April 19, 2021
This Week in Health Policy for April 19
This Week (April 19 - 23)
The Senate Health, Education, Labor and Pensions Committee holds a hearing on "COVID-19 Recovery: Supporting Workers and Modernizing the Workforce Through Quality Education, Training, and Employment Opportunities."
The Senate Health, Education, Labor and Pensions Committee holds a hearing on "Protecting U.S. Biomedical Research: Efforts to Prevent Undue Foreign Influence."
Last Week (April 12 - 16)
Health Care Highlights
Biden signs bill to postpone Medicare cuts. On Wednesday (April 14), President Biden signed H.R. 1868, which delays a 2 percent cut to Medicare payments for the rest of 2021. The House passed the bill earlier in the week by a vote of 384-38, pushing off a larger debate over federal spending until next year. The House initially voted in March to postpone the cuts in addition to waiving budget requirements of the $1.9 trillion American Rescue Plan, however Senate Republicans only agreed to deal with the more-immediate threat to Medicare. Democrats have said they supported waiving the requirement for sequestration after the Republican 2017 tax cuts and that Republicans should do the same for the stimulus package. Congress will be faced with more than $36 billion in pending reductions to Medicare in 2022 barring additional action.
House passes health care workplace violence bill. Today (April 16), the House passed a bill targeting violence involving health care and social service workers (H.R. 1195) by a vote of 254-166. The bill would require the Occupational Safety and Health Administration (OSHA) to issue a rule requiring health care and social service employers to implement workplace violence prevention plans. An interim final standard would be required within one year, and a final standard within 42 months. The bill would also give employees protection from retaliation for reporting workplace violence. The bill is among a number of workplace equity and safety measures congressional Democrats are advancing, including the Paycheck Fairness Act (H.R. 7), which the House passed Thursday. Chances of Senate passage for either bill is unclear.
House passes two drug pricing measures. On Wednesday (April 14), the House passed two drug pricing measures aimed at lowering drug costs. One bill (S. 164) would direct the Department of Health and Human Services (HHS) to create a website for educational materials on biosimilar medicines. Another drug pricing measure (S. 415) would adjust the criteria for a drug to receive exclusivity as a new chemical entity, narrowing which medicines get a five-year monopoly. Both pieces of legislation passed the Senate earlier this year and will head to President Biden's desk for his signature.
Lawmakers urge HHS to enforce transparency rule. Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ) and ranking member Cathy McMorris Rodgers (R-WA), as well as the leaders of the health subcommittee, Reps. Anna Eshoo (D-CA) and Brett Guthrie (R-KY), urged HHS Secretary Xavier Becerra in a letter this week to conduct "vigorous oversight" of the implementation of HHS's Hospital Price Transparency Rule, amid reports that some hospitals are moving slowly to comply. The E&C leaders write that they "urge HHS to enforce the final rule to ensure hospitals are fully compliant with the disclosure requirements so that patients can readily access the price information" and ask HHS to "revisit its enforcement tools, including the amount of the civil penalty, and to conduct regular audits of hospitals for compliance."
HHS proposed to reverse Trump-era abortion rules. The Biden administration issued a proposed rule this week aimed at rolling back Trump-era restrictions around abortion, which prohibit providers receiving federal funds from the Title X family planning program from referring patients to facilities that provide abortions and require "strict physical and financial separation" between clinics that receive Title X funds and facilities that provide abortion services. The proposal largely readopts the 2000 regulations "with several modifications needed to strengthen the program and ensure access to equitable, affordable, client-centered, quality family planning services for all clients, especially for low-income clients." The rule states that under the Trump-era regulations, the Title X program lost more than 1,000 service sites representing approximately one quarter of all Title X-funded sites in 2019.
CMS extends Primary Care First deadlines. CMS announced this week that it is extending the deadline for interested applicants to apply to Primary Care First Cohort 2. The deadline for PCF practice applications has been extended to May 21, 2021 and the deadline for payer applications has been extended to June 18, 2021.CMS is also announcing two additional Office Hour events for potential practice and payer applicants to ask questions ahead of the PCF application deadline.
Energy and Commerce Health Subcommittee Hearing on Substance Use and Misuse in America. On Wednesday (April 16) the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled "An Epidemic Within A Pandemic: Understanding Substance Use and Misuse in America." The first panel Regina M. LaBelle, Acting Director, White House Office of National Drug Control Policy (ONDCP) highlighted the Biden administration's drug policy priorities, which include expanding access to evidence-based treatment and prevention, harm reduction and recovery support services, along with advancing racial equity, expanding the addiction workforce, and reducing the supply of illicit substances. She stressed the need for a wholistic approach to addiction and an acknowledgement that it is a chronic condition to be managed across someone's lifetime. Ms. LaBelle said the administration supports a short extension of the temporary scheduling order for fentanyl analogues, which expires May 6, while they work with DOJ and HHS to consider its impact on things like mandatory minimums and drug research. Ms. LaBelle also noted the importance of removing barriers to treatment, including access to buprenorphine. Some panelists in the second panel postulated that scheduling reduces incentives to create analogues and thus dampens supply, while others noted their concern with the impact on mandatory minimums and research needs. The panel agreed that there is a great need for additional access to substance use disorder (SUD) services and providers willing and ready to screen and treat patients in need, among other things.
House Appropriations Hearing on the Department of Health and Human Services FY 2022 Budget Request. On Thursday (April 15), the House Committee on Appropriations Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies held a hearing entitled, "FY 2022 Budget Request for the Department of Health and Human Services," featuring testimony from Health and Human Services (HHS) Secretary Xavier Becerra. Throughout his testimony, Secretary Becerra highlighted the Biden Administration's HHS priorities, as outlined in their "skinny" budget request, including investments in preparedness and response for the next public health crisis, reducing maternal mortality and morbidity, addressing opioid and substance use disorders, expanding access to mental health care, developing the public health workforce, and supporting innovative research, among other items. Secretary Becerra also said that equity will "permeate everything we do" and noted big investments in social determinants of health and partnerships with local communities. Members from across the aisle expressed support for investments in maternal health, mental health and substance use, and pandemic preparedness. Democrats also applauded investments in community- and home-based care, childcare, and gun violence research while Republicans expressed concern with the size of the appropriations request and potential lack of inclusion of the Hyde amendment, conscience and religious liberty protections. Secretary Becerra also committed to applying lessons learned from the provision of telehealth, a robust consultative process for upcoming surprise billing regulations, and more.
The House Education and Labor Health, Employment, Labor, and Pensions Subcommittee hearing on Behavioral and Mental Health Care. On Thursday (April 15), the House Education and Labor Health, Employment, Labor, and Pensions Subcommittee held a hearing entitled "Meeting the Moment: Improving Access to Behavioral and Mental Health Care." Throughout the hearing, Committee Democrats called for boosting the Department of Labor's (DOL) ability to enforce mental health parity requirements, with Subcommittee Chairman Mark DeSaulnier (D-CA) saying California's recently enacted mental health parity, which defines medical necessity and requires insurers to cover behavioral health based on generally excepted standards of care, as a model to follow. Republicans on the committee, including Subcommittee Ranking Member Rick Allen (R-GA) emphasized the need to expand employers' ability to provide mental health coverage by making it easier to offer telemedicine services. James Gelfand, senior vice president of health policy for the ERISA Industry Committee (ERIC), said that Congress should allow provision of telehealth services across state lines and for those services to be covered without requiring that annual deductibles be met, adding that easing restrictions on telehealth would save money on health care costs while helping to meet the growing demand for mental health services. Brian Smedley, chief of psychology in the public interest with the American Psychological Association, testified that Congress should pass the Parity Enforcement Act (H.R. 1364) to give DOL the authority to levy civil fines for noncompliance with the mental health parity law, also urging increased funding for better oversight of health insurers compliance.
The Senate Finance Committee nomination hearing for Andrea Palm and Chiquita Brooks-LaSure. On Thursday (April 15), the Senate Finance Committee held a nomination hearing for Andrea Joan 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. Both nominees received glowing endorsements from committee Democrats, including Chairman Ron Wyden (D-OR), who said they are both "extraordinarily qualified for these essential positions and would be ready to go on Day One." Republicans on the committee did not voice direct opposition to the nominations, although Palm received a round of tense questioning about HHS oversight of unaccompanied immigrant minors who have come across the U.S.'s southern border. Both nominees agreed to work towards enhancing equity across the health care system, expanding telehealth for patients — particularly in rural areas, working towards greater mental health parity, improving the provider pipeline, lowering the cost of prescription drugs, and expanding Medicare and Medicaid, among other priorities to improve health care coverage, access, and affordability. Among other items, Ms. Brooks-LaSure also said she will make it a priority to release guidelines for state waivers, focus on lessons learned throughout the COVID-19 pandemic, and improve dual-eligible care coordination. Ms. Palm also agreed to work across the aisle and stressed that she will be driven by a "common-ground agenda." A committee vote to send the nominations to the full Senate has not yet been scheduled.
Reports, Studies, and Journals
JAMA Network Open: Trends in Out-of-Pocket Healthcare Expenses Before and After Passage of the Patient Protection and Affordable Care Act. Compared with the pre-ACA period, out-of-pocket spending increased at a slower rate for almost all health care services during the post-ACA period.
Peterson-Kaiser Family Foundation Health System Tracker: Early results from federal price transparency rule show difficulty in estimating the cost of care. This brief focuses on the recently effective hospital price transparency rule to assess hospital compliance and examines how payer-negotiated rates vary.
Centers for Disease Control and Prevention: Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region - United States, March-December 2020. Within each U.S. Census region, the proportion of hospitalized patients with COVID-19 was highest for Hispanic or Latino patients. Racial and ethnic disparities were largest during May-July 2020 and became less pronounced as the pandemic spread throughout the country; however, disparities remained in December 2020 in all regions.
Government Accountability Office: USAID and CDC Funding, Activities, and Assessments of Countries' Capacities to Address Infectious Disease Threats before COVID-19 Onset. As of March 31, 2020, the U.S. Agency for International Development (USAID) and the CDC had obligated a combined total of more than $1.2 billion and disbursed about $1 billion for global health security (GHS) activities, using funds appropriated in fiscal years 2015 through 2019.