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Health Care Policy in the 2024 State of the Union Address
Heading into election season, President Biden delivered his annual State of the Union Address with a number of familiar health care policy mentions. This blog post focuses on what the President talked about, the implications of those issues for 2024, and the chances of movement on these issues in the current Congress.
Inflation Reduction Act
President Biden highlighted the passage of the Inflation Reduction Act (IRA) and the health care provisions in the bill including:
- Medicare drug price negotiations,
- expanded ACA subsidies, and
- the out-of-pocket cap on insulin and other prescription drugs for Medicare beneficiaries.
He called for building on this legislation by expanding Medicare negotiation authority to include more drugs, making the expanded ACA subsidies permanent, and extending the out-of-pocket caps to all Americans. President Biden’s focus on these provisions makes sense given polls such as this one from KFF that show Americans are not very familiar with the specifics of the IRA.
Abortion
President Biden spoke forcefully about his view that reproductive rights should be protected. Polls, such as this one from KFF, show that the issue is very important as a motivator for the Democratic base and key constituencies. President Biden called for Congress to send him a bill to make Roe v. Wade the law of the land. He also highlighted his opposition to state bans on abortion or efforts to curtail access to services such as IVF.
Protecting Medicare
President Biden reiterated his opposition to what he described as efforts to cut Medicare. This portion of the speech elicited jeers from the Republican side of the aisle. As we mentioned in a previous blog, this issue is especially important for older voters, so we expect the President to continue to highlight ways his administration is protecting Medicare, especially in geographical areas with high concentrations of older voters.
Hope for Bipartisanship
President Biden did include some areas of health care policy in the 2024 State of the Union where there is strong potential for bipartisanship. For example, the president spoke about:
- federal funding for the ARPA-H and
- efforts to address concerns about fentanyl.
The President also mentioned a new Women’s Heath Research initiative that he will be asked Congress to fund in the coming days.
So What?
It is difficult to see how Congress can move on any major health care legislation before the election, given the fragile majority Republicans hold in the House and the almost-default requirement for at least 60 votes in the Senate. It was certainly important for the President to bring up these ideas given how much voters want to hear from the president and his opponent about their respective health care policy proposals. If there is going to be any movement in Congress on health care policy in this election year, we expect areas of health care policy in the 2024 State of the Union such as federal funding for cancer research and efforts to address concerns about fentanyl to be the areas where any movement occurs.
On March 8, 2024, MedPAC commissioners discussed the Acute Hospital Care at Home (AHCaH) program reviewing pros and cons and whether the program should continue. After reviewing data and discussion, Commissioners were generally optimistic about the benefits of the program and thought it should be continued until more analysis can be completed on program efficacy.
Kicking of Women’s History Month, Nikki Haley won the primary in the District of Columbia, making her the first woman to win a Republican primary in US history. The other big news of the weekend was that congressional leadership, along with congressional appropriators, released a bipartisan package of six bills to stave off a government shutdown. The goal of both chambers is to pass the spending bills by Friday’s partial government funding deadline.
The Administration
President Biden will deliver the State of the Union this Thursday, as the administration hopes to land a winning message with voters. The President will focus on his accomplishments to include infrastructure and others, while he makes the case for another term. The President will rally around staying the course to continue steady progress as opposed to new leadership. Themes will focus on corporations paying their fair share, protecting democracy, and ending cancer among others. Despite having the bully pulpit, many polls show President Biden losing to Donald Trump if the election was held today.
The Senate
The Senate will take up the bipartisan appropriations bills once they are passed by the House to avoid a partial government shutdown on March 8. All signs appear to point to passage, but we can never be too certain in this environment. The bills included are Agriculture-FDA, Commerce-Justice-Science, Energy-Water Development, Interior-Environment, Military Construction-VA, and Transportation-HUD. Both sides of the aisle are claiming victory on this package, as funding in many areas largely remains flat. Funding for the remaining bills will run through March 22 per the earlier passed continuing resolution.
Healthcare
On Wednesday, March 6, the Senate Budget Committee will hold a hearing on how primary care improves health efficiency. Additionally on Thursday, the Senate HELP Committee will hold full committee hearing on the Older Americans Act. The OAA is usually met with bipartisan support.
The House
The House is back in on Tuesday, with 5 bipartisan health policy-related bills on the schedule for the week, covering issues including maternal health, pediatric research, dental health, promoting primary care in Medicaid, and reauthorizing the Firefighter Cancer Registry.
Drawing more attention though will be the House’s consideration of a legislative package that was released Sunday that will finalize funding for government programs and agencies through the remainder of Fiscal Year 2024. In the closely divided Congress, the package gives both parties victories to champion while there will certainly be detractors among their ranks as well. While Republicans are celebrating certain cuts and law enforcement provisions, Democrats are touting their own success in stopping many cuts and policy riders that Freedom Caucus members had been pushing. Even with some naysayers, the House is expected to pass the legislation by a large margin before sending it to the Senate later this week.
Healthcare
In addition to funding these agencies and programs, the appropriations package includes expiring programs included 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). House Energy & Commerce Ranking Member Frank Pallone (D-NJ) praised the agreement which includes a 10 percent increase for CHCs, a 17% increase for the NHSC, and a 56% increase in THC GME. In addition, after much back and forth, the legislation also provides a 1.68% increase in Medicare physician payments to help mitigate the 3.34% cut in Medicare payments that took effect on January 1.
While the final package also includes measures to reauthorize substance abuse programs under the SUPPORT Act, despite previous optimism, negotiators were unable to reach an agreement on larger health legislation on pharmacy benefit manager reforms, site neutral payment policies, and a reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA). Conversations continue on these measures with action later this year still very much a possibility.
With a busy week for health policy on the House floor, it will be a little quieter week in most House committees. That said, the House Oversight & Accountability Committee’s Select Subcommittee on the Coronavirus Pandemic will hold what could be an interesting hearing on Wednesday, March 6, titled the “White House Role in Pandemic Preparedness and Response,” where it will hear testimony from Maj. Gen. Paul Friedrichs, M.D. (ret.), the White House’s Director of the Office of Pandemic Preparedness and Response Policy.
As always, please reach out with any questions as we continue to track the developments of this week!
On February 29, 2024, the House Energy and Commerce Committee Health Subcommittee held a hearing to discuss several pieces of legislation related to rare diseases. Representatives and witnesses agreed that more needs to be done to ensure Americans with rare diseases have access to innovative treatments at an affordable price.
