Insights^

The Week Ahead: Congress Keeps Pushing Us – Onto the Borderline

Good morning from Washington, DC where the sun is shining, and the town is all abuzz about the finally unveiled bipartisan border package.  Last night, text was revealed after months of negotiations from bipartisan negotiators.  Like anything with good intention in Washington, it was met with mixed reviews and vocal opposition.  The bill was negotiated by Sens. Lankford (R-Okla.), Sinema (I-Ariz.), and Murphy (D-Conn.). The provisions, discussed below, mark the most aggressive and substantive reforms on immigration and border security in years. House Republicans, who wanted border security tied to any supplemental war funding to Ukraine, Israel, and others, are now retreating from the bill.  As previously discussed, election politics and the hand of the presumptive presidential nominee are impacting support while impeding any initial progress. Speaker Johnson labeled the bill “dead on arrival” in the House.  Nothing like members of Congress calling for reform, achieving the reform in legislation, then blasting it as a non-starter. Just like Madonna said, Congress keeps on pushing us – over the borderline. Welcome to the Week Ahead!

The Administration

President Biden will spend some of this week and next pushing for passage of the Senate negotiated border security bill. The bill provides key supplemental funding for Ukraine and other allies. Republican opposition for the bill is largely mounted in not giving President Biden a win on the issue nine months before the election. Opposition is coming from both sides of the aisle, as the ACLU and Latino organizations are concerned the bill does not have substantive immigration reform.  Senator Alex Padilla (D.Cali.) has already opposed the measure.  

In other news, Secretary of State Blinken will be doing a four-day Middle East tour coming on the announcement of a more severe attack on Iran-backed targets due to previously reported drone strikes killing Americans. The President will also speak congressional Democrats at their policy retreat later this week.

The Senate

The border security deal faces a questionable path this week in the Senate.  A summary can be found here. The bill will cost $118 billion and provides over $48 billion in funding to Ukraine, as well as $10.6 billion to Israel.  As mentioned, the bill has opposition from both parties. Minority Leader McConnell, a staunch advocate for Ukraine funding, will face a huge test within his caucus to get support for the bill.  Leader Schumer stated he never worked so closely with McConnell on any other piece of legislation, adding fuel to the fire for Senate Republicans taking shots at McConnell for the top spot. Schumer promises a procedural vote this week which will be the first test of support for this legislation.  

Health Care 

Artificial intelligence in health care is an area in which policymakers want to better understand the impact of technology on a myriad of areas. Currently, AI is used to benefit physicians such as radiologists in analyzing images, it is also used to track cancer, and helps insurers processing claims. Critics of the use of AI in health claim insurers utilize algorithms which disproportionately impact communities of color and sicker individuals further exasperating health disparities. This week, the Senate Finance Committee is holding a hearing Thursday discussing the promises and pitfalls of AI in healthcare. Stay tuned as we cover this important hearing which will surely be the first of several. Also on Thursday, the Senate HELP Committee will hold a hearing on why the US pays more for prescription drugs than any other country.

The House 

The House reconvenes on Monday, and while there are several bills for consideration, it will be another light week for health policy on the House side of the Capitol. Much of the energy from the House will be focused on leadership’s vocal opposition of the border security bill.  Speaker Johnson has already mentioned introducing a standalone bill with funding for Israel – a measure he is hoping would divide Democrats. 

Health Care

While notable health legislation is not expected on the House floor, the Ways and Means Committee will hold on hearing on “Examining Chronic Drug Shortages in the United States,” on Tuesday. The hearing advisory and witness list have been posted online as well. While it will be relatively quiet in the House committees, House committee activity on health issues is expected to pick up in February and March.

As negotiations pick up on appropriations legislation, the March 8 deadline for several expiring health programs looms. The House Republican Doctors Caucus and physician organizations are continuing their push for relief from the 3.37% cut in Medicare payments that took effect on January 1. While indications point some form of relief being passed by Congress in the coming weeks, nothing has been agreed to and conversations continue.

Create a great week.

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The Week Ahead: Congressional Comeback in the Works? Bipartisan Signs of Hope on the Horizon

Good morning from Washington, where the sun is shining after rain dominated the weekend. With the sun on the horizon, a glimmer of hope remains as a bipartisan deal was announced on border security, tax policy, and appropriations funding for agencies. Could it be that both houses are finally coming together to do their jobs on behalf of the American people?  Or will partisan politics in an election year get in the way of legitimate legislative victories? It may be too soon to tell, but perhaps this underdog Congress is inspired by this weekend’s comeback by the 49ers against the Lions after being down 24-7. Much remains to be seen if congressional leaders will spike the ball in February, but one thing remains certain: drama continues to fill the air!  Welcome to the Week Ahead!

The Administration

President Biden is hoping a bipartisan deal on border security will be what he needs to move forward with the supplemental package for funding to Ukraine, Israel, and Taiwan. As discussed more below, the deal, which legislative text has yet to be released, focuses on allowing the administration the ability to shut down the border should crossings reach a certain amount per day among other provisions. Former President Trump blasted any negotiations as a deal could signal a win for President Biden.  The administration is also facing pressure from both sides after Iranian-backed drones killed three soldiers and injured more than 30 in Jordan this past weekend.  Republicans are calling for direct strikes in Iran while some Senate Democrats are calling for a more measured and proportionate response. Whichever way the administration acts will provide plenty of fodder for election season.

Homeland Security Secretary Mayorkas is set to face the first steps of an impeachment proceeding as the House prepares to markup two articles of impeachment this Tuesday. House Democrats believe the articles are politically motivated and are set to vote against them. Some Republicans have publicly voiced opposition to the articles of impeachment, but much is riding on the upcoming votes for Speaker Johnson and his leadership team. All of this comes at a time when Republicans are rejecting a border security package (for which they have not seen any language) they wished to tie to a supplemental package. The plot thickens as election season motivations show its ugly head in critical policy issues.

The Senate

The Senate returns to business Tuesday considering more nominations. The big news however remains around the border security deal brokered by bipartisan negotiators Sen. Chris Murphy (D-Conn.) and Sen. Craig Lankford (R-Okla.). Both senators took the Sunday talk show circuit pushing for the Senate to pass the package.  A procedural vote could be set for this Wednesday or Thursday. The package includes money for foreign aid and contains border security provisions. Lankford is urging Republicans to support the package since they tied up the supplemental with demands for changes in border policy. The Senate could lead the way in demonstrating bipartisanship by moving forward with the package despite calls from Trump to tank it. 

On the appropriations front, Senate and House negotiators reached an agreement late Friday night on funding allocations for federal agencies. The agreement spells out how they will handle the twelve full-year funding bills. The agreement, led by Senator Patty Murray and Rep. Kay Granger, is another win for women leading by example. Congress has until March 1 to prevent a partial government shutdown.  

Health Care 

The US Senate Committee on Veterans’ Affairs will host a hearing focusing on veteran centers supporting the mental health needs of veterans, service members, and their families on January 31. 

The House 

The House of Representatives is back after the weeklong recess and there is an official stalemate with border security, Ukraine, Israel, and any other legislation besides the tax bill.

Speaker Johnson sent a letter to colleagues that stated he disagreed with the Senate bill, and the President has the right to act with Executive Orders to control the chaos at the U.S. Southern border. The border deal is what is holding up other official funding as House Republicans will not vote on any legislation that funds other countries without border security reform. Former President Trump continues to encourage Republicans not to support the Senate deal as he sees this as a winning political issue. This should make for some exciting fireworks between the House and Senate in addition to government funding till the President’s Day work period. 

In other news… Chairman Jason Smith (R-MO) and Ranking Member Neal (D-MA) continue to make headway with a tax bill

Health Care

In addition to addressing the new March 8th deadline for those expiring programs, House leaders are expected to continue a push for legislation that cleared the House with broad bipartisan support late last year—the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act. Added to the mix is the continued push from the House Republican Doctors Caucus and physician organizations for relief from the 3.37% cut in Medicare payments that took effect on January 1. While relief once seemed a distant possibility, some form of relief being passed by Congress in the coming weeks now seems to be within reach of becoming reality.

As the legislative sausage-making conversations ensue, House committees will also hold two health-related hearings on Wednesday with the House Energy and Commerce Health Subcommittee holding a hearing to explore rising health care costs and spending titled “Health Care Spending in the United States: Unsustainable for Patients, Employers, and Taxpayers” (January 31 at 10am) and the House Oversight and Accountability Committee holding a hearing the same day titled “Overseeing the Department of Health and Human Services’ Compliance with Congress.”

While the week back will be relatively light—at least publicly, House committee activity on health issues is expected to pick up in February and March with telehealth, laboratory-developed tests, and efforts to address rare diseases among the topics that are expected for further congressional attention.

As always, please send us your thoughts for this week and what’s next. Create a great week!

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The Week Ahead: Congress Shovels Out of Snow to Punt for Six Weeks

Good morning from Washington, where we are looking to get out of the snow to rise again in the sun this week. The last few days of snow caused people to shovel their driveways a few days ago, just to get more snow a day or two later. The whole scene is akin to Congress barely passing a bill in time to fund the government to just punt the real problem down the line to March 1 and March 8. While we can celebrate the baseline accomplishment of well, you know, the ability to keep the doors open – we still know more issues are set to pile on in six weeks. The House is in recess this week because they’ve worked so incredibly hard, and the Senate is in session and looks to roll up their sleeves. Welcome to the Week Ahead!!

The Administration

Last week President Biden signed legislation to avoid a partial government shutdown and continue the laddered approach under the continued resolution Congress passed last year. The President also met with lawmakers to reach mutually agreeable ground on issues surrounding the administration’s supplemental funding request. Issues remain around border security. This past week also marked Republican presidential hopefuls leaving the Iowa caucus and moving their sights onto New Hampshire. It now appears to be a two-person race with former President Trump and Nikki Haley.

Healthcare

The Center for Medicare and Medicaid Services (CMS) will hold a national stakeholder conference call this Tuesday at 1pm featuring CMS Administrator Chiquita Brooks-Lasure to discuss the CMS Strategic Plan. As a reminder, the plan focuses on expanding access to care, advancing equity, and driving innovation, among others. 

The Senate

The Senate is in session this week and will be churning through a few nominations early in the week. The real action will continue behind the scenes as a group of bipartisan senators continue to work on details around a supplemental funding package. As we reported earlier, the package would provide funding to allies including Ukraine, Israel, and Taiwan. The package is also believed to have border security changes included in it, but as we also previously mentioned to what extent remains to be seen. It’s not quite clear yet when Majority Leader Schumer will begin the process of bringing this to the floor as many pieces remain in play. Minority Leader McConnell will work to bring Senate Republicans along to demonstrate support for Ukraine, but he still has a big task ahead of him. Senate Republicans are not in a rush to have this legislation jammed through the process despite these issues being in play for months. In related news, Senate appropriators remain concerned about allocations despite topline numbers being agreed to as part of funding the government. Complicating the matter is whether the supplemental will pass and what money may be included for the Department of Homeland Security.

Healthcare 

The Senate Aging Committee will hold a hearing on Thursday at 10am on long-term care options for older adults. The hearing will focus on assisted living facilities. Lawmakers from both the House and Senate continue discussions on a potential large health care package that would include opioid support programs, doc payments, telehealth, and price transparency.

The House 

After passing legislation (H.R. 2872) to avert a partial government shutdown and extend the government funding deadlines into March, members of the House of Representatives return to their home states for a district work period. Under the legislation, Congress continued the “laddered approach” under the continuing resolution (H.R. 6363) that Congress passed late last year, bumping out the new funding deadlines from January 19 and February 2 to March 1 and March 8 respectively.

Health Care

Under H.R. 2872, multiple health extender deadlines that were previously set for either January 19 or 20 were now extended to either March 8 or 9. Among the expiring provisions that were extended included payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).

It still remains to be seen if Congress will be able to reach an agreement on larger health legislation, but House leaders are expected to push for including provisions that were included in the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act that the House passed with broad bipartisan support late last year.

In addition, as expected, Congress failed to provide relief to physicians and other clinicians who were hit with a 3.37% Medicare payment cut on January 1 in the H.R. 2872, but members of the House Republican Doctors Caucus and physician organizations are continuing the push to include some form of relief in the appropriations legislation and health extenders that Congress will have to address in advance of the March 8 deadline. At the beginning of last week, there appeared to be little possibility for relief from the cuts this year, but physician and allied health groups and their champions in Congress are continuing to hold out hope.

Create a great week!

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The Week Ahead: CR or Not to CR… this is the Question

Welcome from Washington DC, where a few inches of snow canceled schools and closed the federal government leaving parents gazing into the horizon for relief and confirmation schools will open in the next day or so. As we stare into the legislative horizon, we wonder if Republicans and Democrats can come together to fund the government to avoid a shutdown. During the Martin Luther King, Jr. holiday weekend a deal was struck on a stopgap measure to extend spending authority until March 1 and March 8, keeping intact Speaker Johnson’s laddered approach. However, with time being of the essence, can Congress act quickly (not its best trait) to pass the measure through both bodies in time? Welcome to the Week Ahead – where the 118th Congress continues to struggle to meet the most basic legislative tasks.

The Administration

The Border. Negotiations on border security continue but seem to be stuck at the same time. As we reported earlier, border security is being tied into any additional funding for Ukraine, Taiwan, and Israel by Speaker Johnson and other Republicans. The issue at hand appears to be the ability for the administration to continue to use parole authority. This power allows the government to grant the ability for migrants to have temporary permission to live and work in the United States even though a path to citizenship may not exist. Parole authority is a must have for the Biden administration, but Republicans see this tool as a way for immigrants to get around Congress when they otherwise cannot gain access into the country. It remains a sticking point and could tie up foreign aid to America’s allies.

Healthcare 

Medicare Advantage. A MedPAC presentation and report Friday states the federal government will pay $88 billion more than it should this year because they attract healthier lower-cost beneficiaries thus driving sicker beneficiaries into traditional Medicare. The report also mentions complicated upcoding procedures used to drive up payments to plans.

The Senate

The Continuing Resolution. The Senate is scheduled to hold a vote on the legislative vehicle short-term continuing resolution to extend the government funding deadlines to March 1 and March 8. Despite the snow, the vote is on! Senators who wish to oppose the CR can do so until Sunday, but the Senate really needs to move on this to avoid a shutdown. Both Leader Schumer and Senator McConnell will work to address any concerns members have to prevent this from happening. The CR does not address major issues like funding for our allies or the border security issue, but it does give more time for appropriators to pass their bills before automatic spending cuts come to fruition in mid-April.

Healthcare

The Senate Health, Education, Labor and Pensions Committee will hold a hearing addressing long COVID on January 18th at 10am.

The House 

On the Clock. The House is scheduled to hold votes tonight to encourage members to be back in town despite the weather. It is thought Speaker Johnson may have to work this week to get the proposed CR to pass via suspension which requires a two-third majority, Democrats appear to be united behind passing the CR and helping get this across the finish line. However, it will not come without asks from the Democrats – so let the negotiating begin!

Healthcare 

The House returns after the Martin Luther King, Jr. holiday with a slate of bills and resolutions to consider, but the most pressing question as the House reconvenes will be whether enough House Republicans will vote to join Democrats later in the week and avert a partial government shutdown before the first funding deadline under the “laddered” continuing resolution (H.R. 6363) that Congress passed late last year hits on January 19.

While an agreement has been reached between Speaker of the House Mike Johnson (R-LA) and House Majority Leader Charles Schumer (D-NY) on topline spending numbers, much remains to be determined—not only on final appropriations for the rest of the fiscal year but on health policy priorities as well. Under the “laddered” agreement agreed to by Speaker Johnson and Leader Schumer reached late last week, a final agreement on significant health legislation is now not expected until at least March as multiple health extender deadlines that were previously set for either January 19 or 20 will now be extended to either March 8 or 9. Expiring provisions pending to be renewed include payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).

Prior to adjourning in December, the House passed both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act with broad bipartisan support, and House leaders are pushing for inclusion of many of the bills’ provisions including measures on price transparency, pharmacy benefit manager reform, and hospital payments in a final government funding package for 2024.

The largest health policy casualty of Congress failing to reach an agreement on government funding and larger health hit physicians and other clinicians under Medicare. When Congress adjourned in December, momentum appeared to be building for Congress to provide at least partial relief from the 3.37% cut in Medicare physician payments that took effect on January 1, but Congress failed to reach an agreement on additional relief from Medicare payment cuts in 2024. As a result, Medicare payment rates resulting from the 3.37 percent cut are expected to remain throughout 2024.

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Topline Budget Number Reached – funding to be or not to be?

Good morning from Washington where a Sunday bipartisan deal was announced of $1.7 trillion to fund the government through September 30th with $886 billion to defense and $773 to non-defense amounts. Both parties are spinning wins to their members. We remember the good old days when billions were enough to fund the government.  We also remember the Fiscal Responsibility Act, last year’s deal between President Biden and then Speaker McCarthy which angered Freedom Caucus members and others and helped propel McCarthy out of his leadership post.  The deal announced yesterday adheres largely to the Fiscal Responsibility Act with minor revisions. Will Republicans in the House make Speaker Johnson pay for this agreement?  We know with the small two vote margin the Speaker currently enjoys; it is likely bipartisanship (Dem support) will be needed to get this through the House. With the difficulties presented by the right on this deal, coupled with impeachment season – can Majority Leader Schumer and Speaker Johnson navigate this topline budget number through their respective legislative bodies?  Or will partisanship rear its ugly head once more in this incredibly unproductive 118th Congress?  In this Week Ahead, we tackle both houses together as we examine the ramifications of the upcoming funding deadlines.

The Administration

The President and his negotiators continue to push for a war supplemental for Ukraine and Israel, and as previously reported, the request is being tied into border security reforms. The bipartisan group working on a border security deal, including Secretary of Homeland Security Mayorkas, said they made progress over the weekend and hope to have language later this week.  Of course, Secretary Mayorkas is going to be impeached shortly by House Republicans, and it appears the impeachment will be successful in the House, and he will be acquitted in the Senate. Any border negotiation language comes at a time with congressional elections around the corner, and some vulnerable House Democrats may be interested in supporting any reform language.

Congress

The House is back this week after recess. As mentioned, yesterday evening Speaker Johnson, Leader Schumer, and the White House struck a deal for the 2024 Budget topline numbers. Speaker Johnson worked an additional $16 billion worth of cuts beyond the initial McCarthy / Biden 2023 deal, but it will not be enough to appease the far right of his party. The Budget is just the framework for the overall government spending. Speaker Johnson has a narrow majority, and the House Freedom Caucus is surely going to oppose this measure leading the Speaker to rely on Democrat support to get across the finish line.

When members return, they are going to have to work quickly to ensure the departments of Agriculture, Transportation, Energy, Veterans Affairs, and more are funded by January 19th. Then on February 2nd, Department of State and other important agencies will also need to be funded before they run out of money. With the MLK holiday and less than eleven days before the first deadline, a shutdown could still happen. Rumors are swirling from short-term extensions to a longer funding mechanism that ensures both parties do not have to vote on these measures respectively over the next several months. At this point it is only a guessing game of what the government funding solution will be. The Senate wants the House to work with Senate passed appropriations bills, but it is unlikely the House will concur.

Congress will be also examining the border, Ukraine, Israel, and Taiwan funding, which are thorny political issues with both parties. Who says a Presidential election cycle is quiet? There will not be a shortage of fireworks as we kick off this Presidential election year with what Congress needs to accomplish.

Health

Even though much attention will be paid to the progress of deliberations to fund the government and address certain health policy issues, there will be other work on Capitol Hill as well. On Thursday, the House Committee on Veterans Affairs’ will hold a hearing titled: “Rural Access: Is VA Meeting All Veterans Where They Live?”

While an agreement was reached on topline spending numbers over the weekend, uncertainty around what Congress will agree on funding measures extends to health care as well. Multiple health extender deadlines are coming on either January 19 or 20, and questions remain as to what agreement can be reached on any of these expiring programs. Expiring provisions include payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC). In addition, authorization for the Pandemic and All Hazards Preparedness Act (PAHPA) also expires, and the House and Senate still seem to be a way off from reconciling their differences, which includes opposing views on whether to include measure to address drug shortages.

In addition, while the House acted on both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act before adjourning in December, it also remains to be determined if these measures might be in play for inclusion in one of the funding bills that Congress must pass in the coming weeks.  The Senate remains content to work on its own health care package this year more focused on primary care.

Before Congress adjourned in December, there was momentum building for Congress to provide some relief from the 3.37% cut in Medicare payments that hit physicians and other clinicians on January 1. While full relief is not expected, if provided, the partial relief is expected to be retroactive to January 1, and to closely align with 1.25% offset of 3.37% cut that was passed by the Senate Finance Committee and by the House Energy and Commerce Committee and in separate measures late last year.

Create a great week!

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New Year with Rubik’s Cube like Negotiations – Can Congress Prevail?

Good morning from Washington as we embark on a New Year filled with resolutions, hopes, and a return to a Congress challenged with budget deadlinessupplemental war funding, and border security reform. As Congress returns to Washington next week, this week we look examine some of the upcoming challenges for 2024 from an electoral and policy perspective. Many of us make resolutions for the New Year, we can only hope Congress will resolve to remove its mark in this second session as one of the least productive legislative bodies in history.  Welcome to the Week Ahead!

The Administration

Surely the biggest storyline in 2024 will be President Biden’s quest for reelection.  He will have to overcome concerns about his polling numbers, as well as his age. In recent days, Democrats have rallied behind President Biden arguing the nation has beaten back COVID, the economy is strong, and so is our nation’s standing. Many Americans have yet to give Biden credit for avoiding a recession and having low unemployment numbers which defy expectations. President Biden and his team have dismissed low polling numbers as not being relevant 10 months away from any real election. One thing which is real, is the President never has been popular with high polling numbers. If anything, Biden’s career has been one with consistent low comeback numbers, but one thing can be said: he previously beat the expected Republican challenger, Donald Trump.

For 2024, Health and Human Services will continue to drive home its work on lowering drug costs through Inflation Reduction Act. As discussed last year, the administration will continue to work on drug pricing, mental health, and reproductive health as some of its top priorities for 2024. Key administration officials will continue to discuss the IRA’s impact on Medicare drug pricing, as President Biden’s campaign works to influence seniors prior to the election.  Additionally, the agency will have to form an artificial intelligence task force by the end of the month per President Biden’s Executive Order.

In the meantime, officials from the Biden administration will continue to be involved In budget talks and pushing for war funding for our allies – both of which are tied to border security. With looming deadlines in January and February, President Biden’s team will have to walk a tightline between needed border reforms and not upsetting his Democrat colleagues on the issue.

The Senate

As we approach the 2024 election, it remains clear maintaining control of the Senate is a challenge for Democrats. Incumbent Democrats are defending seats in red states like Montana and Ohio, while West Virginia flips due to the retirement of Joe Manchin. One of the biggest mysteries remains in Arizona since Senator Sinema has yet to announce if she is running again.

The Senate is in session next week kicking off 2024 with a major role in pending deadlines. Senate appropriators want to take the lead in the funding process – but you know… partisan issues prevail between the two bodies. Senate negotiators have been engaged in border security talks for weeks along with folks from team Biden. The Rubik’s Cube of negotiations ties border security to additional funding for Ukraine. Majority Leader Schumer has tied Ukraine to additional funding for Israel and Taiwan. To make the negotiations even more complex, Speaker Johnson only wants the House bill H.R. 2 to be the only discussion on border security, even though it is a nonstarter in the Senate. Are you tired yet?  The New Year is upon us!

The House

Speaker Johnson is going to have his work cut out for him to hang on to a narrow two-seat majority for this Presidential election year. The Speaker is tasked with funding the government in 16 days, producing a plan for the border, Ukraine, Israel, and Taiwan.  All while trying to sell the American people on increasing the Republican majority and selling another term for the likely presidential candidate Trump.

The funding fight is still a battle where the Speaker will likely need Democratic support. Does Speaker Johnson keep the same deal as the McCarthy cut or does he try and negotiate something new to keep the far right of the party happy? Does he just vote on a clean Continuing Resolution to keep the government running? All questions that we in DC want to answer.

What we do know is the Speaker still would like to finish all twelve appropriations bills this year. The likelihood of this happening is slim to none because of divisions in the party and narrow voting margins. We are predicting the outcome in February will be a year-long continuing resolution to fund the government at current levels through Fiscal Year 2024.

Health

While the House remains in recess, things are expected to pick up quickly next week when the House reconvenes. The House will only have eight legislative days before the first tranche of government funding expires on January 19, and then the House will only have an additional four legislative days before the second government funding deadline hits on February 2.  With the limited timeframe to fund government operations for Fiscal Year 2024, there has also been speculation that the House could extend the appropriations bills set to expire on January 19 to February 2.

With multiple health extender deadlines hitting on either January 19 or 20, whatever package is passed to fund the government past January 19 will include at least some health provisions. Among expiring provisions in need of extension are payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC). What remains to be determined in the coming days is what additional health measures might catch a ride with the must-pass January package. With a flurry of activity on health legislation before the House adjourned for 2023, provisions included in both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act could be in play for being attached to government funding legislation in either January or February.

Physicians and much of the provider community will also continue their push for relief from the 3.37% cut in Medicare physician payments that took effect on January 1. While Congress is not expected to provide full relief from the cuts, provisions to provide partial relief, along with an extension of incentive payments for alternative payment models, retroactive to January 1, could be included with the January government funding measure. Should Congress provide some relief from the cuts, it is expected that the relief would closely align with 1.25% offset of 3.37% cut that was passed by the Senate Finance Committee and by the House Energy and Commerce Committee and in separate measures in November and December, respectively.

Create a great week!

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A Whirlwind Week in Washington D.C. – From Political Storms to Legislative Waves

Good morning from Washington DC where the weather changed from rain, to snow, to warmer temperatures and sun in a matter of 36 hours.  The dramatic shift in weather cycles reminds us of the recently announced retirement of former House Speaker Kevin McCarthy.  Where else can you go from being Speaker, to being removed by your own party, to retiring all in one year?  Here in Washington of course!  Rep. McCarthy is not the only one to announce retirement for this term, and we do expect many more to leave before filing for another term.  With the slight majority Republicans hold in the House, each retirement and expulsion (Santos) makes the holiday season more enjoyable for House Democrats looking to take control next session.  In addition, we only have one week left of legislative business, and we still have no agreement reached on aid for Ukraine and Israel.  Congress returns this week to what could be a very busy time! Welcome to the Week Ahead!

The Administration

President Biden continues to work behind the scenes with Senate negotiators on the White House supplemental request for funding to Israel, Ukraine, and Taiwan.  As previously mentioned, Republicans in Congress want to tie any aid for these countries to increased border security measures.  The administration publicly stated reforms are needed at the border, but at this time, no agreement has been reached for foreign aid. President Biden will host Ukrainian President Zelensky this week.  With time running out and House Republicans becoming increasingly skeptical of funding Ukraine, President Zelensky returns to Congress for a last-minute plea to the Senate.

In health care news, and in line with its priorities, the White House celebrated the announcement that the FDA announced the approval of gene therapies to treat sickle-cell disease via its statement.  To address health inequities and improve on treatment of sickle-cell disease which disproportionately impacts African Americans and Hispanic Americans, the Biden Administration believes this breakthrough can save and improve the lives of millions.

The Senate

The Senate will welcome Ukrainian President Zelensky for a speech on the importance of funding to Ukraine.  The invite was extended by both Majority Leader Schumer and Minority Leader McConnell.  Behind the scenes negotiations will need to resume on border security measures to couple with potential funding on the war supplemental.

With an eye on health care for moving into 2024, the Senate will look to the following this week:

The upper chamber will look to conclude the year by finishing off its health care priorities, although they lack a bipartisan larger “package” which Leader Schumer expressed desire to complete this year.

The House

Retirement season has officially kicked off on Capitol Hill. Former Speaker McCarthy is leaving at the end of the year, Chairman Patrick Mc Henry (R-NC) is in his final term, and we expect several more are going to leave before they must file to run for another term. Many members are citing (shocker) dysfunction and just want to go back to their private lives.  With one week remaining, major fireworks remain on emergency packages for Ukraine, Israel, Taiwan, and the border wall. The Senate continues to negotiate, but the Senate package still must pass the House and must include border security.

In the area of artificial intelligence, the House Energy and Commerce Committee will hold a hearing on Wednesday leveraging agency expertise across the economy to position America as a leader in AI.

Health Care

As Congress looks to close its work for 2023, the House will be taking steps to move health legislation forward with an eye to positioning themselves going into 2024.

  • The House will consider 14 bills, including:
    • Lower Costs, More Transparency Act (H.R. 5378), which would establish increased transparency for insurers hospitals and PBMs.
    • Support for Patients and Communities Reauthorization Act (H.R. 4531)
    • PREEMIE Reauthorization Act of 2023 (H.R. 3226).

Each of the bills will be considered under the suspension of the rules signaling House leadership’s belief that the bipartisan bills will garner enough support to pass with the required two-thirds majority needed under the procedure. By moving the legislation with strong bipartisan support, the House leadership will be asserting a strong position on several health issues, including pharmacy benefit manager reforms and provider payments, as House and Senate are expected to work to reach an agreement on health legislation in 2024.

Beyond this public work on health care, we also expect work and conversations to continue behind the scenes, as leadership and committee staff on both sides of the Capitol work with an eye toward drafting legislation to address several expiring health care provisions and programs in January. As readers are likely aware, the House Energy & Commerce Committee moved 19 pieces of health-related legislation last week, including measures to extend the work Geographic Practice Cost Index floor, to revise the phase in of certain payment changes for lab services, an extension of expiring incentive payments for alternative payment models, and additional relief to help mitigate the 3.4% cuts in Medicare physician payments scheduled for January 1, 2024. At this time, we do not anticipate seeing a final agreement on these provisions before Congress adjourns in 2023, but it is expected that these other health provisions could be included in a legislative package in January.

Your insights are valuable, so please reach out with any questions or information.  Please create a great week!

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Can Congress Band Together?

Welcome back to Washington, DC the town which continues to provide as much drama as Hollywood but without the glitz and glamour.  The weather remains mild, but the heat is on for the Biden Administration and Congress to come to an agreement on a supplemental funding package for Ukraine, Israel, and Taiwan.  As per the usual, this weekend your author took his four-year-old daughter to the movies, this time to see Trolls Band Together.  The theme focused on a music group overlooking its differences and working together during an emergency to save one of their own from a potentially fatal outcome.  If only Congress could take a cue from the third installment of the animated trilogy and work together to end the year on a successful note.  Some say it happened this past week with the ousting of the disgraced George Santos from the House, but we here in Washington know there is much more to be done.  We are in December and much more needs to be done!  Welcome to the Week Ahead!

The Administration

As the end of the year approaches, we are beginning to see priorities of the Biden Administration being challenged by a divided government. The Biden Administration will continue this week to focus on pushing for its war supplemental focusing on aid to America’s allies.  Much remains to be seen on this matter as congressional Republicans are demanding border security measures be coupled with the supplemental.  Of particular concern remains additional funding to Ukraine, which could see Congress pass for a third time on providing additional resources.  In a memo to Congress, Budget Director Shalanda Young expressed the urgency of providing additional funding to Ukraine, as she expressed no more funds exist to support Ukraine. Around 60% of the funding has remained here at home to improve military preparedness here at home, while shipping out equipment to Ukraine.

Among other White House initiatives, House Republicans are pushing back on the Supplemental Nutrition Program for Women, Infants and Children.  The House failed to include extra aid money for the WIC program which helps low-income moms and babies.  The program usually enjoys bipartisan support, but House Republicans are pushing to cut spending for the program this year.  The Biden Administration has requested an additional $1 billion in funding for the program.

The Senate

Majority Leader Schumer is looking to move this week on putting the war supplemental on the Senate floor.  The sticking point for the package, as mentioned previously, is that Republicans want to make any funding package contingent on border security reform measures.  While both Senate and House Democrats agree some border reform measures are needed, Republicans are pushing for more aggressive measures on the border front.  They want to include language from HR2, which Democrats view as a non-starter. Weekend talks on working together fell apart, but we can hope lawmakers return to work together to resolve the disagreement as the world is watching.

In notable committee activity this week, the Senate Finance Committee plans will hold a hearing entitled, “Drug Shortages: Examining Supply Challenges, Impacts, and Policy Solutions from a Federal Health Perspective.”  The hearing will touch on drug shortages in light of critical diseases to include cancer drugs.

The House

The never-ending drama continues to drag out in the House. Last week Congressman Santos was expelled from Congress for ethical violations, (and there were a lot of them), and next the Speaker is saying he has enough votes to bring up articles of impeachment against President Biden. Deep divides remain in the narrowly controlled Republican House and more retirements are rumored by the end of the year (including former Speaker McCarthy).

With only two more weeks to go, Speaker Johnson’s honeymoon is over. The Republican majority narrows to three with Santos out and the government shutdown is looming after the holidays. The Speaker said last week they need to fund Ukraine, which sent the Freedom Caucus in an uproar. The rest of the conference is not even close to agreeing on a foreign aid package that funds Israel, Taiwan, and the border. Speaker Johnson has his work cut out for him finishing up the rest of the year and going into next. There are even rumblings they might even call to vacate the Chair on HIM!

As last week, much of Congress’s attention this week will continue to be on matters other than health care. While health policy won’t be on the floor, and even though Congress extended several expiring health provisions and programs into January, that doesn’t mean that work on important health policy matters won’t be happening.  The House Energy and Commerce Committee announced that it will hold a markup of 44 pieces of legislation, with over 20 being of health policy in nature, on Tuesday. Tuesday’s markup could provide an insight into what additional provisions Congress might include in health-related legislation early next year as Congress had extended several health programs and provided protections from potential cuts into January as well.

Among the legislation being considered on Tuesday will be legislation aimed at lowering prescription drug costs and targeting pharmacy benefit managers and certain PBM practices. In addition, the Committee will consider measures to extend the work Geographic Practice Cost Index floor, to revise the phase in of certain payment changes for lab services, and an extension of certain expiring incentive payments for alternative payment models. In addition, of particular interest, will be the Committee’s consideration of legislation that H.R. 6545, the Physician Fee Schedule Update and Improvements Act, which would not only include a provision providing an additional relief of 1.75%, over current law, to mitigate the 3.4% cuts in Medicare physician payments in 2024, but it would also reform and update how budget neutrality requirements impact Medicare payment rates to physicians and other providers as well. While previous indications pointe to the fact it was doubtful that Congress would take action to provide any relief from cuts to Medicare physician payments, assuming Committee approval this week, along with Senate Finance Committee’s action last month, there seems to be growing interest in providing some relief from pending Medicare physician payment cuts in 2024—even if that relief may need to be retroactive.

Create a great week!

What Happened, What You Missed: November 27-December 1, 2023

Biden Invokes DPA to Address Drug Shortages

On Monday, President Joe Biden invoked the Defense Production Act (DPA) during an inaugural meeting of the Council on Supply Chain Resilience to ease drug shortages.  The announcement comes amid shortages of penicillin, Adderall, and certain cancer drugs that have affected doctors and patients across the nation.  The administration plans to use the DPA to invest $35 million to support domestic manufacturing of essential medicines and key ingredients.  Additionally, the White House will appoint a new Supply Chain Resilience and Shortage Coordinator to focus on long-term supply chain issues, and the Defense of Defense (DOD) will release a report on pharmaceutical supply chain resilience.

US Life Expectancy Sees Post-COVID Bump

The US life expectancy rate rose for the first time since the COVID-19 pandemic began, according to data from the Center for Disease Control and Prevention (CDC).  Researchers found a 1.1-year increase in 2022, bringing the overall life expectancy to 77.5 years.  This marks a reversal of the 2.4-year life expectancy drop that occurred over 2020-2021, which was largely driven by COVID-19 deaths.  Native Americans saw the largest life expectancy increase of 2.6 years, while the life expectancy gap between White and Black Americans narrowed slightly in 2022.  However, CDC researchers did note a rise in deaths from flu, pneumonia, kidney disease, and fetal and infant conditions in 2022.  The CDC also found that deaths from suicide reached a record high of nearly 50,000 in 2022.

Lawmakers Explore Use of AI in Health Care

Members of the House Energy and Commerce Health Subcommittee heard from health care industry stakeholders in a hearing on Wednesday about the potential for artificial intelligence (AI) to decrease administrative burden and improve care delivery.  However, witnesses warned that regulations will be needed to protect patients’ privacy and ensure that AI does not discriminate against patients.  While subcommittee members were particularly interested in the ways AI could address clinician burnout as well as workforce shortages, there has yet to be any significant momentum on legislation to address AI in health care settings.

Califf Taps New Principal Deputy Director for FDA

FDA Chief Scientist Namandjé Bumpus will succeed Janet Woodcock as the agency’s Principal Deputy Director, according to an announcement from FDA Commissioner Robert Califf.  Earlier this month, Woodcock announced that she will be stepping down from her role in early 2024, marking the end of a 37-year career at FDA that included stints as action commissioner as well as head of the agency’s Center for Biologics Evaluation and Research (CBER).  Bumpus’ priorities in her new role include the creation of a new model for the office charge of inspecting facilities that manufacture drugs and medical devices.  Prior to joining the FDA in August 2022, Bumpus chaired the Department of Pharmacology and Molecular Sciences at the Johns Hopkins University School of Medicine, where she conducted research on drug metabolism and the effects of antivirals on humans and pathogens.

ICYMI: High Winds Take Down White House Christmas Tree

The White House Christmas Tree was a casualty to 46 mph winds that befell the National Capital Region on Tuesday, just two weeks after the tree had been planted at the White House Ellipse.  The incident caused 20 ornaments to fall from the tree, although none of the ornaments were damaged.  Fortunately, the tree was raised just hours later, allowing the White House Christmas Tree lighting ceremony to continue as planned.

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AI is Taking Over the Capital

In the ever-evolving landscape of technological advancement, the discourse surrounding artificial intelligence (AI) regulation has quickly emerged as the focal point of the global conversation. The unprecedented summit between President Joe Biden and President Xi Jinping added a new chapter to this narrative, igniting discussions that transcend borders and underscore the critical importance of shaping the future of AI. The two leaders agreed that using AI in nuclear or other military operations creates many risks, however, the senior U.S. official said neither was ready for any mutual declaration banning the use.  

The Senate also showed concern regarding AI innovation on a global scale. Earlier this month, they held a hearing on how the U.S. can influence allies and non-allies to ensure that the development of AI systems globally doesn’t empower digital authoritarianism. A worry for the committee was how to handle Chinese innovation in AI technology; Witness Nathaniel Fick from the Department of State explained that the best way to hinder Chinese innovation is to continue to foster innovation among allies at home and abroad. Fick refers to President Joe Biden’sVoluntary Commitments as an example of partnerships at home fostering innovation. 

However, the Senate isn’t just interested in AI’s effect on foreign affairs; the Senate Health, Education, Labor, and Pensions Committee (HELP) and the Homeland Security Committee held hearings on domestic concerns regarding AI. The Senate HELP Committee focused on AI’s positive and negative impact on the healthcare system as a whole. Members discussed three bills addressing the negative positive impacts of AI in healthcare:  the Artificial Intelligence & Biosecurity Risk Assessment Act; the Securing Gene Synthesis Act; and a new bill from Sen. Mike Braun (R-IN), the Medicare Transaction Fraud Prevention Act. (The final bill is aimed at preventing the elderly population from being victims of fraud.)  

The Committee on Homeland Security met to discuss the Philosophy of AI and as interesting as it sounds, the Senators indicated that the hearing was to explore what action(s) should be taken rather than introducing solutions. The witnesses included various professors and their testimonies urged the Senate to pass laws that regulate AI rather than letting AI dictate the regulations. An interesting point brought up during this hearing was by Prof. Daron Acemoğlu, he claims that even though he doesn’t believe that AI will/does automate white-collar jobs, it will most likely automate the IT and IT security jobs. 

Lastly, going back to Biden’s Voluntary Commitments from Leading Artificial Intelligence Companies to Manage the Risks Posed by AI, it very much just reads like a pact of promises that may or may not do anything, we will have to see some time pass before we have a definitive answer on their viability. Nonetheless, it’s good to see that AI is on the list of priorities for the Administration. 

This isn’t the end for AI on the Hill either, even just this week there is a House Energy and Commerce, Health Subcommittee hearing on Understanding How AI is Changing Health Care. Now even though AI is taking over the Capital, you can count on us listening and watching with our own human, eyes and ears. 

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