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On September 18, 2024, the House Ways and Means Health Subcommittee held a hearing on chronic disease prevention and management. Representatives and witnesses expressed concerns that rates of chronic disease are skyrocketing, and not enough is being done in the way of prevention and promotion of healthy nutrition.
It’s the beginning of the season! Nope, not election or back-to-school season – it’s MedPAC season! The Medicare Payment Advisory Commission opened up their annual cycle last week discussing the sustainability of the Medicare program and issues in rural health care. And we are here for all of it!
MedPAC Has a Job to Do
Congress created the Medicare Payment Advisory Commission (MedPAC) to recommend Medicare payment updates and strategies to improve the Medicare program. MedPAC is mandated in their charter to submit recommendations on annual payment updates for several fee-for-service payment sectors within Medicare. The other half of the MedPAC charter focuses on improvements and innovations for the Medicare program.
MedPAC Weighs in on Medicare’s Future
So, what did MedPAC say in their September 5, 2024 meeting about the future financial sustainability of the Medicare program? Staff reported that national healthcare spending is now at $4.5 trillion (2022) or 17.3% of GDP and said those levels will increase to 19.7% in 2032. Staff also pointed out that Medicare’s HI Trust Fund will become insolvent in 2035. While discussing factors increasing spending like demographics (more older Americans) and inflation, the Commission purposely called out the cost of GLP-1 drugs and said that those drugs alone will increase Medicare Part D spending by $36 billion over the next 10 years. The Commission rounded out the meeting discussing beneficiary enrollment/financial obligations, beneficiary care disparities, and clinical workforce shortages in the U.S.
Rural Beneficiary Cost-Sharing is a Major Problem
Shifting from the financial side, MedPAC switched to one of their main focuses for this year’s agenda – how to ensure the viability of rural health care in America. The most animated discussion of the day revolved around cost-sharing obligations for rural Medicare beneficiaries receiving care in Critical Access Hospitals (CAHs). Staff analysis showed that rural Medicare beneficiaries receiving care in CAHs pay significantly more than beneficiaries in Prospective Payment System (PPS) hospitals due to a byproduct of how CAHs are paid. One analysis even showed that half of CAHs’ outpatient payments come from beneficiary copayments.
The debate among Commissioners was not about whether this is a problem – all agreed it was – but whether to address the situation with a quick fix or to fix the entire CAH payment system. The majority of Commissioners seemed to settle around the idea of changing beneficiary cost sharing on services to 20% of FFS payment rates, while a faction wanted to not only change cost-sharing but also the entire payment system for CAHs. There was also discussion of placing a cap on outpatient coinsurance for rural beneficiaries to limit out-of-pocket costs. This issue will be discussed again publicly in the January 2025 Commission meeting.
Rural Quality Reporting is Harder to Understand
The final session revolved around rural quality reporting – and if there were metrics available from rural providers. Staff outlined all available metrics but did note that some rural providers are not required to participate in Medicare quality reporting programs. Staff and Commissioners also pointed out the difficulty of Medicare Advantage plan reporting – which is done at the contract level – making it hard to tell what is going on within specific health care markets. Many Commissioners also discussed the difficulty of measuring quality if providers only have small amounts of patients/data (sample size issues). The Chairman said this would be a chapter in an upcoming report, but there were no recommendations or further work outlined on the issue.
What’s Next
So, next steps? After the payment adequacy discussions in October/November/December, we expect these topics and discussions on Medicare Advantage to resurface in January. And we will be in the virtual front row with popcorn!
With the first (only?) Harris vs. Trump debate behind us, Congress is looking to get a funding deal as they try to get back on the campaign trail ahead of the election. We are hearing the chances are increasing for a bipartisan continuing resolution, but with this Congress in this election cycle, anything is possible. With that, let’s get into it. Welcome to the Week Ahead!
The Administration
The Department of Health and Human Services’ Office of Research Integrity ( HHS ORI) is scheduled to publish a rule on September 17 that finalizes the 2024 Public Health Service (PHS) Policies on Research Misconduct, which has not been updated for 19 years. HHS noted that many public comments on this rule expressed general support for better execution and oversight of research misconduct proceedings.
Oversight of federally funded research has also recently received bipartisan interest in Congress. On September 9, the House of Representatives passed the BIOSECURE Act (H.R.8333) by a vote of 306-81. This bill would prohibit federal agencies from awarding contracts, loans, or grants to biotech companies owned by foreign adversaries. We will be watching to see if this bipartisan interest in oversight of federal funding of research continues into the next Administration and the next Congress.
The Senate
Schumer Plans Second Vote on IVF Bill
Senate Majority Leader Chuck Schumer (D-NY) announced that the Senate plans to hold a second vote on legislation to protect access to vitro fertilization (IVF), a type of fertility treatment. Sen. Schumer has criticized Republicans for previously opposing bringing the legislation up for a vote in June (although Sens. Lisa Murkowski (R-AK) and Susan Collins (R-ME) did vote to bring the bill up for debate).
We do not expect the bill to move forward this time around, and we suspect Sen. Schumer knows it won’t either. But it is a good opportunity for the Majority Leader to highlight the issues of abortion access and reproductive health, which have generally been seen as winning issues for Democrats following the overturning of Roe v. Wade.
SFC Highlights IRA Ahead of November
Speaking of highlighting issues before the election, the Senate Finance Committee is scheduled to hold a hearing on the impact of the Inflation Reduction Act on health care costs. As is often the case with congressional hearings, you can identify how the majority feels about the issue or issues being addressed in the hearing by the title: “Lower Health Care Costs for Americans: Understanding the Benefits of the Inflation Reduction Act.”
We expect Democrats on the committee to use the hearing to praise the Biden-Harris (with perhaps more emphasis on Harris) Administration for implementing the law and highlight how Medicare is already in the process of negotiating drug prices for Medicare beneficiaries to reduce costs. Expect Republicans to counter with charges that the law implements price controls that deny seniors access to innovative treatments and will cause health plans to raise premiums.
Other Senate Health Hearings
- 9/18: Senate Homeland Security and Governmental Affairs Committee business meeting (agenda includes S.4667, the Risky Research Review Act, to create a board to oversee potentially risky scientific research)
- 9/19: Senate Health, Education, Labor, and Pensions Committee executive session to consider contempt resolutions against Steward Health Care CEO for refusal to testify
The House
Health Markups Maybe on the Horizon
It sounds like some health care bills might make an appearance in upcoming House Committee markups. Specifically, we are hearing that the House Energy and Commerce Committee is looking to a markup this week which may include extending COVID telehealth flexibilities and other health care bills. Additionally, the House Ways and Means Committee might be looking to move on rural health legislation before the House adjourns at the end of September.
We will be watching to see if any of these bills make it into an end-of-the-year legislative package.
Health Care Week at Last?
We previously reported on the potential for a “health care week” where the House might consider several bills related to health care. Although that never materialized, we expect to see a lot of health care action this week.
House Majority Leader Steve Scalise (R-LA) announced the schedule for floor action that includes several health care bills on topics such as Medicaid access to care, reauthorization of funding for disease-specific research programs, telemedicine, and more. You can find the list of these bills (along with links to bill text) here.
Passing the House is one thing, but might these bills be included in an end-of-the-year legislative package? It’s always easier to get bills included in an end-of-the-year package if they are bipartisan and have passed one chamber of Congress. The health care bills that could be considered this week all meet the first part of that criteria. For example, H.R.4758, the Accelerating Kids’ Access to Care Act has 76 Democratic and 48 Republican cosponsors.
Other Health Care Hearings
- 9/18: House Ways and Means Health Subcommittee hearing on chronic disease prevention and treatment
- 9/18: House VA Health Subcommittee hearing on oversight of the Veterans Suicide Hotline
- 9/18: House VA Health Subcommittee markup
There You Have It
On September 17, we celebrate Constitution Day because this is the date the document was signed back in 1787. Check out this list of facts about the Constitution from the National Archives. Do you have any fun facts about the Constitution? Let us know! Make it a great week!
Congress is returning to town, with a deadline fast approaching to fund the government past September 30. The word is that Speaker Mike Johnson (R-LA) is planning on bringing up a continuing resolution (CR) that would provide level funding for the government. But Senate Majority Leader Chuck Schumer (D-NY) and Appropriations Chair Patty Murray (D-WA) issued a joint statement on September 6 calling the bill highly partisan and pre-blaming House Republicans of a potential government shutdown. With that, let’s get into it. Welcome to the Week Ahead!
The Administration
Harris and Trump Prepare for Big Debate
Vice President Harris and former President Trump will face off for the first time on a debate stage on September 10 in Philadelphia. There is a lot to watch for, but we will especially be on the look out to see how the candidates try to position themselves on health care issues. Specifically, will Vice–President Harris be asked to explain her current position on Medicare for All? Will former President Trump be asked if he still wants to repeal the ACA? We will tune in to find out!
Season of Rules
The Centers for Medicare and Medicaid Services (CMS) will close the comment period on two proposed rules this week: the Calendar Year 2025 (CY2025) Physician Fee Schedule proposed rule and the CY2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. We are also expecting HHS to issue a rule to expand coverage mandates for certain types of health plans to provide mental health and substance abuse coverage.
So What? We will be watching to see how CMS resolves concerns raised about the more controversial parts of the proposed rules. For example, the American Medical Association has been very upset about the proposed reimbursement cuts in the proposed physician fee schedule rule. However, these cuts are Congressionally mandated so there is not much the agency can do. We expect more anger from the AMA if the proposed cuts are finalized.
The Senate
HELP Hearing Drama
The Senate Health, Education, Labor, and Pensions (HELP) Committee is scheduled to have a hearing on September 12 to examine the bankruptcy of Steward Health Care and the impact that management decisions had on patient care. Chairman Bernie Sanders (I-VA) issued a press release Friday announcing the committee will still move forward with the hearing despite Steward CEO Ralph de la Torre’s refusal to testify.
Dr. de la Torre is refusing to testify, despite a bipartisan subpoena issued by the committee in July. Dr. de la Torre had reportedly requested delaying his testimony until after federal investigations into fraud and corruption allegations were complete but HELP Chair Sanders was not interested in delaying committee action in the wake of what he calls an “outrageous display of corporate greed” that put “patients and communities at risk.” We will be monitoring how the Committee proceeds in the wake of Dr. de la Torre’s decision not to testify.
Wanted: A New Member for Senate Finance
After former Sen. Menendez (D-NJ) announced he would be stepping down in light of bribery charges, the Senate Finance Committee was left a member short. This matters because the Committee now has an equal number of Republican and Democratic Senators, which makes it hard for the majority to move legislation unless they have support from at least one member of the minority.
So, what is to be done? Democratic New Jersey Governor Phil Murphy appointed George Samir Helmy to serve as a U.S. Senator on August 18 until the winner of the November election is determined. To keep things simple, Helmy might be given the opportunity to serve on the Finance Committee until the November elections.
The House
BIOSECURE Act on Deck
House leadership looking to advance biosecurity legislation targeting Chinese biotechnology firms, has placed the BIOSECURE Act (H.R. 8333) on a list of items that could be considered the week of September 9. This bipartisan bill would prohibit federal agencies from awarding contracts, loans, or grants to biotech companies owned by foreign adversaries. The bill would apply the ban to five specific companies of concern and require the publication of a list on an annual basis. The bipartisan bill, which would have major implications for the global biotech industry, has the support of BIO and is expected to pass by suspension.
Looking ahead for Ways and Means… and Energy and Commerce
The Ways and Means Committee is planning to get back into the swing of things with health care activity later in September. The committee is likely to hold a hearing on special needs plans (SNPs) focusing on coordination of care and the cost of chronic care. In addition, word is that the committee will also meet to mark-up various bills, including some health priorities, later this month.
We also are still expecting the Energy and Commerce Committee to announce a mark-up of multiple health bills, including an extension of telehealth flexibilities, later this month.
Other Health Care Hearings
- September 10: House Oversight and Accountability Subcommittee on Government Operations and the Federal Workforce hearing on improper payments and fraud in pandemic programs
- September 10: House Energy and Commerce Health Subcommittee legislative hearing on FDA food and tobacco product regulation
- September 10: House Education and Workforce Subcommittee on Health, Employment, Labor, and Pensions hearing on employer-sponsored health benefits
- September 10: House Select Subcommittee on the Coronavirus Pandemic hearing with former NY Governor Cuomo
- September 10: House Veterans’ Affairs Subcommittee on Economic Opportunity Oversight hearing on evaluating mental health support programs for separating servicemembers
- September 11: House Veterans’ Affairs Health Subcommittee legislative hearing
- September 11: House Energy and Commerce Subcommittee on Oversight and Investigations hearing on the organ procurement and transplantation network
- September 11: House Judiciary Subcommittee on the Administrative State, Regulatory Reform, and Antitrust hearing on PBMs
- September 11: House Appropriations Subcommittee on Agriculture, Rural Development, and Food and Drug Administration and House Agriculture Subcommittee on Nutrition, Foreign Agriculture, and Horticulture oversight hearing on food distribution shortages in tribal and elderly communities.
There You Have It
Are you planning on watching the presidential debate? Do you play Debate Bingo? How many health care priorities are on your card? Let us know! Make it a great week!
