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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.
On February 5, 2024, the House Rules Committee held a hearing discussing the use of quality-adjusted life years (QALYs) in healthcare methodologies. The bill under discussion would ban using quality-adjusted life years (QALYs) and other measures to make coverage and payment decisions in all federal health care programs.
The KFF report on Health Coverage by Race and Ethnicity underscores the crucial role of health insurance coverage in accessing healthcare services and mitigating excessive medical expenses. This blog post summarizes the report’s findings.
Persistent Disparities in Coverage
The KFF report reveals that disparities in coverage have been entrenched over time and, in some instances, have widened despite previous gains under the Affordable Care Act (ACA).
- From 2010 to 2022, the uninsured rate among American Indian and Alaska Native (AIAN) individuals increased from 2.5 times higher than that of White individuals to 2.9 times higher.
- Similarly, Hispanic and Black individuals remained disproportionately more likely to be uninsured compared to their White counterparts.
Advancements during COVID-19 But Still Problematic
Notable improvements in health coverage were observed across various racial and ethnic groups between 2019 and 2022. These improvements primarily resulted from state and federal efforts to ensure affordable coverage during the COVID-19 pandemic.
- These efforts narrowed the gap in uninsured rates between Hispanic, Black, and AIAN individuals compared to their White counterparts.
- However, disparities in coverage persisted as of 2022, with nonelderly AIAN and Hispanic individuals exhibiting the highest uninsured rates.
High Uninsured Rates for Black and Hispanic Individuals Persist Even in Medicaid Expansion States
States that expanded Medicaid, as highlighted in the KFF report, witnessed lower uninsured rates across racial and ethnic groups than non-expansion states.
- However, the relative likelihood of Black and Hispanic individuals being uninsured as compared to White individuals remained consistent across both expansion and non-expansion states, underscoring ongoing systemic challenges.
Risks of Disenrollment from Medicaid Unwinding
The KFF report emphasizes concerns about potential disenrollment following the unwinding of Medicaid continuous enrollment post-pandemic. This raises concerns about its disproportionate impact on Hispanic, Black, AIAN, and NHOPI individuals, as highlighted in the report. Disenrolled individuals may face challenges accessing alternative coverage options, potentially exacerbating existing disparities.
Addressing Coverage Disparities
The report highlights the following to prevent coverage losses and narrow disparities:
- Policies that stabilize coverage
- Enhanced outreach and enrollment efforts
- Policies that provide continuous coverage for vulnerable populations, particularly children
- Increasing Medicaid expansion across states
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On January 31, 2024, the House Energy and Commerce Committee Health Subcommittee held a hearing to discuss the growth in U.S. health care spending. Committee members discussed the need to create solutions to curb spending growth, discussing both bipartisan and partisan solutions to the issue.
