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International Crisis and Washington in Limbo

Good morning from Washington DC where the leaves are beginning to signal the change of the season while much remains the same in the House of Representatives. Last night your author took his seven-year-old son and four-year-old daughter to “Boo at the Zoo” held at Smithsonian’s National Zoo.  The logjam and chaos ensued when trying to enter the zoo by car and get to a parking lot. While sitting in the car for minutes on end, I could only think of the current legislative purgatory in which we find ourselves. My mind also wondered to football where my underdog New York Giants defeated the Washington Commanders – reminding me that anything is possible. With those two thoughts converging, we remain hopeful that at some point the House will find its way to its parking lot and spike its metaphorical football to elect a new Speaker. We currently stand at nine candidates for Speaker of the House – which begs the question – can you too be Speaker?  Welcome to the Week Ahead!

The Administration

Last week, President Biden made the case for the United States supporting Israel following the attacks by Hamas. The President is also making the case for a funding package to include aid to Israel and Ukraine, while also giving a nod to Republicans by including funding for border security. Behind the scenes the administration is continuing to work to provide humanitarian aid to Gaza and on hostage negotiations.  The President is already facing Senate opposition to his grouping of aid to Israel and Ukraine together, as Republican Senator JD Vance (Ohio) is circulating a letter to colleagues outlining the differences in our nation’s approach to Israel versus Ukraine.  Minority Leader McConnell (R-Kentucky) has already signaled he is ok with linking aid to both Israel and Ukraine.

On the health care front, Secretary of Health and Human Services Becerra continues to speak about the importance of the Inflation Reduction Act on reducing health care costs. This Thursday he will speak at the National Press Club regarding his agenda of reducing health care costs and eliminating health disparities among other topics.  Later today the President will hold an event on Bidenomics. With government funding ending on November 17, the President must figure out a way to lean in on Congress in the coming weeks.

The Senate

The Senate returns to legislative business on Tuesday of this week.  The upper chamber plans to take up President Biden’s nominee for the Federal Aviation Administration on Tuesday. Additionally, Senators will resume discussions on the previously pending three-bill minibus which includes the fiscal year 2024 appropriations bills for Agriculture-FDA, Transportation-HUD, and Military Construction-VA.  On Wednesday, the Senate Health, Education, Labor, and Pensions Committee will hold an Executive Session on nominations to include Monica Bertagnolli to be Director of the National Institutes of Health.  On Thursday, the Senate Special Committee on Aging will hold a hearing entitled, “Unlocking Hope: Access to Therapies for People with Rare, Progressive, and Serious Diseases.” This Friday, the Senate HELP Committee will conduct a field hearing in New Jersey entitled, “Overworked and Undervalued: Is the Severe Hospital Staffing Crisis Endangering the Well-Being of Patients and Nurses?”

The House

The drama continues in the House where the Republicans find themselves leaderless after Congressman Matt Gaetz (R-FL) called for the motion to vacate several weeks ago. The House Republicans cannot secure 217 votes to move on with the House’s business. Both Steve Scalise (R-LA) and Jim Jordan (R-OH) that have been nominated over the past two weeks and both their campaigns were unsuccessful. Jim Jordan had three votes on the house floor and Steve Scalise never made it to the floor, as each vote accumulated MORE opposition to his candidacy.  The other solution to move on with the House’s business was to nominate Congressman Patrick McHenry (R-NC) to be the Speaker Pro-Tem to continue legislative business till the end of the year. That solution was quickly voted down in Conference.

As previously mentioned, we currently have NINE nominations for Speaker of the House. Most notably the current WHIP Tom Emmer (R-MN), Byron Donalds (R-FL), former NRCC Chairman Pete Sessions (R-TX), Mike Johnson (R-LA), and Kevin Hern (R-OK). Based off reports and our intel, it currently seems unlikely that any of these members will get to the voting threshold of 217. Rep. Emmer has a great infrastructure already established for getting votes and appears to be the current frontrunner. However, he faces opposition from former President Trump as Rep. Emmer has bucked Trump in the past. It will be interesting to see how the internal politics plays out this week. The conference will meet today and begin voting on a Speaker tomorrow. The lowest vote getters in each round get bumped off, well because – they are the weakest link.

As the country waits for the Republican Conference to find a Speaker, we have less than 30 days to fund the government, a foreign affairs package to aid Ukraine and Israel, and other legislative priorities for the remainder of the year. Time waits for no one – and House Republicans need to move quickly. Senate Republicans are also weighing into the matter, recognizing the standstill is not beneficial to the Republican Party for the 2024 elections or movement on any of the important issues which currently stand before Congress.

This week the House Energy and Commerce Subcommittee on Health will host a hearing on the long-term care workforce this Wednesday.  The hearing is entitled, “Supporting Access to Long-Term Services and Supports: An Examination of the Impacts of Proposed Regulations on Workforce and Access to Care.”  The subcommittee wants to focus on how proposed regulations on the health care workforce, to include the Biden administrations proposed rule on nursing home ratios, could affect access to care.

Create a great week!

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What Happened, What You Missed: October 16-20, 2023

KFF Survey: Family Premiums in Employer Plans Up 7%

The average annual family premium for employer-sponsored coverage jumped 7% this year to reach nearly $24,000, according to the annual Employer Health Benefits Survey from the Kaiser Family Foundation (KFF).  The largely inflation-driven increase comes after a few years where family premiums for employer-sponsored plans generally remained stagnant.  While employers saw their share of the premium grow by a similar percentage, most employers are unlikely to shift growing premiums on to employees as the labor market remains tight.  However, 25% of employers reported in the survey that they are likely to increase employees’ premium contributions in the next 2 years.

HELP Committee to Vote on NIH Director Nomination on Oct. 25

The Senate Health, Education, Labor, and Pensions (HELP) Committee has scheduled an October 25 vote on Dr. Monica Bertagnolli’s nomination to lead the National Institutes of Health (NIH), which has been without a permanent director since December 2021.  The committee vote follows an October 18 nomination hearing during which Bertagnolli faced questions about prescription drug prices and gender-affirming care.  While Bertagnolli affirmed a commitment to making drugs more accessible, she declined to take a position on march-in rights that give the federal government the authority to take over a patent for a drugs it helped developed in order to lower drug costs.  Bertagnolli also expressed a commitment to improving the diversity of clinical trials and research staff.

New Study Links Low Serotonin to Long COVID

Lower levels of the neurotransmitter serotonin could be a contributing factor in the development and persistence of long COVID, according to a new study.  While estimates on the percentage of people affected by long COVID vary wildly, common symptoms include memory problems, fatigue, and headaches.  The study suggests that traces of COVID-19 remain in the gastrointestinal tract, where the majority of serotonin is produced.  The presence of COVID-19 could cause inflammation that depletes serotonin levels, which play an important role in mood and sleep regulation as well as transferring messages between brain cells and the rest of the body.  Researchers conducted the study by analyzing blood and stool samples from various clinical studies and in small animal models.

Insurers Call for Changes to Administration’s Mental Health Parity Rules

Organizations representing commercial health insurers say proposed rulemaking from the Biden administration to improve mental health parity could have unintended consequences that would limit access to care.  Released in September, the proposed rule would require plans to more closely evaluate their provider networks to ensure plan enrollees don’t face burdensome costs for out-of-network services, as well as would require a reevaluation of prior authorization protocols. However, stakeholders like the Blue Cross Blue Shield Association (BCBSA) argue that the proposed requirements could increase care that is not clinically recommended and limit a patient’s ability to choose care that best meets their needs.  The insurers’ concerns contrast with positive feedback from provider organizations and mental health advocacy groups.  As alternatives, BCBSA and America’s Health Insurance Plans (AHIP) are urging the administration to focus on workforce issues and licensure.

ICYMI: Senators Launch Bipartisan Mental Health Caucus

On Tuesday, a group of bipartisan senators launched the Senate Mental Health Caucus, which will focus on collaborating on mental health solutions, holding events to boost awareness of mental health issues, and reducing stigma.  During a press conference and subsequent reception to kick off, Sen. Tom Tillis (R-NC) spoke about how his experiences with mania and depression while he was on medication 16 years ago inspired him to work on mental health issues.  Similarly, Sen. John Fetterman (D-PA) discussed how his children became aware of his depression and his obligation to continue the conversation on mental health struggles.

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Political Gridlock, International Tensions, and NFL Upsets

Good Morning and welcome from Washington D.C. where Congress adverted shutdown several weeks ago and is still in gridlock like D.C. traffic on the beltway.  Tension continues to rise from the horrific attacks on Israeli citizens more than a week ago. The Republican House still has not elected a Speaker and has had as many candidates fail. Where the Cleveland Browns were triumphant against the 49ers in the biggest upset of the NFL season and the Washington Commanders skated by the lowly Atlanta Falcons. Both houses are back to business this week… Welcome to the week ahead!

The Administration

The Biden Administration is currently working to show support for events in Israel, while also looking to tie funding for Ukraine and Israel together to capitalize on bipartisan support for Israel. In the healthcare realm, the administration continues to move forward on Tuesday in light of congressional stagnation. Secretary of Health and Human Services Xavier Becerra will be featured on a webinar hosted by The Washington Post focused on the next generation of challenges and innovations in health care. Additionally that day, Centers for Medicare and Medicaid Services Administrator Brooks LaSure will host the Quarterly CMS stakeholder call.

The Senate

The upper chamber returns to business this week with an eye on approving nominations.  The Senate will look to move the Jack Lew nomination as Ambassador to Israel amid the Israel-Hamas conflict. Additionally, on Wednesday the Senate HELP Committee will look to hold a hearing for Monica Bertagnolli to serve as Director of the National Institutes of Health.  Also on Wednesday the Senate Budget Committee will hold a hearing on lowering health care costs.  Finally, the Senate Finance Committee will hold a hearing on MA enrollment entitled, “Medicare Advantage Annual Enrollment: Cracking Down on Deceptive Practices and Improving Senior Experiences.”

House

Last week was dramatic as the Republican Conference still cannot get to 217 votes to elect a new Speaker after Kevin McCarthy (R-CA)  was forced to vacate the Chair. Lots of people continue to run for Speaker but have been unsuccessful in their bids. Last Wednesday, Steve Scalise (R-LA) won the nomination on a slim vote (110-99 with additional help from 3 delegates who cannot vote on the floor), but could not get enough Republican support to get the votes on the House Floor to confirm his Speakership.

Jim Jordan who ran against him initially (and actually backed him) was drafted to run again. Austin Scott (R-GA) had a brief run and it really never got out of the starting gate. Currently Jim Jordan (R-OH) is the only person in the race but is 40 plus votes shy to get nominated. Presiding Speaker McHenry has no power to move any legislation so the House of Representatives is at a legislative standstill. A group of six moderate Democrats said they would support a McHenry bid if he wanted it, but McHenry (as of now) does not have any interest of taking the gavel.

There are a little more than 30 days till the government runs out of funding. There is no one to negotiate a deal for the Republican controlled house for a CR because there is no leadership in the House. This has caused a legislative stoppage of all House Committees and no key legislation is going to move forward until the Republicans decide who is going to be Speaker of the House. Additionally, there are several pressing issues that are facing Congress besides government funding like aid packages to Israel and Ukraine. Hopefully, the House decides on who their next Speaker will be so they can fund the government and work on the aid packages to the biggest hot spots in the world right now.

Committee work resumes in the House despite the Speaker voting drama. On Thursday, October 19 the Energy and Commerce Subcommittee on Health host a hearing entitled, “What’s the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors.”

Create a great week!

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What Happened, What You Missed: October 9-13, 2023

Sanders, AHA Disagree over Charity Care Standards

According to a new report by Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Bernie Sanders, most non-profit hospitals don’t provide enough charity care to justify their tax-exempt status.  To rectify this, Sanders’ report recommends tying tax exemption to a certain level of charity care, setting better standards for financial assistance, and defining the community engagement that non-profit hospitals are required to partake in.  In a separate report released this week, the American Hospital Association (AHA) disputed Sanders’ findings by pointing out that non-profit hospitals provided more than $129 billion in total benefits to their communities in 2020.  According to AHA CEO Rick Pollack, these benefits include housing assistance, financial aid, and patient education.

Walgreens’ Pharmacy Staff Go On 3-Day Strike

Several hundred pharmacists and pharmacy staff employed by Walgreens went on strike for 3 days this week to protest poor working conditions.  The strike follows recent walkouts at fellow pharmacy CVS and health care provider Kaiser Permanente.   According to staff, the strike is a response to increasing pressure from management to hit quotas for vaccinations, prescriptions filled, and testing, as well as bullying and harassment from customers.  To improve working conditions, staff are asking for dedicated training time for new staff, changes to the quota system, and more transparency in hour staff hours are set.  1 day after the strike ended, Walgreens announced plans to close 60 clinics and exit 5 markets as part of a $1 billion cost-cutting program.

CDC: Long COVID Rare in Children

Long COVID is rare among children, according to new survey data from the Centers for Disease Control and Prevention (CDC).  The survey found 1.3% of children had long COVID in 2022 and 0.5% currently have it in 2023.  The survey defined long COVID as post-viral symptoms lasting more than 3 months.  While long COVID can include a multitude of conditions, the most common are fatigue, shortness of breath, and chronic pain.  The survey data comes as public health experts and educators continue to debate whether school closures and other non-pharmaceutical interventions intended to limit children’s exposure to COVID-19 were justified.

FDA Launches New Committee on Digital Health, AI

The Food and Drug Administration (FDA) launched a new Digital Health Advisory Committee that will be tasked with advising the agency’s leaders on the risk, benefits, and possible outcomes of emerging technologies.  Possible subjects of exploration for the committee include artificial intelligence (AI) virtual reality, digital therapeutics, wearables, and remote patient monitoring.  The committee’s announcement comes as FDA’s regulatory activities have grown to include AI-enabled medical devices, clinical decision support software, and genomic data.  The committee, which is slated to have 9 members, is expected to be operational sometime next year.

ICYMI: Tours Aim to Show to the Scary Side of Washington

A pair of tours hope to give patrons a sense of the paranormal side of Congress and Capitol Hill.  National Nightmares’ Hill of Haunts walking tours on Fridays and Saturdays in October will immerse participants in the ghost stories and hauntings of the Capitol, the Library of Congress, and congressional office buildings.  Just a few miles away at the Congressional Cemetery, Soul Strolls provides visitors with a haunting recap of the cemetery’s more famous residents, complete with portrayals from local actors.

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House Speaker Race Intensifies Amidst Global Turmoil

Good morning from a frazzled Washington, DC following a three-day weekend where not much has changed – but everything has at the same time.  Much like my six-year-old son in his almost empty jiujitsu class last night due to the holiday, the House is the only game in town.  Just as my son has previously struggled to nail certain moves, we have all seen the House struggle to function in the best of times. The Senate is out until next week, and all eyes remain on the race for the next House Speaker. This week we get into a quick overview of the candidates and where the House is in the process.  Of course, the politics of the House are taking on new urgency as Hamas militants attacked Israel leaving hundreds dead and many (including US citizens) taken as hostages.  Bipartisan calls for assistance to Israel are underway, complicating political stances on foreign affairs issues for members of both parties.

Speaker’s Race

The Speaker’s race has come down to two candidates. Jim Jordan (R-OH) and Majority Leader Steve Scalise (R-LA). Today, Republican House members will meet in conference. Both candidates will make a case to the Republicans on why they should lead the party (and the House) into the remaining of the year.  On Wednesday, the House is expected to vote for a new Speaker, but will Republicans have agreed on their leader? Here we run down the ins and outs of the candidates for the Speakership.

Jim Jordan (R-0H)

Jim Jordan is an ultra-conservative right leaning candidate. He can garner solid support from the House Freedom Caucus and other conservative members. Jordan has the backing of many conservatives as well as former President Trump. He is in the inner circle of former Speaker McCarthy.  If the former Speaker decides to put his weight behind the Jordan candidacy, it will ensure him the necessary votes to put him over the edge. Currently, it is believed that Jim Jordan will have to do a lot of back-room dealings to keep the rank and file happy, and he would have to make deals to keep the status quo while trying to unite the Conference.

Steve Scalise (R-LA)

Steve Scalise is the current Majority Leader in the House. He is known for his fundraising abilities, and he is the former Republican Study Conference (RSC) Chairman who took out a rank-and-file member Peter Roskam back in 2014. He was quietly working behind the scenes for the Speakership until former Speaker McCarthy decided to resign. He has a lot of support amongst the rank and file, but he will have a difficult time delivering the Freedom Caucus as they view him a continuation of McCarthy’s leadership. Also, Leader Scalise is recovering from cancer and his health remains a concern for some members.

Patrick McHenry (R-NC)

There are several rank and file and former McCarthy loyalists calling for the drafting of McHenry for Speaker because of his leadership as the presiding Chair. This would be a difficult climb with the Freedom Caucus as they view him as a continuation of the McCarthy era. Even though several of the Freedom Caucus members are impressed with his leadership abilities.

Kevin McCarthy (R-CA)

Kevin McCarthy (you are reading this correctly) there is a long shot bid that McCarthy could become Speaker once again. Since the attack on Israel this past weekend, many are wanting him to put his hat in the ring because of his leadership abilities and help guide the conference through a very difficult time with the current pressing foreign policy issues.  Additionally, many in the Republican Caucus are unsure if Scalise or Jordan can get to 217 votes. McCarthy stated he would return to the role if that were the will of the party.

Senators and former Speaker Kevin McCarthy were on the Sunday talk shows highlighting the need for the House to come together and select a Speaker considering current world events. Hopefully, the resolve will come by Wednesday where they are expected to vote on a new Speaker.

The Administration

President Biden will make remarks later this afternoon on the attacks on Israel.  The Hamas attack has upended much of the President’s political calculus on other issues. Bipartisan lawmakers are urging the Biden administration to pursue a joint aid package for Israel and Ukraine that would capitalize on bipartisan support for the Jewish state.  Such efforts could overcome opposition from some Republicans on continued funding for Ukraine.

On the health front, the Centers for Medicare and Medicaid Services (CMS) will host its Quarterly National Stakeholder with Administrator Brooks LaSure to discuss implementation of CMS’ Strategic National Plan.  Interested parties can register here.

Create a great day!

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