September 13, 2021
This Week in Health Policy for September 13
This Week (September 13 - 17)
House committee markups for the Build Back Better Act are scheduled to be completed next week, at which point the House will work to consolidate them into a single package. While timing of a vote is uncertain, the target date is September 27 — the date agreed upon to consider it in tandem with the bipartisan infrastructure package.
Last Week (September 6 - 10)
Health Care Highlights
Biden administration unveils new COVID-19 strategy. On Thursday (September 9), the Biden Administration released a new, six-pronged national strategy to combat COVID-19 amid the surge in cases driven by the highly transmissible Delta variant. The "aggressive, comprehensive" plan focuses on three priorities: 1) getting more people vaccinated, 2) decreasing hospitalizations and deaths, and 3) keeping schools and the economy up and running. According to the plan, several regulations aimed at increasing the number of vaccinated individuals are already in development. The Occupational Safety and Health Administration (OSHA) will require all employers with 100 or more employees to ensure their workforce is fully vaccinated or require any workers who remain unvaccinated to produce a negative test result on at least a weekly basis before coming to work, as well as require employers to provide paid time off for vaccination and recovery. The Centers for Medicare & Medicaid Services (CMS) will also require vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement as a condition of participation, expanding prior emergency mandates for nursing home workers to include hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others. The President also signed Executive Orders earlier in the day extending vaccine requirements to all federal executive branch workers and federal government contractors.
The plan notes that the administration will be prepared to offer booster shots as early as the week of September 20th, but will await authorization and approval by the Food and Drug Administration (FDA) and recommendation from the Advisory Committee on Immunization Practices (ACIP). Other provisions contained within the plan are aimed at further supporting increased vaccinations and public health mitigation efforts like masking, ramping up testing and treatment capacity, and providing additional supports for schools and small businesses impacted by the pandemic so they can remain safely open.
W&M committee advances health expansion proposals. On Thursday and Friday (September 9-10), the Ways and Means Committee (W&M) advanced out of committee their portions of the Build Back Better Act. Health care provisions included:
The Committee also advanced proposals to provide up to 12 weeks of universal paid family and medical leave for all U.S. workers, changes to retirement savings and trade programs for working Americans, and more.
E&C unveils reconciliation proposals. On Thursday (September 9), the House Energy and Commerce Committee (E&C) announced it is set to move forward with its portion of the Build Back Better Act, to be marked up on Monday, September 13. Among the health policies in the plan are proposals to lower the cost of prescription drugs through price negotiation and other means; expand access to Medicare dental, vision, and hearing coverage; close the so-called Medicaid coverage gap; invest $190 billion in home- and community-based services; permanently extend the Children's Health Insurance Program (CHIP); expand maternal health care; provide funding to start the Biden administration's proposed biomedical research agency, the Advanced Research Projects Agency for Health (ARPA-H), and more. In announcing the markup, Chairman Frank Pallone (D-NJ) said "The American people are facing a public health crisis, a rapidly escalating climate crisis, and long-term economic challenges that demand decisive action by Congress." In addition to health care, the proposal includes energy and environmental provisions aimed at following through on their commitment to combat the climate crisis. It also features various public safety, broadband, manufacturing and privacy provisions.
HHS outlines drug pricing plan. On Friday (September 10), Health and Human Services (HHS) Secretary Xavier Becerra released a "Comprehensive Plan for Addressing High Drug Prices," in response to President Biden's Executive Order (EO) on Promoting Competition in the American Economy. The EO instructed the Secretary to submit "a plan to continue the effort to combat excessive pricing of prescription drugs and enhance domestic pharmaceutical supply chains, to reduce the prices paid by the Federal Government for such drugs, and to address the recurrent problem of price gouging." The plan echoes earlier drug pricing proposals offered by the Biden administration, including allowing the Secretary of HHS to negotiate Medicare Part B and Part D drug prices directly with pharmaceutical companies and making those prices available to other purchasers. The plan also expresses support for legislative policies aimed at tamping down on anti-competitive practices, increasing transparency across the pharmaceutical supply chain, and capping costs for seniors. It also outlines additional administrative tools at HHS's disposal such as testing value-based payment models in Medicare Part B and continuing to enhance and improve upon the approval process for generic drugs.
HHS releases $25.5B in Provider Relief Funds. On Friday (September 10), HHS announced that it is releasing another $25.5 billion under the Provider Relief Fund (PRF). "This funding critically helps health care providers who have endured demanding workloads and significant financial strains amidst the pandemic," HHS Secretary Xavier Becerra said in a statement. "The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need." The funding includes $8.5 billion from the American Rescue Plan (ARP) for providers who serve rural Medicaid, Children's Health Insurance Program (CHIP), or Medicare patients and $17 billion for a broad range of providers who can document revenue loss and expenses associated with the pandemic. In an effort to promote equity and address the providers most in need, smaller providers will receive a higher percentage of payments and "bonus" payments will be based on the amount of services provided to Medicaid, CHIP, and Medicare Patients. Providers will be able to apply for relief funds on September 29, 2021.
CMS Administrator outlines top priorities. In a blog post, CMS Administrator Chiquita Brooks-LaSure outlined a strategic vision for CMS and reflected on her first 100 days. She laid out six pillars for achieving CMS's vision of "advancing health equity, expanding coverage, and improving health outcomes," which includes addressing health disparities, building on the Affordable Care Act (ACA), engaging partners and communities, driving innovation and promoting value-based care, protecting program sustainability, and fostering excellence across CMS operations. "In the short time I have been CMS Administrator," she wrote, "we have already made significant progress on these pillars, focusing our efforts on improving health equity and access to coverage by working across what I call 'the three Ms': Medicare, Medicaid & CHIP, and the ACA Marketplaces."
Reports, Studies, and Journals
NBER: The Impact of Healthcare IT on Clinical Quality, Productivity and Workers. Adoption of health information and communication technologies ("HICT") has surged over the past two decades. Researchers found that HICT improves clinical outcomes and lowers healthcare costs, but (i) the effects are modest so far, (ii) it takes time for these effects to materialize, and (iii) there is much variation in the impact
Government Accountability Office: Medicaid Home- and Community-Based Services: Evaluating Covid-19 Response Could Help CMS Prepare for Future Emergencies. COVID-19 presented risks to Medicaid home- and community-based services (HCBS) programs, where providers help beneficiaries with daily activities, such as bathing, dressing, and eating.
The Commonwealth Fund: The Coverage and Cost Effects of Key Health Insurance Reforms Being Considered by Congress. Making ARPA premium subsidies permanent and filling the Medicaid coverage gap would reduce the number of people without insurance by nearly one-quarter, or 7.0 million people, in 2022.
New England Journal of Medicine: Effectiveness Of Covid-19 Vaccines In Ambulatory And Inpatient Care Settings. There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. (Thompson et al, 9/8)
Health Affairs: Use The Hospital Compare Website To Make Hospital Community Benefit More Transparent. Researchers propose options for using the Hospital Compare website to make for-profit and nonprofit hospital systems justify their tax status based on community and charity care provided.