02 August 2021 This Week in Health Policy for August 2 The Senate Health, Education, Labor and Pensions Committee holds a markup of S. 1486 (117), the "Pregnant Workers Fairness Act;" S. 1543 (117), the "Suicide Training and Awareness Nationally Delivered for Universal Prevention Act;" S. 2425 (117), the "Suicide Prevention Lifeline Improvement Act;" and S. 2401 (117), the "21st Century Assistive Technology Act;" and to vote on the nominations of David Weil to be administrator of the Labor Department's Wage and Hour Division; Catherine Elizabeth Lhamon to be assistant Education secretary for civil rights; and Javier Ramirez to be director of the Federal Mediation and Conciliation Service.
Bipartisan infrastructure deal moves forward. On Wednesday (July 28) the Senate voted 67-32 to proceed to a bipartisan infrastructure bill (H.R. 3684) that was the product of weeks of negotiations among a core group of 10 senators. The deal, which has the backing of President Biden, includes $550 billion in new federal spending and features historic investments in the nation’s core infrastructure including roads and bridges, rail, transit, ports, airports, water systems and broadband. The new spending is paid for in part by several health care offsets including the recoupment of $205 billion in unused COVID-19 relief dollars; delay of the Trump-era Medicare Part D rebate rule; extension of the Medicare sequester; and a measure to make drug companies pay back Medicare Part B for unused portions of drugs packaged in vials. Notably, a proposed clawback of $43.7 billion in unspent pandemic relief funds marked for health-care providers, which the bipartisan group had considered as a pay-for, was not included in the bill. Senate Finance Committee Chairman Ron Wyden (D-OR) told Bloomberg that coronavirus “cases are going up. I want to make sure this doesn’t impact our nursing homes and hospitals that are getting hit.” The Senate could pass the bill as early as next week, after debate and amendments. Senate Majority Leader Chuck Schumer (D-NY) has warned that weekend work may be necessary prior to the August recess, and members are expecting the chamber to be in this weekend. Until the bill text is released, details are unknown on certain provisions, such as what is contained in the $205 billion recoupment of unused COVID-19 relief dollars. Despite Senate progress, House Speaker Nancy Pelosi (D-CA) has said she won’t bring the bill to the floor until the Senate passes a Democratic-only bill featuring health care, education, and caregiving investments that has been envisioned to cost $3.5 trillion, though moderate Senator Kyrsten Sinema (D-AZ) is objecting to a bill of that size. CDC changes masking guidance. On Tuesday (July 27), the Centers for Disease Control and Prevention (CDC) changed its guidance regarding indoor masking, representing a third change in indoor mask guidance in the last three months. The updated guidance recommends “universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status” and that “fully vaccinated people to wear a mask in public indoor settings in areas of substantial or high transmission.” In a press conference announcing the changes, CDC Director Rochelle Walensky reiterated that CDC guidance and recommendations “will follow the science,” citing new data finding that the Delta variant behaves “uniquely different from past strains,” in that some vaccinated people infected with the Delta variant may be contagious and spread the virus to others. She continued to “strongly encourage” everyone to get vaccinated and noted that the highest spread continues to be in places with low rates of vaccination. A summary of the changes can be found here. Attending Physician Brian Monahan of the House of Representatives also reimposed a mask wearing requirement for lawmakers and others while on the House floor, in hallways, and offices. Biden announces vaccine incentives. On Thursday (July 29), President Biden announced several measures aimed at incentivizing COVID-19 vaccines amid a surge in cases driven by the Delta variant, saying “we have the tools to prevent this new wave of COVID from shutting down our businesses, our schools, our society, as we saw happen last year.” Biden stopped short of mandating that federal workers get vaccinated but will require they either show proof of vaccination or wear masks and submit to frequent coronavirus tests. He also instructed the Pentagon to determine how and when to require that all U.S. troops receive the COVID-19 vaccine, which Defense Department leaders have been wary of doing. Biden also called on states and local governments to provide $100 to people who get vaccinated using funds from the $1.9 trillion American Rescue Plan. The IRS and Treasury Department also issued new guidance noting that employers with under 500 employees can claim tax credits for providing paid leave to employees who take household members to vaccination appointments or care for them as they recover from the shot, expanding on prior guidance that said the credits were available to those that provided paid leave to staff receiving or recovering from COVID-19 vaccinations. Also this week, the Department of Veterans Affairs became the first federal agency to require COVID-19 vaccinations for its workers, while California and New York City announced mandates for their employees but provided exemptions for those who agree to undergo regular testing. Earlier in the week, over 50 prominent medical organizations called for all health care employers and long-term care facilities to require COVID-19 vaccines for their entire staffs. In support of these movements and in the face of lawsuits surrounding the mandates, the Department of Justice came out this week saying that COVID-19 vaccines’ status as an emergency product does not ban employer, universities, or other entities from requiring inoculations. House passes spending package with HHS funding. On Thursday (July 29), the House passed along party lines (219-208) a seven-bill spending package (H.R. 4502) with a combined $597.7 billion in discretionary budget authority that largely aligns with President Joe Biden’s proposals for health care and other agencies. The package includes a measure that would provide a $3 billion down payment to create the Advanced Research Projects Agency – Health (ARPA-H), an agency proposed by President Biden that would reside within the National Institutes of Health and follow in the footsteps of similar ambitious research agencies for defense and energy. The funding package also sets the stage for a partisan standoff over abortion. The Health and Human Services funding bill does not include the Hyde amendment, a longstanding ban on federal funds for abortion, or the Weldon amendment, which bars federal agencies from discriminating against individuals, health care facilities, or insurance companies because they refuse to provide or pay for abortions. Republicans have warned that lawmakers won’t reach a final government funding deal until Democrats include those longstanding restrictions on abortion funds along with lowering lower their proposed domestic spending totals and increase military funds. Senate Judiciary Committee Markup on Generic Drugs And Pharmaceutical Supply Chains. On Thursday (July 29), the Senate Judiciary Committee unanimously advanced four bipartisan bills aimed at improving access to affordable prescription drugs:
CDC: Disparities in COVID-19 Vaccination Coverage Among Health Care Personnel Working in Long-Term Care Facilities, by Job Category, National Healthcare Safety Network - United States, March 2021. During March 2021, 300 LTCFs reported COVID-19 vaccination coverage for their HCP. COVID-19 vaccination coverage was highest among physicians (75.1%) and lowest among aides (45.6%). Vaccination coverage among aides was lower in facilities located in zip code areas with higher levels of social vulnerability. Kaiser Family Foundation: Medicare and Dental Coverage: A Closer Look. This brief provides new data on the share of Medicare beneficiaries with dental coverage, the share with a dental visit in the past 12 months, and out-of-pocket spending on dental care. It also takes a closer look at the scope of dental benefits offered to Medicare Advantage enrollees in individual plans in 2021. Center on Budget and Policy Priorities: Closing the Coverage Gap Would Improve Black Maternal Health. States that expanded Medicaid under the Affordable Care Act have seen a significant rise in health coverage among women of reproductive age. JAMA Network: Using Consistently Low Performance to Identify Low-Quality Physician Groups. In this cross-sectional study of a commercially insured population with diabetes or cardiovascular disease, authors found weak consistency of low performance scores across multiple measures but moderate to strong consistency of scores over multiple years.
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