28 June 2021 This Week in Health Policy for June 28 Sanders budget aims to expand Medicare amid two-track infrastructure process. Yesterday (June 24), President Biden and a group of 10 centrist senators announced a tentative agreement on a roughly $1 trillion physical infrastructure package, securing a long-sought bipartisan deal on transportation, water, and broadband infrastructure. The deal, however, is already being threatened by President’s Biden’s remarks that the package must move in tandem with a Democratic reconciliation bill, expected to address the administration’s other “human infrastructure” priorities like health care, caregiving, and climate change. Movement on a more expansive package would require the House and Senate to agree to the same FY2022 budget resolution with reconciliation instructions, which will unlock the reconciliation process to allow the broader package to pass the Senate with only 51 votes. Senate Majority Leader Chuck Schumer (D-NY) said he hopes to hold Senate votes on both the infrastructure bill and the budget resolution in July, which could leave the development of the follow-on bill to after the August recess and push enactment of the two-part legislation into the fall. In preparation for the budget process, Senate Budget Chairman Bernie Sanders (I-VT) is preparing a budget that goes further than Biden’s proposals on health care, including $299.6 billion in spending in fiscal 2022 to provide coverage for dental, vision, and hearing through Medicare and $200 billion to lower the Medicare age of eligibility to 60, according to documents obtained by Bloomberg Government. Schumer said on Sunday that he is working with Sanders to push to include dental, vision, and hearing coverage in Medicare as part of the American Jobs and Families Plans. “There is a gaping hole in Medicare that leaves out dental, vision, and hearing coverage. This is a serious problem,” Schumer wrote on Twitter. Wyden outlines drug pricing priorities. On Tuesday (June 22), Senate Finance Committee Chairman Ron Wyden (D-OR) released a document outlining his Principles for Drug Pricing Reform. He said the document “reflects the core principles that will guide my work this summer: let Medicare negotiate, limit price gouging, provide relief to consumers at the pharmacy counter, ensure those with individual and employer insurance also benefit, and reward scientific research for those who are truly innovating.” The release includes several components of bipartisan legislation Wyden co-sponsored last year with then-Finance Chairman Chuck Grassley (R-IA), including restructuring of the Medicare Part D benefit, limiting high out-of-pocket spending for Medicare beneficiaries, and a controversial proposal to require rebates for drugs whose prices increase faster than the rate of inflation. The principles also include allowing Medicare to negotiate the price of prescription drugs, which is the main component of H.R. 3, the drug pricing bill being pushed by Speaker Nancy Pelosi (D-CA) and other democratic House leaders, however it does not include H.R. 3’s use of international reference pricing to drive negotiation and set a cap on the maximum negotiated prices. The Wyden principles would also extend “beyond Medicare to all Americans, including those covered by employer and commercial health plans” and focus on rewarding scientific innovation, “not gaming of the patent system.” Also this week, Senate Finance ranking member Mike Crapo (R-ID) and Health, Education, Labor and Pensions ranking member Richard Burr (R-NC) reintroduced the Lower Costs, More Cures Act (LCMCA), the leading Republican alternative for lowering drug pricing. The bill would set annual out-of-pocket $3,100 caps for Medicare Part D enrollees as well as reduce cost sharing for beneficiaries from 25% to 15% before the out-of-pocket cap is reached, among other provisions. DeGette and Upton release Cures 2.0 bill. On Tuesday (June 22), bipartisan Representatives Diana DeGette (D-CO) and Fred Upton (R-MI) released a discussion draft of their anticipated Cures 2.0 legislation, which among other items would authorize President Biden’s proposed Advanced Research Projects Agency for Health (ARPA-H). In a joint press release, DeGette and Upton said, “The federal government has amazing resources at its disposal and now is the time to put the full weight of those resources to use to cure some of the world’s most devastating diseases, such as cancer, diabetes, Alzheimer’s and more. Developing and delivering new lifesaving cures is a mission that must unite all of us.” The bill seeks to build upon the 2015 passage of DeGette and Upton’s 21st Century Cures Act, noting in the release that “while the 21st Century Cures Act sought to improve how new drugs and treatments are researched and developed in the U.S., Cures 2.0 seeks to improve how those new treatments and therapies are delivered to patients.” The bill inclusions provisions aimed at authorization of medical research, regulation of medical products, and Medicare payment for cutting-edge treatment. Cures 2.0 includes pandemic-focused provisions, such as the development of a nationwide testing and vaccine distribution strategy for future pandemics, while also authorizing $25 billion to “spark the economy” by funding independent research institutions, public laboratories, and universities. The bipartisan duo have said they want to pass their bill by the end of the year. (Press release/Discussion Draft/section-by-section summary). Biden will miss vaccination goal, pushes global vaccine shipment date. The Biden administration acknowledged this week that they will miss their goal of vaccinating at least 70% of U.S. adults by July 4, and will instead aim to get 70% of those 27 and older at least partially vaccinated through the holiday weekend. The comments come as a formal acknowledgement of a trend that has been apparent for weeks as vaccinations slow among younger Americans and across the south and Midwest. President Biden and other senior White House leaders are campaigning across the country to encourage people to get their vaccines as the federal government shifts from a mass vaccination effort to a more localized approach. The administration also announced this week it is pushing back its initial target date to shop 80 million COVID-19 vaccines oversees, now saying it will “allocate” rather than “send” the doses by the end of June, amid logistical challenges in the global vaccination. High-level HHS nominees confirmed. On Thursday (June 24), two high-level nominees for the Department of Health and Human Services were confirmed by the Senate. Dawn O’Connell will serve as assistant secretary for preparedness and response and Miriam Delphin-Rittmon as assistant secretary for mental health and substance use. The two were part of a group of 10 nominees for federal posts in President Joe Biden‘s administration that the Senate approved by voice vote. Warren and Cassidy request Aduhelm hearing. In a joint letter to Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Republican Mike Crapo (R-IA), Senators Elizabeth Warren (D-MA) and Bill Cassidy (R-LA) requested the committee convene a hearing to examine the cost of Biogen’s recently approved Alzheimer’s drug, Aduhelm, which will bear a list price of $56,000 per year. The letter urges the Finance committee leaders to hold a hearing “to examine the vexing new questions and challenges that approval raises for the Medicare program and other health programs.” Energy and Commerce hearing on data to advance equity and health. On Thursday (June 24), The House Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled, "Empowered by Data: Legislation to Advance Equity and Public Health." The hearing focused on the need for better data collection to address public health and advance equitable access to care, including the need to invest in data infrastructure. Bills discussed would enhance data collection for new coronavirus variants, societal issues that impact health like transportation access, and aim to address issues like maternal mortality and systemic racism. While Republicans generally agreed on the need for stronger data collection and better infrastructure, Reps. Brett Guthrie (R-KY) and Neal Dunn (R-FL) expressed concern over spending more money without first analyzing how past funds were used. Rep. Larry Bucshon (R-IN) also said he wants to ensure any new data collection efforts wouldn’t put additional administrative burden on health-care providers, who are already suffering from burnout. CMS: December 2020 and January 2021 Medicaid and CHIP Enrollment Trends Snapshot. The Centers for Medicare & Medicaid Services (CMS) released a new Enrollment Trends Snapshot report showing a record high, over 80 million individuals have health coverage through Medicaid and the Children’s Health Insurance Program (CHIP). Nearly 9.9 million individuals, a 13.9% increase, enrolled in coverage between February 2020, the month before the public health emergency (PHE) was declared, and January 2021. CDC: Urgent Care Center and Retail Health Clinic Utilization Among Adults: United States, 2019. Urgent care centers and health clinics within grocery or retail stores can provide acute health care services for nonemergencies, and they can also provide preventive care services, such as routine vaccinations. The availability and utilization of urgent care has risen dramatically in recent years. This report examines urgent care center and retail health clinic visits among adults in the past 12 months by sex and selected characteristics. CDC: Declines in Births by Month: United States, 2020. The number of births declined in both the first and second 6 months of 2020 compared with 2019 for nearly all race and Hispanic-origin groups, with larger declines in the second half of 2020 compared with the first half of the year.
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