disproportionally impacted by the coronavirus pandemic and how we must not mistake a lack of access to care or information as vaccine hesitancy, instead thoughtfully addressing community-specific barriers including transportation, broadband availability, paid leave, and other socioeconomic factors. They also noted the need for systemic changes including prioritizing health equity and allocating resources accordingly while building out public health data systems to ensure race, ethnicity, and language data are collected in more detail. Committee members and panelists also discussed their concerns about the lack of prioritization and supports in place for people with intellectual and physical disabilities, the impact of the coronavirus on preventative care visits and maternal and infant health, as well as issues such as long-covid and mental health impacts of the pandemic lasting long beyond the emergency period.

Reports, Studies, and Journals

NBER: The Value of Employer-Sponsored Health Insurance. Based on published estimates of its price elasticity of demand and of tax wedges, as well as the method of revealed preference, the author estimates that the annual social value of employer-sponsored insurance is about $1.5 trillion beyond what policyholders, their employers, and taxpayers pay for it.

Centers for Disease Control and Prevention: Counties with High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations - United States, April 1-December 22, 2020. During the early weeks of April 2020, a larger percentage of counties with high incidence of COVID-19 had large Asian and Black populations, whereas during the early weeks of August, high-incidence counties were concentrated among those with large Black and Hispanic populations.

Health Affairs: Medicaid Expansion Reduced Uncompensated Care Costs At Louisiana Hospitals; May Be A Model For Other States. Researchers found that We found that Medicaid expansion was associated with a 33 percent reduction in the share of total operating expenses attributable to uncompensated care costs for general medical and surgical hospitals in Louisiana in the first three years after expansion.


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