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January 21, 2019  |  Policy Update

Addiction Policy Update January 2019

BUDGET AND APPROPRIATIONS

FY19 Appropriations

The partial government shutdown, now in its record-setting 28th day, is likely to drag into next week.

On Thursday, the House passed a bill that would reopen the nine shuttered federal departments through February 28 by voice vote, although passage was later voided because Republicans said they were denied the recorded vote they sought, and House Majority Leader Steny Hoyer (D-MD) agreed to hold a roll call vote on the measure next Wednesday instead. This vote follows a failed House vote on Tuesday on a continuing resolution (CR) to reopen closed portions of the government through February 1. The House also passed a disaster aid package this week that included a CR funding the government through February 8 by a 237-187 vote. These pieces of legislation join the other House-passed spending bills Senate Majority Leader Mitch McConnell (R-KY) has vowed the Senate will not take up until he gets assurances of President Trump’s support. As you know, Trump refuses to sign any funding measures that don’t include at least $5 billion for the border wall.

Some Republican senators have pushed back on President Trump’s insistence on border wall funds, saying he should end the shutdown with a three-week stopgap measure before beginning negotiations over a border security and immigration package. Senator Lamar Alexander (R-TN) made a pitch earlier this week calling for a short-term CR and a markup to negotiate a compromise immigration package. Several other Republicans joined a meeting on Monday to discuss the shutdown, but it is unclear how many would sign a letter to formally push back on the president. In addition, this week seven moderate House Democrats in the Problem Solvers Caucus met with Trump on Wednesday to discuss the shutdown, but they also urged him to end the shutdown before seeking a broader agreement on border security.

In addition, in an attempt by House Democrats to keep the pressure on Republicans next week, on Thursday House Appropriations Committee Chairwoman Nita Lowey (D-NY) released legislation to reopen and fund most federal agencies through September 30 that reflects bipartisan House-Senate conference agreements negotiated by Republican and Democratic appropriators in both chambers last year. The explanatory statement is available here and a section-by-section summary here.  The move isn’t likely to end the shutdown, and the House plans to vote on the six-bill spending package next week, putting Republicans in an uncomfortable position by daring them to vote against bills they themselves drafted. The measures would provide appropriations for all unfunded agencies except the Department of Homeland Security and does not include border wall funds. As with the previous bills voted on by the House, the bills are expected to be dead on arrival in the Senate.

Both chambers are planning to stay in session for a holiday-shortened week, instead of taking a previously-scheduled recess, but Democrats, Republicans and the White House remain at odds over a solution to the partial government shutdown.

 

HEALTH POLICY LEGISLATION

 

Drug Pricing

Department of Health and Human Services (HHS) Secretary Azar is making the rounds on Capitol Hill to discuss drug pricing.  Azar’s meetings come as key House and Senate Committees are prioritizing drug prices as a top issue for the new congress.  According to press reports, Azar has met thus far with Senate Finance Committee Chair Grassley (R-IA), Senate Health, Education, Labor and Pensions (HELP) Committee Chair Alexander (R-TN), House Oversight and Reform Chair Cummings (D-MD) and Sen. Burr (R-NC).  He plans to meet with Senate Finance Committee Ranking Member Wyden (D-OR), Senate HELP Ranking Member Murray (D-WA), and Ways and Means Committee Chair Neal (D-MA) later this month.

 

Following their meeting on Tuesday, Cummings told reporters that the meeting was a “good start” and said, “I think he, like I, wants to get something done” and added, “Hopefully we can put any kind of party label to the side and do something that both the Trump administration and Democrats promised to do.”

 

On Monday, Cummings sent a letter to twelve pharmaceutical manufacturers asking for information about their pricing practices. In a press release, the Oversight Committee said they are focusing on drugs “that are among the costliest to Medicare Part D, among the costliest per beneficiary, or had the largest price increases over a five-year period.”

 

Medicaid

Last night, the Senate passed by voice vote HR 259, legislation to extend two Medicaid policies related to home and community-based services.  The bill, which previously passed the House on January 8 by voice vote, now heads to the President’s desk for his signature.

 

UPCOMING HEARINGS

The following upcoming health care hearings of note have been noticed as of press time:

 

TRUMP ADMINISTRATION

 

Naloxone

Yesterday, the Food and Drug Administration (FDA) announced that it developed a consumer-friendly Drug Facts Label that drug companies can use when they apply to sell naloxone as an over-the-counter (OTC) product.  FDA said it took the step in the hopes of encouraging drug companies to enter the OTC naloxone market.  In a statement, FDA Commissioner Gottlieb said that, “Having naloxone widely available, for example as an approved OTC product, is an important public health advance, and a need that we’ve been working on at the FDA.”

 

Health Insurance Marketplace Rules

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule for plans sold on the health insurance exchanges for the 2020 benefit year.  Some of the provisions in the rule address:

 

The rule, a fact sheet and other materials are available here.  Comments are due February 19.

 

MedPAC Meeting

On Thursday, the Medicare Payment Advisory Commission (MedPAC) met and voted on 2020 payment recommendations for service providers. Briefs and presentations from the meeting are available here.

 

Some of the recommendations to Congress approved by the MedPAC commissioners included:

 

116TH CONGRESS

 

Committee Membership

 

Several announcements were made this week regarding Subcommittee leadership and membership.

 

Energy and Commerce and Ways and Means

Of particular note, Rep. Eshoo (D-CA) will be leading the House Energy and Commerce Health Subcommittee, Rep. DeGette (D-CO) will be leading the Energy and Commerce Oversight Subcommittee and Rep. Doggett (D-TX) will be leading the Ways and Means Committee Health Subcommittee.

 

While Eshoo is known for having a friendlier position to pharmaceutical manufacturers than some of her colleagues, including incoming Ways and Means Health Subcommittee Chair Doggett, who has been aggressive on drug pricing issues, as noted above, drug pricing is expected to be a top agenda item at the Energy and Commerce Committee. DeGette, whose subcommittee has subpoena power, said at an event this week that “The top thing we want to do in the Democratic Congress, with the new majority, is to look at making health care more accessible and more affordable for more Americans” and promised aggressive oversight.  DeGette co-chairs the Congressional Diabetes Caucus and part of her drug pricing focus may be on insulin costs.

 

In addition to drug pricing, Energy and Commerce leadership is also prioritizing oversight over implementation of the Affordable Care Act (ACA).  As we reported previously, the first three hearings at the Committee will be on ACA implementation, climate change and the separation of migrant children from their parents at the border.

 

Members of the Energy and Commerce Health and Oversight Subcommittees will include:

 

Energy and Commerce Subcommittee on Health

 

 

Energy and Commerce Subcommittee on Oversight and Investigations

 

 

Member of the Ways and Means Health and Oversight Subcommittees will include:

 

Ways and Means Health Subcommittee

 

 

Ways and Means Oversight Subcommittee

 

 

House Republicans announced three new members of the House Ways and Means Committee this week.  The new members include Reps. Ferguson (R-GA), Arrington (R-TX) and Estes (R-KS).

 

House Appropriations Committee

The House Appropriations Committee this week announced its Democratic subcommittee rosters for the 116th Congress. A list of all Democratic subcommittee assignments is attached.  Reps. Lois Frankel (D-FL), Cheri Bustos (D-IL) and Bonnie Watson Coleman (D-NJ) have been added to the Labor HHS Subcommittee.

 

Also this week, House Appropriations Committee Ranking Member Kay Granger (R-TX) announced the Members of the House who will serve as Ranking Members of the Appropriations Committee’s various subcommittees for the 116th Congress after they had been recommended by the House Republican Steering Committee. Granger also appointed Congressman Tom Cole (R-OK) to serve as Vice Ranking Member of the Committee. He will also remain the top Republican on the Labor HHS Subcommittee.

 

Senate Appropriations Committee

The Appropriations Committee announced subcommittee assignments this week.  Members of the Labor-HHS Appropriations Committee will include:

 

 

 

COURTS

 

Disproportionate Share Hospital Court Case

On Tuesday, the US Supreme Court heard Azar v. Allina Health Services.  The case seeks to overturn a 2014 HHS policy altering the instructions regarding how to calculate payments to hospitals issued to insurers hired to process claims for CMS to DSH hospitals.  After years of litigation, in 2017 the DC Court of Appeals ruled the government erred by not issuing notice and comment. The heart of the case is whether the CMS rule was a substantive rule which would require notice and comment, or an interpretive rule which does not require notice and comment. In other words, is the rule in question binding.  Attorneys from both parties argued to that point with the seven justices present.  The case rests upon the “notice and comment” requirements under Medicare statutes which require the federal government to seek notice and comment from affected parties proposed changes to the Medicare DSH formula.  The DSH formula could affect as much of $4 billion in DSH payments made between 2005 and 2013.  Note, Justice Kavanaugh has recused himself due to his participation in earlier rulings at the DC Court of Appeals, and Justice Ginsberg was away for health reasons, though she may still rule on the case.

 

 

 

 

This Policy Update was generously provided by Holly Strain & Carol McDaid of Capitol Decisions

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