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September 27, 2021

This Week in Health Policy for September 27

This Week (September 27 - October 1)

Civil Rights and Human Services Subcommittee and Health, Employment, Labor, and Pensions Subcommittee joint hearing on "How to Save a Life: Successful Models for Protecting Communities from COVID-19."

  • Details: 10:15 AM EDT on 09/28/2021
  • More information available here.

Last Week (September 20 - 24)

Health Care Highlights

Congress facing key deadlines next week. Democratic leaders on Capitol Hill are running up against multiple critically important deadlines in the coming weeks. The government runs out of funding on September 30 and while the debt limit technically hit in August, the Treasury department has deployed a series of "extraordinary measures" to prevent a default but is expected to run out of options in mid- to late-October. Earlier this week, the House approved on a party line vote a continuing resolution to extend government funding to December 3 and suspend the debt limit until December 16, in addition to disaster and Afghan resettlement aid. However, the inclusion of the debt limit suspension in the package resulted in all 211 Republicans voting against the bill. Senate Republicans have committed not to vote for a measure to increase the debt limit and to filibuster any legislation that includes it. "Whatever it is, we will have a [continuing resolution] that passes both houses by Sept. 30," House Speaker Nancy Pelosi said Thursday. Democrats say that Republicans should vote to raise the debt limit because it has traditionally been a bipartisan exercise and government debt includes money spent under former-President Donald Trump, with Speaker Chuck Schumer (D-NY) calling it "a dine and dash of historic proportions." Republicans, however, say that Democrats are able to extend the debt limit through the reconciliation process, which would require only 50 votes in the Senate.

In August, Speaker Pelosi also promised House moderates she would put the Senate-passed bipartisan infrastructure bill up for a vote by September 27, in exchange for their vote on the $3.5 trillion budget resolution, which allowed House committees to being work on their $3.5 trillion social spending package, the Build Back Better Act. Now, at least 20 progressive Democrats are threatening to vote against the bipartisan bill should it come up before the reconciliation package. Their argument is that Congress must deliver the entirety of Biden's agenda to the President — not just one piece of it. Chair of the House Progressive Caucus, Rep. Pramila Jayapal (D-WA), said the bipartisan infrastructure bill will fail if it comes up for a vote without a clear commitment from Senate Democrats on advancing the reconciliation package, saying she wants an agreement "signed in blood" on the matter. Speaker Pelosi said during a news conference: "We take it one day at a time but I'm confident that we will pass both bills." The House Budget Committee is planning a markup on the reconciliation package on Saturday. The consolidated legislative text is available on the committee's website.

Reconciliation bill faces hurdles and health care hang ups. The reconciliation bill still faces several hurdles in Congress as Democrats debate the details and the topline number. Moderate Democrats including Senators Joe Manchin (D-WV) and Krysten Sinema (D-AZ) have said they won't vote for a $3.5 trillion package, in addition to Manchin suggesting a "strategic pause," potentially until next year. Coming to agreement on a smaller reconciliation package will force Democrats to make tough calls about their priorities and the Biden agenda. Pelosi and Senate Majority Leader Chuck Schumer (D-NY) said Thursday (Sept. 23) they have a "menu of options" to pay for their programs, but the ideas have not been finalized or vetted by the caucus. John Yarmuth (D-KY) told reporters Democrats hope to resolve key differences in talks between the House, Senate, and White House over the next 48 hours. "I've been herding cats now for four months or so, and my message to all of them has been, posture all you want on all your priorities, " Yarmuth said. "Fight for what you believe in. But ultimately, you're all going to vote for this, because you're not going to vote against childcare, you're not going to vote against paid family leave, yada yada yada. And by the way, have you met Nancy?"

  • Drug pricing: House Ways & Means Chairman Richie Neal (D-MA) said the exact prescription drug pricing negotiation language was still under discussion. The language passed out of his committee last week was a sweeping proposal based on H.R. 3 which would allow Medicare to negotiate the price of prescription drugs and apply those discounts to the private market, however the same provision failed in the Energy & Commerce committee after three moderate Democrats voted against the provisions. Rep. Scott Peters (D-CA), one of the three members who opposed it, is proposing a narrower approach that would only allow Medicare to negotiate drugs in Part B for products that no longer have exclusivity and for which there is no competition on the market. "Our plan will drastically lower out-of-pocket drug costs for consumers, as Democrats have promised, while we preserve American jobs and investment in future innovation," said Peters. Senator Ron Wyden (D-OR), is crafting a drug pricing proposal aimed at winning the support of centrist Democrats by promising to carve out exceptions for small biotech companies and preserve innovation, which is a key hang up for Peters and others, however he has yet to release legislative text on the proposal.
  • Medicare expansion: Senator Joe Manchin (D-WV) has said he doesn't support expanding Medicare benefits without first addressing the program's long-term solvency, putting him at odds with Sen. Bernie Sanders (I-VT) and other in the caucus who want to prioritize the expansion of benefits for dental, vision, and hearing. "I'll say this about Medicare: We need to stabilize it. By 2026, you understand the trust fund is going to be insolvent … I want to make sure we are stabilizing what we have before we start going down this expansion role." Sen. Sanders wants to make the current expansion, however, more generous. Currently, dental benefits in the proposal would not kick in until 2028, and vision and hearing benefits would start in mid-202 and mid-2023, respectively. Sen. Sanders has proposed providing $1,000 loaded onto a debit card for dental visits, hearing aides, or eye glasses in the interim. The debit cards — which Sanders has called vouchers — would be available to individuals making less than $75,000 per year and families with incomes under $150,000.

CDC adopts booster shots for 65+ and those at high-risk. Today (Sept. 24) The Centers for Disease Control and Prevention (CDC) issued a statement adopting the use of booster shots for those aged 65 and up and for people at high risk of contracting or falling seriously ill from Covid-19, despite a narrower recommendation from the agency's advisers who voted against giving the additional shot to people ages 18 to 64 in jobs or settings where they're at risk of becoming infected. The agency said in a statement that millions of Americans who were immunized with the Pfizer-BioNTech vaccine at least six months ago would be eligible to receive a booster dose starting immediately. CDC Director Rochelle Walensky said: "At CDC, we are tasked with analyzing complex, often imperfect data to make concrete recommendations that optimize health. In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.

The FDA authorized the third shot of Pfizer's COVID-19 vaccine on September 22, but has not addressed when or if those who received Moderna and Johnson & Johnson COVID-19 vaccines will be eligible for boosters. The agency still needs to review data produced by those drug makers, which Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he expects within a few weeks.

Senate Finance Committee launches bipartisan effort to address mental health. On Wednesday (September 22), Senate Finance Committee Chairman Ron Wyden (D-OR) and Finance Committee Ranking Member Mike Crapo (R-ID) launched an effort to develop bipartisan legislation to address barriers to mental health care as the COVID-19 pandemic has worsened alarming trends in Americans' mental health care. In a letter to behavioral health care stakeholders, the Finance leaders requested evidence-based solutions and ideas to enhance behavioral health care in five areas:

  • Strengthening the workforce
  • Increasing integration, coordination and access to care
  • Ensuring parity between behavioral and physical health care
  • Furthering the use of telehealth
  • Improving access to behavioral health care for children and young people

The letter stated their goal "is to develop a bipartisan legislative package before the end of the year addressing many of the behavioral health care challenges currently faced by millions of Americans."

Bipartisan support for price transparency in hospitals. This week, House Energy and Commerce Chair Frank Pallone (D-NJ) and ranking member Cathy McMorris Rodgers (R-WA) sent a letter to Health and Human Services (HHS) Secretary Xavier Becerra in support of recently proposed rules that "seek to increase the effectiveness of the Hospital Price Transparency Final Rule." The Hospital Price Transparency Final Rule requires hospitals to publicly report standard charges and negotiated rates for all items and services with noncompliant hospitals facing a $300/day civil monetary penalty for noncompliance. The latest rule proposes to increase noncompliance penalties to up to $5,500 per day for larger hospitals in addition to clarifying requirements for price estimator tools and specifications for enhancing accessibility of standard charge information. The bipartisan letter noted the committee leaders' concern with low levels of hospital compliance to date and stated their support for HHS to "conduct vigorous oversight and ensure full compliance with the final rule."

CMS finalized 2022 ACA market policies. Late last week, CMS issued their "Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond final rule." The rule aims to expand access to health insurance coverage through the Affordable Care Act (ACA) Marketplaces by lengthening the annual Open Enrollment Period and establishing a Monthly Special Enrollment Period for low-income consumers; restoring and expanding Navigator duties to provide consumers with information and assistance on certain post-enrollment topics; and repealing separate billing regulations that required issuers to send a separate bill for the portion of a policyholder's premium attributable to coverage for abortion services, for which federal funding is prohibited, among other items. According to a fact sheet, "these changes further the Biden-Harris Administration's goals of providing greater access to coverage, improving affordability for consumers, and reducing burden for issuers and consumers." Earlier this week, CMS confirmed that even though it only finalized policy changes for the 2022 plan year last Friday (September 17), the certification timeline for Qualified Health Plans (QHPs) seeking to sell plans through has not changed.

House passes on abortion protection bill; Supreme Court announces case update. On Friday (September 24), The House voted 218-211 on a bill (H.R. 3755) that would give the Justice Department the power to bring civil actions against government officials or individuals who try to impose limitations on abortions, other than those deemed medically necessary. The provision would require 60 votes to pass in the Senate, and is destined to fail. The Supreme Court also announced this week it would hear arguments December 1 on Mississippi's abortion ban after 15 weeks of pregnancy, a case that's been blocked by lower courts and represents a direct challenge to Roe v. Wade. The announcement comes after conservative justices allowed Texas to implement a ban on abortions when fetal heartbeat is detected, generally around six weeks of pregnancy, earlier this month, and a ruling in the Mississippi case is expected next summer.

Reports, Studies, and Journals

U.S. Department of Health and Human Services Office of Inspector General: Some Medicare Advantage Companies Leveraged Chart Reviews and Health Risk Assessments To Disproportionately Drive Payments. The OIG analyzed MA encounter data from 2016 to determine whether any MA companies' use of chart reviews and HRAs increased their risk-adjusted payments disproportionately relative to their size and their peers. They note concerns about the extent to which certain MA companies may have inappropriately leveraged both chart reviews and HRAs to maximize risk-adjusted payments

CDC: Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions - United States, March-August 2021. Among U.S. adults without immunocompromising conditions, vaccine effectiveness against COVID-19 hospitalization during March 11-August 15, 2021, was higher for the Moderna vaccine (93%) than the Pfizer-BioNTech vaccine (88%) and the Janssen vaccine (71%).

Altarum: September 2021 Health Sector Economic Indicators Briefs. Altarum's monthly Health Sector Economic Indicators (HSEI) briefs analyze the most recent data available on health sector spending, prices, employment, and utilization.

Kaiser Family Foundation: Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage. Difficulty with hearing and vision is relatively common among Medicare beneficiaries, with close to half (44%, or 25.9 million) of beneficiaries reporting difficulty hearing and more than one third (35% or 20.2 million beneficiaries) reporting difficulty seeing in 2019. A larger share of Medicare beneficiaries used dental services than either hearing or vision services in 2018.


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