February 14, 2022
This Week in Health Policy for February 14
This Week (February 14-18)
The Senate Finance Committee holds a hearing entitled, "Protecting Youth Mental Health: Part II - Identifying and Addressing Barriers to Care."
The House Education and Labor Health, Employment, Labor, and Pensions Subcommittee holds a hearing on "Exploring Pathways to Affordable, Universal Health Coverage."
The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing entitled, "Americans in Need: Responding to the National Mental Health Crisis."
Last Week (February 7-11)
Health Care Highlights
House passes short-term funding bill. On Tuesday (Feb. 8), the House passed by a 272-162 vote a continuing resolution to extend government funding through March 11, which, following expected Senate passage next week, would give Democratic and Republican appropriators more time to forge an agreement on defense and non-defense discretionary spending levels and policy riders and complete an omnibus appropriations bill for the rest of the fiscal year. The stop-gap measure would extend several health-related authorities through March 11:
Finance announces next steps on mental health. This week, Senate Finance Committee Chair Ron Wyden (D-OR) outlined the committee's next steps as it continues to work to address the shortfalls in America's mental health care system. The announcement was made during a hearing with U.S. Surgeon General Dr. Vivek Murthy on youth mental health care. "With today's hearing, the Finance Committee is ramping up our legislative efforts as a group. Several of our members have graciously agreed to partner on specific policy challenges, one Democrat and one Republican. The goal is to produce a bipartisan bill this summer that brings together all that work," Wyden said. The co-chairs, listed below, will work together and with committee staff on a bipartisan basis to identify legislative steps to improve the mental health care system:
Action on telehealth expansion. A bipartisan, bicameral group of lawmakers called unsuccessfully for the permanent extension of expanded coverage of telehealth services to be included in the stopgap legislation passed earlier this week. "Throughout this pandemic we have seen how telecommunications systems can help triage and assess ill patients remotely," and reduce exposure to Covid-19 "for our most vulnerable," the 44 lawmakers including Sen. Marsha Blackburn (R-Tenn.) and Brian Schatz (D-HI) said in a letter to congressional leaders. The letter was sent the same day Sens. Catherine Cortez Masto (D-NM) and Todd Young (R-IN) introduced a bipartisan bill to extend Medicare telehealth flexibilities for two years. According to a press announcement, "The Telehealth Extension and Evaluation Act would allow Centers for Medicare and Medicaid Services (CMS) to extend Medicare payments for a broad range of telehealth services, including for substance abuse treatment, for an additional two years. The bill would also commission a study on the impact of the pandemic telehealth flexibilities extended in this bill in order to better inform Congress' work to make telehealth flexibilities permanent." The bill is similar to a bipartisan bill proposed by Ways and Means Committee leaders last year, the Telehealth Extension Act, which would also extend COVID-19 emergency telehealth waivers for another two years while making permanent other provisions such as ending geographic and site restrictions on where patients can receive approved telehealth services.
Democrats seeks action on drug pricing. This week, President Biden called on lawmakers to pass his plan to lower prescription drugs prices, saying he's seeking to cut down surging costs faced by families at a time when inflation is spiking. "Bringing down the cost of healthcare, bringing down the cost of prescription drugs is an easy thing for us to do," Biden said. "It can be done legally with the stroke of a pen." Meanwhile, Senate Budget Chairman Bernie Sanders (I-VT) and Sen. Amy Klobuchar (D-MN) are pushing leaders to quickly move a standalone measure to cut drug prices, an effort that would require 60 votes to pass in the evenly divided chamber. Though Manchin has said he supports efforts to reduce drug prices, Democrats in both the House and Senate balked at major drug price controls last year, and Republican Senators are vehemently opposed to provisions in the stalled Build Back Better (BBB) bill. The provisions contained in BBB seeks to lower prescription medication costs by allowing the federal government to negotiate the price of certain high-cost drugs, requiring rebates for drugs whose prices increase more than inflation, and capping out-of-pocket spending for some Medicare enrollees while also limiting insulin costs.
CDC studies guidance for easing mask rules. Centers for Disease Control and Prevention (CDC) experts are developing guidance to help states ease COVID-19 rules for mask-wearing, even as U.S. health officials said it's still premature to dispense of the measures, as some governors are doing. "We are working on that guidance," CDC Director Rochelle Walensky said in a White House press call, cautioning that: "our hospitalizations are still high, our death rates are still high. So as we work towards that, and as we are encouraged by the current trends, we are not there yet." A number of Democratic states this week announced plans to lift or ease mask mandates in at least some settings. These states included Connecticut, New Jersey and Massachusetts, which are lifting mask mandates in schools. Some states are opting for a phased approach as the wave driven by the omicron coronavirus variant subsides.
FDA issues draft guidance on development of non-opioid pain relievers. On Wednesday (Feb. 9), the U.S. Food and Drug Administration (FDA) announced new steps aimed at fostering the development of non-addictive alternatives to opioids to manage acute pain and decreasing exposure to opioids and preventing new addiction. The agency issued draft guidance to provide recommendations to companies developing non-opioid analgesics for acute pain lasting up to 30 days, typically in response to some form of tissue injury, such as trauma or surgery. he The proposed changes, which would be the first update to the guidance since 2016, highlight the risks of opioids and wouldn't apply to some patients. "Opioid misuse and abuse remain a serious public health crisis facing the country. Preventing new addiction through fostering the development of novel non-opioid analgesics is an important priority for the FDA," said Patrizia Cavazzoni, M.D., director of the FDA's Center for Drug Evaluation and Research. "The guidance reinforces the agency's commitment to confront opioid misuse, abuse and addiction by taking steps to help those with acute pain get access to improved non-opioid treatment alternatives."
HELP Subcommittee Hearing on the Health Care Workforce Shortage.On Thursday (Feb. 10), the Health, Education, Labor and Pensions (HELP) Subcommittee on Employment and Workplace Safety held a hearing entitled, "Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage." The committee and witnesses discussed the health care workforce shortage and opportunities to alleviate them now and, in the future, in addition to opportunities to build a diverse pipeline of next generation providers. Dr. Margaret Flinter from theNational Nurse Practitioner Residency and Fellowship Training Consortium said nurse practitioners (NPs) are the next generation of primary care providers, but that we must provide them with adequate training to effectively serve in this way. She and others also spoke about the importance of health care providers working to the fullest extent of their license and ways to eliminate "double work," such as through e-consults and prioritization of specialty visits for those who truly need them. Dr. Reynold Verret, President of Xavier University of Louisiana spoke about the need to reach potential medical professionals early on in life through STEM and other outreach programs, and how high-quality faculty and quality facilities can enable them with the support they need to succeed. Others discussed how government loan forgiveness programs can help to bring health care professionals into underserved areas, and that in many times that is where they will continue to practice, something they called "imprinting." On a somewhat different note, Subcommittee Ranking Member Mike Braun (R-IN) spoke about the lack of transparency and choice in the U.S. health care system and said they need better ideas, not just more money to throw at the problem. Rachel Greszler from The Heritage Foundation agreed that money is not the answer and said that they should focus on removing barriers that are exacerbating the workforce shortage such as vaccine mandates and other burdensome regulations, which Sen. Braun also expressed concern over, and noted that states are ultimately the "keepers" of who can practice.
Energy and Commerce Subcommittee Hearing on ARPA-H Proposal. On Tuesday (Feb. 8), the House Energy and Commerce Subcommittee on Health held a hearing entitled, "ARPA-H: The Next Frontier of Biomedical Research." The Advanced Research Projects Agency for Health (ARPA-H) is an initiative proposed by President Joe Biden to utilize the Defense Advanced Research Projects Agency (DARPA) as a model to foster faster development of novel treatments, diagnostics, cures, and preventive measures to improve health. Subcommittee Chair Anna Eshoo (D-CA) stated that she would work with Reps. Diana DeGette (D-CO) and Fred Upton (R-MI), authors of the broader health care delivery legislation, the Cures 2.0 Act (H.R. 6000) to advance both that bill and her bill authorizing ARPA-H (H.R 5585) through the committee markup process in the near future. DeGette, Eshoo, and Upton issued a press release after the hearing outlining their agreement. During the hearing, witnesses presented perspectives from medical research, health care delivery, patient advocacy and DARPA. There were no witnesses representing the administration following the Feb. 7 resignation of White House Office of Science and Technology Policy Director Eric Lander, PhD, after White House investigations revealed Lander's history of bullying subordinates. A main point of discussion during the hearing was whether to house ARPA-H within the National Institutes of Health (NIH), as the president proposed, or as a new independent entity, as proposed in the ARPA-H Act.
Reports, Studies, and Journals
Medicaid and CHIP Payment and Access Commission: Access in Brief: Experiences in Accessing Medical Care by Race and Ethnicity. Researchers found that although the majority of Medicaid and CHIP beneficiaries across all races and ethnicities have had health insurance coverage for the past 12 months and have high rates of having a usual source of care, there were disparities in many key measures of access. In addition, these disparities vary among racial and ethnic groups.
Health Services Research: Paying patients to use lower-priced providers. Researchers found that the introduction of financial incentives to reward patients for receiving care from lower-priced providers is associated with modest price reductions, and savings are concentrated among MRI services.
Centers for Disease Control and Prevention: Demographic Variation in Health Insurance Coverage: United States, 2020. In 2020, 31.6 million (9.7%) people of all ages were uninsured at the time of the interview. Among people under age 65, about two in five children and one in five adults were covered by public health coverage, mainly by Medicaid and the Children's Health Insurance Program (CHIP).
Peterson-KFF Health System Tracker: Outpatient telehealth use soared early in the COVID-19 pandemic but has since receded. This brief assesses telehealth use from March 2019 through August 2021 using data from Cosmos, a HIPAA-defined Limited Data Set of more than 126 million patients from over 156 Epic organizations, including 889 hospitals and 19,420 clinics across all 50 states. In particular, this brief examines the share of outpatient visits taking place through telehealth.