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November 1, 2021

This Week in Health Policy for November 1

This Week (November 1-5)

The Senate Health, Education, Labor and Pensions Committee holds a hearing on "Next Steps: The Road Ahead for the COVID-19 Response."

  • Details: 10:00 AM EDT on 11/04/2021
  • WitnessesAnthony Fauci, Director of the National Institute of Allergy and Infectious Diseases; Dawn O'Connell, Assistant HHS secretary for preparedness and response; Rochelle Walensky, Director of the Centers for Disease Control and Prevention; Janet Woodcock, Director of the National Institute of Allergy and Infectious Diseases.
  • More information available here.

Last Week (October 25-29)

Health Care Highlights

Build Back Better Act draft text released. On Thursday (October 28), The House Rule Committee unveiled draft text and a section-by-section summary for the Build Back Better Act (H.R. 5376), following President Joe Biden's release of a proposed framework for the Democratic compromise package. The scaled-back reconciliation package includes a temporary extension of the expanded Affordable Care Act (ACA) tax credits advanced under the American Rescue Plan Act (ARPA) and tax credits to help those in the so-called Medicaid gap purchase exchange plans; a new Medicare hearing benefit; $150 billion for home and community-based services; one-year continuous eligibility requirements for children and postpartum women; permanent extension of the Children's Health Insurance Program; a repeal of the Trump administration's drug rebate rule; and a slew of other health care provisions. Despite the draft legislation release, it could take days or even weeks before it might be ready for a vote as Congressional Democrats begin a new round of negotiations to determine the final text. The framework leaves out progressive Democrats' priority provisions adding Medicare dental and vision benefits, to give Medicare power to negotiate drug prices, and to provide paid family and medical leave, among other non-health items. The bill needs all 50 Democratic senators to pass.

Drug pricing negotiations for BBB continue. Progressive Democrats in both the Senate and the House are still negotiating to include priorities such as prescription drug costs, Medicare benefits, and paid family leave. House Energy & Commerce Chair Frank Pallone (D-NJ) told reporters he is still trying to get drug pricing provisions into the bill and Senate Finance Committee Chair Ron Wyden (D-OR) said "we're staying at it" and that it was "too important" to exclude. Sen. Krysten Sinema (D-AZ), who has been viewed as one of the biggest obstacles to passing Medicare negotiation, has sought to limit negotiations to Part B physician-administered drugs that aren't under patent protections, which reflects a bill proposed by moderate House Democrat Scott Peters (D-CA); however, Wyden and others want to include Part D — the prescription drug benefit — because "that's where seniors live and they see it in line at the pharmacy counter." It remains to be seen if lawmakers can reach a deal to satisfy both Sinema and the many Democrats who want to go further on drug price negotiation.

FDA authorizes Pfizer COVID-19 vaccine for children aged 5 to 11. On Friday (October 29), an advisory panel to the Food and Drug Administration (FDA) voted 17-0 to recommend emergency use authorization to the Pfizer/BioNTech COVID-19 vaccine for children aged 5 to 11, after the group concluded that the shot's benefits outweigh any risks. The dosage is 10 micrograms per shot, which is lower than the 30-microgram-per-shot dosage used in people 12 and older. Several of FDA's vaccine advisers, however, hope the Centers for Disease Control and Prevention (CDC) will recommend only high-risk kids in the age group get the vaccine. If CDC recommends the vaccine for all children ages 5 to 11, the White House will immediately begin distributing around 15 million pediatric doses across the country, followed by millions more doses in the following weeks to areas with the highest demand. The White House has stated that is already has enough doses to supply all 28 million children between the ages of 5 and 11 in the United States.

CMS penalizes 2,499 U.S. hospitals due to readmissions. In its 10th annual round of penalties, Medicare is reducing its payments to 2,499 hospitals, or 47% of all facilities Medicare, because they had excessive patient readmissions, with an average penalty of 0.64 percent per Medicare patient stay that is expected to save the government $521 million over the next fiscal year. The fines levied by the Hospital Readmissions Reduction Program (HRRP) averaged $217,000 for a hospital in 2018, according to Congress' Medicare Payment Advisory Commission (MedPAC); Medicare estimates the penalties over the next fiscal year will save the government $521 million. Thirty-nine hospitals received the maximum 3% reduction, 547 hospitals had no penalty under the program, and an additional 2,216 hospitals are exempt.

CMMI finalizes changes to ESRD Treatment Choices (ETC) Model. On Friday (October 29), the CMS Innovation Center (CMMI) finalized changes to the ESRD Treatment Choices Model through the ESRD Prospective Payment System (PPS) annual rulemaking. The ETC Model is intended to encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD, while reducing Medicare expenditures and preserving or enhancing the quality of care furnished to beneficiaries with ESRD. The changes to the ETC Model policies aim to encourage dialysis facilities and health care providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic status, making the model one of the agency's first models to directly address health equity. (Final rule; fact sheet)

Biden vaccine rule will reportedly let employers make workers pay for tests. According to reports from Bloomberg Government, the Biden administration's vaccine mandate rule, which applies to private-sector companies with 100 or more workers, will allow businesses to force workers who refuse to get the COVID-19 shot to pay for required weekly tests and masks unless they are entitled to an exemption. The emergency rule, being developed by the U.S. Labor Department's Occupational Safety and Health Administration (OSHA), remains under consideration at the White House's regulatory office and is expected to be released next week. The testing-cost question has been the subject of significant lobbying pressure because of the enormous logistical and financial ramifications for many companies.


House Energy and Commerce Hearing on Legislation to Support Patients, Caregivers, and Providers. On Tuesday (Oct. 26), the House Energy and Commerce Committee held a hearing entitled, "Caring for America: Legislation to Support Patients, Caregivers, and Providers." The hearing focused on seven pieces of legislation aimed at fostering a more robust, diverse, and supported public health workforce. Of the bills discussed, there was notable bipartisan support expressed for the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667), as well the Allied Health Workforce Diversity Act of 2021 (H.R. 3320). In addition to the legislation discussed, other Republicans also expressed their disagreement with federal vaccine mandates and potential negative repercussions on the workforce. Reps. Michael Burgess (R-TX) and Larry Bucshon (R-IN) also both expressed their concern that there was no discussion of pending cuts to provider payment and their strong opposition to the recent regulations from the Biden administration on surprise billing, which they said does not reflect Congressional intent. Rep. Blunt Rochester also discussed the nursing shortage and importance of hospital-based nursing schools in providing highly skilled nurses into the pipeline, noting her legislation (H.R. 4407) that would fix a technical glitch by CMS that would prevent large cuts to hospital-based nursing programs. Witnesses also expressed their support for expanded telehealth flexibilities and the importance of shifting to value-based payment as a way to improve outcomes and reduce costs while also reducing provider burnout.

  • More information available here.

Reports, Studies, and Journals

ASPE: Tracking Health Insurance Coverage in 2020—2021. This report analyzes evidence from a variety of data sources, including surveys and administrative data, which collectively indicate that the number of uninsured people in the U.S. did not change substantially during the first 12 months of the COVID-19 pandemic. Results also suggest that Medicaid and Marketplace enrollment have continued to grow in 2021, playing an important role in preventing widespread coverage loss during the pandemic.

National Bureau of Economic Research: Market Segmentation and Competition in Health Insurance. Using data from Oregon, researchers find households with group coverage spend 26% less on covered health care than households with individual coverage yet face higher markups.

Kaiser Family Foundation: Potential Costs and Impact of Health Provisions in the Build Back Better Act. Researchers walk through 10 of the major health coverage and financing provisions of the Build Back Better Act, with discussion of the potential implications for people and the federal budget.

Centers for Disease Control and Prevention: Routine Vaccination Coverage — Worldwide, 2020. In 2020, estimated global coverage with DTP3 and Pol3 decreased to 83%; MCV1 coverage decreased to 84%. Globally, 17.1 million zero-dose children did not receive the first DTP dose, an increase of 3.5 million from 2019.


Contact Information
For additional information concerning this Alert, please contact:
Washington Council Ernst & Young
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