Insights^

Let’s start with 3 questions about timing this week.  See if you can guess the answers! 

• What happened on time?   Selection Sunday for the NCAA Men’s and Women’s Basketball Tourneys – one of our favorite events of the year! 
• What happened early?  Cherry blossoms.  The National Park Service declared peak blooms hit on March 17 – the second earliest peak on record. 
• What happened late? Well, sort of, we still don’t have a clear path to fund the government past March 22.  Better late than never?! 

The Administration 

Health and Human Services Sec. Xavier Becerra will makes a second set of appearances this week on the President’s Budget.  His testimony before the Senate Finance Committee last week touted the Administration’s efforts to lower prescription drug costs and increase the number of people insured under the Affordable Care Act.  Expect more pointed questions in the House Appropriations Committee about funding priorities and the House Ways and Means Committee about Medicare and health savings accounts on March 20. 

What hasn’t yet come up in these hearings is the Administration’s response to the cyberattack on Change Healthcare, a unit of UnitedHealth Group that processes 15 billion health care transactions annually and touches 1 in every 3 patient records.  CMS, the HHS Office of Civil Rights, and the Department of Labor have all sent out notices of assistance within their jurisdiction.  The American Hospital Association has indicated the response to date has been woefully inadequate. 

The Senate 

The mad dash this week is to make sure the government remains funded past March 22 and before both the Senate and House will go back to their states and districts for a 2-week district work period.  While appropriations leaders have been working through the weekend, there’s no paper yet.  

We will be keeping our eyes peeled for any updates on the AI front, as the Gang of Four was predicting releasing their lessons learned from the various AI Insight Forums held over the last few months.  While the leaders will release a set of findings and suggested direction, the work of legislating will be left to the committees. 

The House 

If it feels like déjà vu all over again, you’re not alone.  We have 1 week to go to fund 6 major departments including HHS, Education, Labor, Homeland Security, Defense, State, and Treasury.  Funding for Homeland Security is one of the sticking points.  We had been anticipating the possibility of certain health care policy riders being attached, such as pharmacy benefit manager reform, hospital price transparency, and community health center funding, but it looks like these proposals may have to wait until after the election. 

• Don’t forget – Rep. Ken Buck (R-CO-4) is retiring on March 22 – shrinking the GOP majority to a mere 5 votes (218-213). The margin will likely shrink further when New Yorkers go to the polls on April 30 to select a replacement, likely a Democrat, for the recently retired Rep. Brian Higgins (D-NY-26).  

Besides Sec. Becerra’s appearance before the House Ways and Means Committee, we will be watching closely as the House Energy and Commerce Health Subcommittee rips into FDA’s controversial proposed rule to regulate lab developed tests on March 21. The full Committee may also be marking up a number of health and non-health bills. 

So, here we go – March Madness – DC style.  If you have a free minute, don’t forget that MedPAC and MACPAC sent up their annual March Reports to Congress!  If you remember being able to receive those pubs by mail, let us know….  

The daffodils are in full bloom in Washington and Congress and the administration are trying to make the most of the next 2 weeks before taking a break for the Easter holiday.  There’s a lot going on in DC, so let’s get to it!

The Administration

All eyes on are the President’s annual budget release which will set out the President’s priorities for the government heading into the November elections.

• Pay attention to what the President is proposing that can be done through Executive Order or regulation vs. what needs Congressional action.  While the “dead on arrival” phrase is often used in Washington, some things will be deader than dead, if that’s a thing, but anything the President can do on his own is fair game.

On March 1, President Biden gave his third State of the Union address, leaning into issues that energize the Democratic base and remind viewers and voters of his accomplishments.  For health care, he:

• promised to restore Roe v. Wade as the law of the land, noting how red states have restricted access to IVF
• expressed his desire to extend the Medicare insulin cap at $35/month to those with commercial insurance
• made the case for expanding the number of prescription drugs subject to Medicare negotiations beyond current law

The Senate

The Senate took a victory lap over the weekend by passing a package of 6 bills to fund the government through September, including the Food and Drug Administration.  Congress now has 2 weeks to figure out how to fund the rest of the government before the March 22 deadline to avoid a partial government shutdown.

• As an aside, how many times have we typed those words – avoiding a government shutdown – in the last few years?  We’ve lost count….

With immigration remaining at the forefront, the next set of bills, including Defense, Homeland Security, and Health and Human Services, won’t come so easily.

For health care, the Senate Finance Committee will host Sec. Becerra for a discussion of the President’s budget on March 14.  Yes, there will be partisanship but that isn’t what most interests us….

• Watch for Senators’ priorities as they comment on the budget – this shows what each is championing and what might be able to move forward yet this year.

The House

The House comes back to take up 11 bipartisan bills coming out of the Transportation and Infrastructure Committee under suspension of the rules. But partisan tensions are sure to resume later in the week as the House brings up a resolution denouncing the Biden Administration’s immigration policy.

For health care, the focus is on the committees this week.  On March 12, the House Energy & Commerce Committee will be meeting to markup and move 19 bipartisan health-related bills, covering a wide range of issues, including maternal health, dementia treatment, cancer screening and a host of other initiatives. One bill of note that has garnered considerable attention is the “Dr. Lorna Breen Health Care Provider Protection Reauthorization Act” (H.R. 7153), which seeks to raise awareness and provide resources to address the mental health issues facing the health care workforce.

Also, on March 12, the House Ways & Means Committee will hold a full committee hearing titled, “Enhancing Access to Care at Home in Rural and Underserved Communities,” which will include testimony from both patients and providers about the challenges in improving access to in-home care and to modernizing the delivery of care in rural and other underserved communities.

There You Have It

We at Chamber Hill Strategies, are counting down the days:

• 10 days left of winter
• 11 days till the men’s NCAA basketball tourney starts
• 12 days to avoid a government shutdown

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!

Good morning from Washington where sunny skies and warm weather on the way signals positive vibes that a deal might be in the works for a temporary patch to fund the government.  Reports over the weekend however made those of us following these developments believe a shutdown might still be in the works. If nothing is accomplished this week, a temporary shutdown would occur at midnight this Friday, followed by a full-scale shutdown on March 8. Procrastination is often a hallmark of Congress, much like my first-grade son getting dressed for school in the morning. Nothing like a good hurry up and wait heading into upcoming negotiations… Welcome to the Week Ahead!

The Administration

President Biden took the lead this weekend to bring House and Senate leaders together for discussions at the White House. The “big four” (Schumer, McConnell, Johnson, and Jeffries) will be meeting on Tuesday to discuss how to fund the government and delay a shutdown. With the State of the Union also on the horizon, it is important the President work with Congress to find a resolution. Concerns from agencies mount, as Congressional Republicans are looking to cut funding across the board like the National Institutes of Health which is looking to face a $3.8 billion cut to their $48 billion in funding the agency received last year. Meanwhile, House Republicans plan to continue to push for the impeachment of Homeland Security Secretary Mayorkas this week.  It is very likely the impeachment proceeding goes nowhere in the Senate as many vulnerable Democrats and conservative senators signaled, as they do not have an appetite to move forward.

The Senate

Senator Schumer sent a Dear Colleague letter blasting House Republicans for not coming to the budget negotiations in earnest. The letter outlines concerns and ramifications as to what will occur if a deal is not struck this week. Concerns include cuts to programs which could impact vulnerable families through the Supplemental Nutrition Program for Women, Infant, and Children (WIC), potential shutdowns of veteran offices, as well as a potential FAA freeze which would negatively impact the hiring of air traffic controllers and cause delays in air travel across the country.

Health Care 

Right now all eyes remain on whether or not the big four can come to an agreement on funding the government and what impact a partial or full shutdown will cause on a variety of health care programs.

The House 

After a week-plus legislative break for the Presidents’ Day district work period, the House returns on Wednesday to consider a slew of bills under suspension of the rules. In a sign of the times, and the struggles facing both chambers, another short-term extension of reauthorization through May 10 was added to the legislative schedule, and arguably, the need for another short-term FAA extension points to the larger challenges facing House Speaker Mike Johnson (R-LA) and House Republicans in coming to an agreement both internally and ultimately with Senate negotiators on legislation to fund the government and on numerous policy provisions that have been connected to the government funding conversations as well.

With the first tranche of funding for four appropriations bills expiring this Friday, March 1, a partial government shutdown is now looking to be a very real possibility. Heading into the weekend, congressional leaders looked poised to release a bipartisan agreement on the first tranche of appropriations bills on Sunday, but ultimately, House and Senate leaders could not come to an agreement as Speaker Johnson continued to face pressures within his own conference—particularly from the Freedom Caucus—over the inclusion of certain policy riders. While this has impact on government appropriations, these struggles also raise questions about what agreement can be reached on various health measures, including several health programs that are set to expire on March 8. Among the expiring provisions 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). In addition, 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.

Health Care

With the House not returning for legislative business until Wednesday afternoon, it will be a light week for health policy. Of note, though, the Energy & Commerce will continue to be active on the health care front with the Committee’s Health Subcommittee holding a legislative hearing on Thursday, February 29, titled “Legislative Proposals to Support Patients with Rare Diseases.” The hearing, which is set to set to coincide with the nationally recognized “Rare Disease Day 2024,” will examine 18 bills related to rare diseases and the challenges facing rare disease patients.

As always, we will be in touch with developments. Create a great week!

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.

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!