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Find our analysis on legislation, regulations, MedPAC meetings, and more. 

What Happened, What You Missed: October 2-6, 2023

Makers of 10 Drugs Agree to Participate in Medicare Price Negotiations

The manufacturers of all 10 drugs selected for Medicare drug price negotiations have agreed to participate in the program, according to a White House announcement.  The announcement comes as several drugmakers have filed lawsuits against the Biden administration to stop the drug price negotiation program, including one that has already committed to participate in the negotiations.  The administration named its first 10 drugs to participate in the program over a month ago, which includes two diabetes drugs, a blood thinner, and a rheumatoid arthritis treatment.  Initial price offerings on the drugs will be announced on February 1, 2024, although Medicare beneficiaries won’t be able to access drugs with the negotiated prices until 2026.

75K Kaiser Permanente Workers Kick Off Largest Health Care Strike

More than 75,000 unionized employees of Kaiser Permanente, one of the nation’s largest health care providers, started the largest health care strike in US history this week.  Union leaders say they’re hitting the picket lines for outsourcing protections, safe staffing, and better wages to reduce turnover.  The strike comes amid an uptick in organized labor across the country, with unions representing auto workers and actors calling for higher pay.  While Kaiser’s hospitals and emergency departments will stay open during the strike, the company has warned that elective and non-emergency services may be rescheduled.

Moderna’s Combination COVID-Flu Shot Shows Promise

Moderna is moving on to late-stage clinical trials for its combination COVID-19 and influenza vaccine after early-stage trials found the shot to be effective against both viruses.  The combined vaccine has been shown to have a similar safety profile to existing mRNA COVID-19 vaccines, and no new safety concerns have been reported.  The company’s efforts to create a two-in-one COVID-19 and flu shot mirror similar efforts at Pfizer and Novavax.  Health experts say a combination vaccine has many logistical benefits, such as a reduced need for storage space and fewer injections for patients.  Known as mRNA-1083, Moderna’s experimental vaccine could become available to the public in time for the 2025 flu season.

Study: “Good” Cholesterol Linked to Dementia

“Good” cholesterol may not be as good as previously thought, according to a new study.  The researchers found a correlation between high-density lipoprotein (HDL) cholesterol and dementia in older adults, although they did not conclude if high or low levels can directly cause dementia.  The study, which was supported by the National Institutes of Health (NIH), included more than 180,000 California residents who now have an average age of 70 years old.  The average HDL cholesterol level in the study was 53.7 mg/dL, which is within the recommended range of 40 mg/dL in men and 50 mg/dL in women.  People whose cholesterol levels deviated too far from these numbers were more likely to develop dementia, according to the study.  Too much HDL cholesterol in the brain can cause inflammation that causes the production of amyloid plaques, which are attributed to dementia.

ICYMI: Biting Incidents Prompt Ouster of Biden’s Dog

Commander, President Joe Biden and First Lady Jill Biden’s German shepherd, has been removed from the White House following a string of biting incidents involving White House residence staff and Secret Service personnel.  Commander’s departure from DC is similar to Major, the Bidens’ other German shepherd, who was sent to live with family friends in Delaware in 2021 after biting people at the White House.  According to emails published by Judicial Watch, Commander bit several Secret Service agents a total of 10 times.

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MedPAC Discusses How to Reform Medicare Physician Payment

On October 5, 2023, the Medicare Payment Advisory Commission (MedPAC) discussed Medicare physician payment reform. The Commission believed spending growth limits/volume adjustments won’t work and that new methods should be implemented like more payments for quality of care.

The Weekly Update: Congress’s Last-Minute Save

Good morning and welcome from Washington, DC where Congress averted a government shutdown just in time for government employees to return to work today (and actually get paid for it).  Only in Washington can you meet the minimum standards of your basic job and somehow attempt to take credit for it. In other developments, today former President Trump begins his civil trial in New York for fraud as a judge last week determined he is liable for inflating the value of his properties to secure and obtain business loans.  You know what is not overinflated? The 400% increase in jersey sales for the Kansas City Chiefs tight end, Travis Kelce, since Taylor Swift appeared at Arrowhead Stadium a little over a week ago.  Last night Swiftie was in the Meadowlands as the Chiefs beat the Jets and all remained well in the football world. Other celebs filled the owner’s box to include Ryan Reynolds and Blake Lively which probably worked in their schedules since actors remain on strike in Hollywood.  Other strikes remain to include the United Auto Workers, and a potential upcoming three-day strike by 75,000 workers from Kaiser Permanente which will begin Wednesday. The workers demand a resolution to the staffing shortage in the health system. Speaking of resolutions, now that the continuing resolution was passed, we only have until November 17th to fund the government – as my four-year-old daughter would say – “for real life” this time.  Welcome to the Week Ahead!

The Administration

President Biden signed the continuing resolution this weekend to fund the government for 45 days. The CR included disaster relief funding, FAA reauthorization, and an extension of the federal flood insurance program.  One priority for the Biden administration which was not included was additional funding for Ukraine. President Biden spoke on Saturday and blasted “extreme House Republicans” for wanting drastic funding cuts and not supporting funding efforts for Ukraine. He wants Speaker McCarthy to secure a commitment from the House to provide funding for Ukraine moving forward – something to watch as the next rounds of negotiations continue.

The Senate

The Senate played its part this past weekend in helping to avert the government shutdown.  As we previously reported, the Senate was looking to take the lead in the government funding drama by attempting to pass its own bipartisan package. Both the House and Senate were in a race for a collision course, until the House passed their package (details below). However, the proposed CR drama did reveal that Minority Leader Mitch McConnell experienced a slight setback as Republican senators refused to include additional funding for Ukraine in their version of the CR.

With the passing of Senator Feinstein last week, California Governor Newsom appointed Laphonza Butler to fill her seat. Butler is the head of EMILY’s List, and she will not work for the organization now that she will fill the vacant seat. This of course is not the end of the story, with a series of special elections schedule to take place next year in the Golden State.

The Senate Committee on Veterans Affairs will hold a [hearing]hearing entitled, “VA Accountability and Transparency: A Cornerstone of Quality Care and Benefits for Veterans” this Wednesday at 3pm. Last week, the Senate Finance Committee leaders introduced bipartisan legislation entitled the Modernizing and Ensuring PBM Accountability Act (MEPA) which largely reflects the Chairman’s Mark from July.

The House

Over the weekend Speaker McCarthy cut a deal with House Democrats to avert government shutdown.  The continuing resolution (CR) passed both the House and Senate on Saturday and funded the government for the next 45 days. The measure was passed, 334-92, with 200 Democrats supporting the bill 334-92. The legislation did not include funding for Ukraine. The CR Includes funding to keep community health centers, teaching health centers, and the National Health Service Corps open through November 17th. Additionally, the bill would maintain funding for health centers that offer services to underrepresented communities.

Oh – but the fun continues. Speaker McCarthy is in hot water with the Freedom Caucus as threatening Matt Gaetz aims to bring up the motion to vacate the Chair along with four or five other members of the far-right wing of the Republican party. This is going to be interesting politics as Speaker McCarthy is the number one fundraiser and Gaetz would need Democrat support to overthrow the Speaker. Democrats have yet to signal how they will move in this House Republican civil war.

Additionally, Congress will continue the same fight for the next forty-five days as the government shutdown will be threatened again on November 17th. This will be the ultimate title fight as McCarthy tries to hang on to his Speakership along with avoiding another possible shutdown.

Create a great week!

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What Happened, What You Missed: September 25-29, 2023

NC Medicaid Expansion to Launch on Dec. 1

Medicaid expansion is set to kick off in North Carolina on December 1, 2023, marking the end of a decade-long effort to use federal dollars to expand coverage for low-income residents.  The North Carolina Department of Health estimates up to 600,000 people will be eligible for Medicaid coverage.  Adults ages 19-64 earning up to 138% of the federal poverty line (about $20,000 for an individual and less than $34,000 combined for a family of three) may be eligible.   North Carolina Republicans used their veto-proof majority in the state’s General Assembly to make Medicaid expansion a reality by including it in a budget bill laden with other GOP priorities, much to the chagrin of Gov. Roy Cooper (D).

Deloitte: Women Pay $15B More on Health Care Each Year

Women pay $15 billion more on out-of-pocket health care costs annually compared to men, according to a new study by Deloitte.  Among the factors attributed to the so-called “pink tax” are the high cost of breast cancer imaging compared to screening for other cancers, the frequency of gynecological exams, and earlier age recommendations for annual checkups compared to men. The study’s authors examined the medical spending of 16 million American workers with employer-sponsored health plans from 2017 through 2022.  To help cut costs, experts recommend addressing as much as possible during annual checkups to limit the need for follow-up visits.

GAO: 5% of Nursing Homes Owned by Private Equity

Five percent of the nation’s 14,800 nursing homes are estimated to be owned by private equity, according to a report by the Government Accountability Office (GAO).  However, the report’s author noted that the 5% figure could be an underestimate because the Centers for Medicare and Medicaid Services (CMS) does not collect data on all nursing facility owners.  Another issue limiting the report’s findings is the fact that CMS does not present its data in a way that makes it easy to identify private equity firms.  The report’s comes amid growing calls for health transparency, as well as concerns that private equity ownership may affect health outcomes at nursing homes.   In February 2023, CMS proposed rulemaking that would nursing homes to provide more information about their ownership.

Cambridge, Dallas Tapped as ARPA-H Regional Hubs

The Advanced Research Projects Agency for Health (ARPA-H) has selected Cambridge, MA and Dallas, TX as the locations for 2 of its 3 “hubs” that will focus on different activities.  According to the agency, the Boston-area hub will focus on engagement with investors and entrepreneurs, while the Texas hub will focus on patient experience issues such as clinical trial diversity and improving health outcomes for all populations.  ARPA-H plans to announce later this year the specific location of its third and final hub in the Washington, DC metropolitan area, which will focus on supporting stakeholders.  Each of the hubs will connect with “spokes” to carry out research at existing facilities.  Created in 2023, APRA-H is intended to support high-risk, high-reward medical research that can deliver breakthrough treatments and cures.

ICYMI: Suits Return to the Senate

Senators voted unanimously on Wednesday to codify a business casual dress code for the Senate floor, reversing a decision by Majority Leader Chuck Schumer (D-NY) last week to end enforcement of the dress code.  Schumer’s decision was primarily aimed at Sen. (Diazepam) John Fetterman (D-PA), who has regularly worn hooded sweatshirts and shorts around the US Capitol Complex since returning to the Senate after being hospitalized for depression earlier this year.  Both Schumer and Fetterman offered their support and cooperation on the resolution to reinstate the dress code’s enforcement shortly before Wednesday’s vote.

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The Weekly Update 9/25/2023

Good morning from Washington (Texas style) where we had a hurricane sitting on the DMV area and the Commanders and Cowboys both lost games in which they should have been more competitive. The fall blues are coming to Congress fast, as doom and gloom appears imminent as the government is set to shut down on September 30th. Any progress on any legislation other than government funding is at a complete standstill. Welcome to a government funding update on the Week Ahead!

Administration

All weekend long the Administration has advised federal agencies to prepare for a long shutdown. The President was at a Congressional Black Caucus event casting blame to the “extreme” Republicans on holding up the funding of the government, as well as casting blame at Speaker McCarthy because he agreed to the budget framework and his party is not delivering. The irony of course is McCarthy needed Democrat support to pass the budget resolution and the bipartisan agreement was not supported by the “extreme” Republicans. The shutdown could affect thousands of workers throughout the federal government as both sides continue to play a game of political chicken – leaving a government shutdown an almost certain event.

House 

Here is the latest from the trenches in the House of Representatives. There has been no progress on avoiding a government shutdown before September 30th. Last week the House brought up TWICE the Defense Funding bill and it was immediately voted down on the Rule to hear the bill on the floor. The Freedom Caucus had a rotation of five different members that constantly would interfere with the bill passing. This is important because it is the vehicle the Senate would use to send back to the House a CR that would last till December.

The Freedom Caucus is still holding up the process to move any appropriations bills from the House chamber and demanding a 30% across the board government cut to all agencies. These proposed cuts are deeper cuts than the initial Budget agreement. More significantly,  the Freedom Caucus has promised to hold the line on not voting on any type of continuing resolution.

The latest plan from the Republicans to advert shutdown comes from Congressman Matt Gaetz (R-FL). His plan would package all 12 appropriations bills into 4 separate packages. McCarthy is running full steam ahead with the plan as he wants to show some progress to the American people and put the Senate on watch. The House Rules Committee met Friday before Congress left town to work on the rule to start voting these bills out on Tuesday. Even with Congressman Gaetz leading the charge, it does not guarantee any of these packages would pass the House.

Senate

Members of the Senate have openly stated they want to take control of the budget process, as House efforts continue to fail. The upper chamber continues to work in a bipartisan manner on a CR that would fund the government right up to Christmas recess. The Senate plans to take this measure up as soon as Tuesday or Wednesday and send it over to the House. Senate Leadership has been working with the Administration behind the scenes to get a bill through even though no one knows what is in the bill itself. The Senate also has told House Leadership that Congressman Gaetz’s plan is a non-starter in the upper chamber. According to House Leadership sources the Senate plan is a non-starter in the lower chamber. So – there’s that…

Create a great week!

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