October 25, 2021
This Week in Health Policy for October 25
This Week (October 25 - 29)
The House Energy and Commerce Health Subcommittee holds a hearing on "Caring for America: Legislation to Support Patients, Caregivers, and Providers."
The House Veterans' Affairs Health Subcommittee holds a hearing on "Lessons Learned? Building a Culture of Patient Safety Within the Veterans Health Administration."
Last Week (October 18 - 22)
Health Care Highlights
Democratic leaders indicate they are close to deal on slimmed down package. According to House Majority Leader Steny Hoyer (D-MD), a spending plan framework for the Democrats' reconciliation package is expected by the end of the weekend. House Speaker Nancy Pelosi (D-CA) also said she's hopeful there can be a vote on both the bipartisan infrastructure package and the Democrats' reconciliation package next week. "I would say more than 90% is agreed to and written," she told reporters on Friday (Oct. 22).
President Joe Biden during a CNN town hall this week said getting all dental, vision and hearing provisions he wants in the deal on his economic agenda is "a reach." The President said they might get an $800 voucher on dental from Medicare, but there's no deal yet, and mentioned that some hearing benefits will be included in the deal due to support from key moderate Senator Krysten Sinema (D-AZ). Bolstered Affordable Care Act (ACA) subsidies could also only be extended for four years — a much shorter period than what House Speaker Nancy Pelosi (D-CA) sought — as part of a slimmer health care package. Senate Finance Chairman Ron Wyden (D-OR) says he is committed to crafting a plan to empower the federal government to negotiate with pharmaceutical companies despite pushback from industry and moderates in his own party. He said he "will not give up" on his drug pricing plan and noted that his plan would offer "flexibility," likely aimed at wooing the support of moderates, however it is not yet clear what that will look like.
Meanwhile, Rep. Lizzie Fletcher (D-TX) and 23 other members from states that have yet to expand Medicaid called on Speaker Pelosi and Senate Majority Leader Chuck Schumer (D-NY) to keep Medicaid expansion incentives in Biden's economic agenda. The request comes after reports that congressional leadership is considering repealing the Medicaid expansion incentives passed in the American Rescue Plan Act (ARPA) earlier this year.
CBO: ACA enhancements would cost $552b, extend coverage to 4 million. According to an analysis by the Congressional Budget Office (CBO), ACA enhancements contained in the Democrats' proposed reconciliation legalisation would cost $553.2 billion and extend coverage to nearly 4 million Americans over the 2022—2031 period. This includes a 4 million increase in Medicaid enrollment; 3.6 million increase in subsidized nongroup enrollment; 1.0 million decrease in unsubsidized nongroup enrollment; and 2.8 million decrease in enrollment in employment-based coverage. The estimated reduction in employment-based coverage is primarily driven by a reduction in offers as a response to the increased subsidies for coverage through the marketplaces. CBO estimates that under the legislation, 23.6 million people under the age of 65 would be uninsured in 2031 — a reduction of 4.1 million from the current-law total of 27.7 million people.
FDA and CDC advisors endorse Moderna, J&J boosters. This week the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices voted unanimously to recommend COVID-19 booster shots from Moderna and Johnson & Johnson, echoing booster clearance by the Food and Drug Administration (FDA) earlier this week and enabling recipients of all three of the shots cleared in the U.S. to receive a supplemental dose to boost their immunity. The CDC also said that eligible people may choose a different booster shot form the vaccine they originally received. CDC Director Rochelle Walensky said in a statement that data show all three COVID-19 vaccines authorized in the U.S. are safe and "highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant." The FDA authorized Moderna's additional shot for people 65 and older along with other adults at high risk of severe disease due to health conditions or work at least six months after their initial inoculation. The agency also cleared J&J boosters for people 18 and older who got the single-dose vaccine at least two months ago. Pfizer and BioNTech said this week their booster is 95.6% effective against symptomatic COVID-19 following a large study which followed 10,000 people aged 16 and older.
U.S. to start shipping vaccines for younger children in anticipation of clearance. The Biden administration said they will begin shipping vaccines for kids age 5 to 11 as soon as next week, following expected authorization from the FDA, and shots could start going into arms the following week. That would allow vaccines to arrive at doctors' offices — where the shots will largely be offered — so that they could be administered as soon as they are cleared by the CDC, which could be soon after a panel hearing scheduled for November 2 and 3. Younger children's' dose is 10 micrograms, or one-third the regular Pfizer-BioNTech dose, and will be given with smaller needles. The White House said doses will be administered at 25,000 pediatricians' offices and primary care sites, along with pharmacies and — to a lesser extent — schools and clinics.
House passage of public health bills. The House this week passed four bipartisan health care bills:
The House is scheduled to vote Friday (Oct. 22) on a bill (H.R. 3110) to expand workplace accommodations for nursing workers, including reasonable break times and private lactation areas.
FDA issues over-the-counter hearing aid proposal. On Tuesday (Oct. 19), the FDA announced a proposal to establish a new category of over-the-counter (OTC) hearing aids "intended to improve access to and reduce the cost of hearing aid technology for millions of Americans." When finalized, the rule would allow hearing aids within this category to be sold directly to consumers in stores or online without a medical exam or a fitting by an audiologist. The proposed rule is designed to help increase competition in the market while also ensuring the safety and effectiveness of OTC and prescription hearing aids. The action follows President Biden's July Executive Order on "Promoting Competition in the American Economy," which called for the FDA to take steps to allow hearing aids to be sold over the counter. Health and Human Services (HHS) Secretary Xavier Becerra said the move "takes us one step closer to the goal of making hearing aids more accessible and affordable for the tens of millions of people who experience mild to moderate hearing loss."
Senate Finance Committee Hearing on Health Insurance Coverage. On Wednesday (Oct. 20), the Senate Finance Committee held a hearing entitled, "Health Insurance Coverage in America: Current and Future Role of Federal Programs." Throughout the hearing, Democratic committee members and witnesses discussed health provisions contained within the Democratic "Build Back Better" proposal, primarily focusing on the permanent expansion of Affordable Care Act (ACA) premium tax credits (PTCs) advanced under the American Rescue Plan Act (ARPA); addressing the Medicaid "coverage gap" in non-expansion states; expanding Medicare benefits to include dental, vision, and hearing coverage; and, enhancing access to home- and community-based services (HCBS). Chairman Ron Wyden (D-OR) said that expanding the ARPA provisions is "a no brainer" and also expressed support for the other coverage provisions. Sen Rafael Warnock (D-GA) spoke about the importance of closing the Medicaid coverage gap and said it is about "basic equity and fairness." Ranking Member Mike Crapo (R-ID) acknowledged that the health care system has "substantial room for improvement" but said that instead of the proposals offered by Democrats, "creative and market-based models provide a compelling blueprint for bipartisan reform." In addition to fundamentally disagreeing with the expansion of government supports through the various proposals, Republicans expressed concern with the high cost of the package, health provisions negative impact on Medicare solvency, and overall impacts on taxes for individuals below 400% of the federal poverty line (FPL).
Energy and Commerce Committee Hearing on Enhancing Public Health. On Wednesday (Oct. 20), the House Energy & Commerce Committee held a hearing entitled, "Enhancing Public Health: Legislation to Protect Children and Families." The committee discussed twelve bipartisan public health bills including those aimed at expanding pediatric research and health care services; studying the effect of media on children and infants; addressing childhood mortality and limiting the spread of childhood diseases; screening for lung, breast, and prostate cancer; funding cardiac research and education; and allowing physician's assistants (PA) and nurse practitioners to supervise cardiac rehabilitation to ensure that more Medicare patients can benefit from this care. Chairman Frank Pallone (D-NJ) said "Since the pandemic has had a disparate impact on lower income families, it is important that we act to reverse any harmful effect on the health and well-being of children." Ranking Member Cathy McMorris Rodgers (R-WA) urged the committee "to get back to the people's work, not the speaker's agenda," adding that "I hope we can continue this encouraging trend by addressing the important major public health issues facing our nation today."
Reports, Studies, and Journals
HHS Office of the Inspector General: Most Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship (OEI-02-20-00521). Notably, 84 percent of beneficiaries received telehealth services only from providers with whom they had an established relationship. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship, compared to beneficiaries in Medicare Advantage. This pattern persisted among virtually all of the most common telehealth services. Beneficiaries tended to see their providers in person about 4 months prior to their first telehealth service, on average.
Urban Institute: Commercial Health Insurance Markups over Medicare Prices for Physician Services Vary Widely by Specialty. Private insurers generally pay physicians substantially higher rates than Medicare does for the same service. Policy proposals to reduce commercial prices and curb health care spending by benchmarking private payment rates to Medicare prices could therefore significantly affect physician payments, but the effects will likely vary considerably by specialty. This study assesses the variation across physician specialties in commercial markups over Medicare prices for professional services.
Primary Care Collaborative: Primary Care and COVID-19: It's Complicated. Overall, the analysis found that counties with greater primary care access, more robust public health, and fewer social vulnerabilities — counties with the highest scores on the Community Health Index — had better COVID-19-related outcomes (incident and death).