The Weekly Update 9/18/2023


Good morning from Washington where in September there’s nothing like wearing long sleeves, jackets, and pants in the morning just to wear t-shirts and shorts after 1pm. The up and down weather is indicative of the topsy turvy nature of the current state of play of government funding. To demonstrate their ability to strengthen their hand in budget negotiations with the White House and the Senate, we reported last night that House Republicans are looking to vote on a short-term spending plan with little chance of passing the Senate – and now is facing an uphill battle in the House. In other news, President Biden authorized the Department of Homeland Security and FEMA to coordinate the disaster relief and assistance for communities impacted by the Lee aftermath which continued to knock out power and cause havoc this past weekend. In sports, week 2 of the NFL is almost complete with the New York football Giants making a fantastic comeback to redeem themselves from their embarrassing loss last week. Can Congress comeback from the literal and figurative deficit which they find themselves in – or is a shutdown a foregone conclusion?  Welcome to the Week Ahead!!

The Administration

President Biden is also facing a tough September with Republicans getting the go ahead to begin an impeachment inquiry, as well as the Auto Workers strike which President Biden thought would not happen. Biden continues to work to improve access in a variety of facets in healthcare – this time focusing on mental health parity. HHS issued proposed regulations focusing on addressing gaps in coverage of mental health by insurance companies compared to that of other care. The administration hopes the proposed regulations will make insurance companies comply with providing mental health coverage and is ready to impose hefty fines for those insurers who fail to comply. Insurers believe a lack of qualified mental health professionals is a key problem. The regulations are open to comment until October 2.

The Senate

For weeks we’ve spoken about the exemplary bipartisanship in the Senate as it relates to the appropriations process. Well, it appears that the smooth sailing has hit a rough patch. Senator Ron Johnson (R-Wis) is currently blocking a bipartisan amendment package relating to the $280 billion minibus (the package contains the FY2024 MilCon-VA, Agriculture-FDA, Transportation-HUD appropriations). The senator believes the bill should be voted on its individual components as opposed to one larger package. Majority Leader Schumer and Minority Leader McConnell will work to see if the package can come to the floor this week.

The Senate Health, Education, Labor, and Pensions committee will meet in Executive Session on Thursday to consider three bills: the Bipartisan Primary Care and Health Workforce Act, the Preventing Maternal Deaths Reauthorization Act of 2023, and the Gabriella Miller Kids Research Act 2.0.  The Senate Finance Health Care Subcommittee will meet on Tuesday to hold a hearing on “Aging in Place: The Vital Role of Home Health in Access to Care”.  According to staff, the hearing is framed around promoting aging in place through the lens of beneficiaries being able to access the Medicare home health benefit. The discussion will focus on some of the current barriers in Medicare and the relationship with Medicaid HCBS for duals. There will be a discussion on urban/rural differences and the costs to beneficiaries when there are access challenges. The Senate will also continue hearings on the use of artificial intelligence (AI) this week.

The House

House Energy and Commerce Chairwoman Rodgers’ price transparency bill, which we reported last week, is up on the floor tomorrow – but it remains to be seen how much Democrat support it will receive. The Senate will not take it up.

Energy and Commerce has a hearing scheduled Tuesday at 10 am on seniors’ access to innovative drugs and devices and it some PBM bills. Many of the bills are purely messaging and somewhat ironic given their cost and impact to the Medicare Trust Fund. Also Tuesday at 2 pm, is the Member Day hearing, where members will be able to air grievances and try to rally support for their pet projects. Many members on the health subcommittee will focus on cost, access, rural access, generic pricing, and the supply chain challenges of the drug and device ecosystems. Fentanyl proliferation and abuse mitigation will also be hot topics.

Ways and Means is holding a hearing on “Reduced Care for Patients: Fallout from the Flawed Implementation of Surprise Medical Billing Protections” and its impact on patients’ care and pricing. This hearing will be partisan, and the witnesses will have their work cut out for them as Democrats and Republicans will blame each other for the failed implementation and impact on pricing for their constituents.

The government funding (or lack thereof?) is the key piece, with Speaker McCarthy’s future as the usual bit of palace intrigue holding everything else in limbo.

Government Funding

As we reported last night, House Republicans have agreed to put a stopgap spending measure on the floor for this Thursday. However, the votes are currently not there within the Republican conference to get the bill across the finish line. The proposed CR is set to fund the government through the end of October, but it cuts government spending by eight per cent and does not include Hurricane Lee relief funding or funding for Ukraine requested by the President. The CR as it is currently drafted is being opposed by several Freedom Caucus Members and has no chance of passing the Senate. House Democrats will not support the package. With limited time remaining before a government shutdown, Congress continues to have an uphill battle in coming to a palatable CR which both sides will agree to before the funding deadline.

Create a great week!

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