Insights

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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Meet Stacey Rampy: Seasoned Health Care and Appropriations Government Affairs Specialist

We spoke with Stacey Rampy, Principal at Chamber Hill Strategies, about the value of bipartisanship, the current political environment, and what she is tracking as we start the new year.

You have several years of experience working on health care policy, both in Congress and in the private sector. What professional accomplishments are you proudest of?

There are a couple of accomplishments that come to mind. Both have shaped my understanding of how bills with bipartisan and bicameral support have the best chance of becoming law.

For example, I helped a trade association that represents managed care pharmacies convince policymakers to enact legislation clarifying a safe harbor for the pre-approval exchange of health care economic information between payors and pharmaceutical manufacturers about therapies in the pipeline. This information is critical for plans to make timely coverage decisions when new treatments come to

market. Key to our success was the use of a partnership forum to bring together diverse stakeholders to inform our legislative “ask” and convince key Members of Congress and the committees of jurisdiction to intervene with a legislative safe harbor to foster this integral exchange of information.

Another example from my career comes from the more than 17 years that I represented the American Clinical Laboratory Association (ACLA). One of their most pressing issues recently has been addressing a Medicare payment policy that exacts deep cuts to clinical lab reimbursement rates. I helped develop and implement a legislative strategy to convince Congress to delay implementation of that law, and we successfully secured three consecutive delays of that damaging policy.

You mentioned bipartisanship. Tell us more about the value of bipartisanship to achieve success?

I would tell anyone who wants to know more about the value of bipartisanship to look at examples in Congress and in the private sector. When I worked for Rep. Anna Eshoo (D-CA), I saw how she worked with Republicans to advance health policy that she knew would benefit her constituents. When I started my career in multi-client consulting, I worked for a mid-sized bipartisan firm where our best chance of achieving success on behalf of a client centered around a bipartisan strategy. When I decided to strike out and start my own government affairs shop, I knew I would be my most effective with a strong GOP partner. I know Democrats: how they think, how they prioritize issues, and what they care

about. I rely on smart GOP partners to provide insights on Republicans and to help inform my strategy when meeting with Democrats. For example, I’ve adjusted how I approach an issue and which Members to target for support based on what I learn from my GOP colleagues. The bipartisan makeup of Chamber Hill Strategies was a driving motivation for my decision to join the team.

How, if at all, has the political environment changed in DC during your career? How have you adapted to changes to best do your job?

One of the biggest changes I have observed in DC during my career is how the pressure has increased on Members of Congress on both sides of the aisle to tow the party line. In response, I have found that health policy issues often require a diverse group of stakeholders to convince a Member that a policy makes sense for their constituents. It can be more challenging to get a Member to take action, especially if it is something that antagonizes their party’s leadership, or if there is only one stakeholder asking for their support. It is also helpful for stakeholders to be based in the Member’s district or state. Finally, it is imperative to be strategic about which Members you are seeking out to lead an issue. Prioritizing those who sit on committees with jurisdiction over the issue, is paramount and finding those willing to engage their party’s leadership, even if it means bucking it, is also really important.

As we begin the new year, what issue(s) in the health care space do you think are the most important to watch?

The issue that comes to mind for me as being the most important to watch is the use of Artificial Intelligence, or AI, in health care. This issue has been a focus for the White House as well as key committees such as the House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee. Bipartisan leaders, as well as health care stakeholders, have called for greater regulation given the potential impact on patient safety and security. For instance, concerns have been raised about how the use of AI in health care can lead to discrimination based on certain demographics. So, I think there is going to be a growing focus on this coming from policymakers in 2024.

Can you talk about any experience you have lobbying federal agencies?

I have significant experience lobbying federal agencies, including the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), the Office of Management and Budget (OMB), as well as the White House. I served as the Executive Director of the Essential Health Benefits Coalition (EHBC), an alliance of employers, insurers, and providers, focused on establishing guardrails around the essential health benefits requirement under the Affordable Care Act (ACA). The bulk of our advocacy was focused on senior staff at HHS and the White House.

When lobbying federal agencies and the White House, you generally are dealing with very senior staff, so you need to use those meetings judiciously and be really prepared. You

can’t just depend on talking points and you need to be ready to answer questions on deep policy considerations. The use of reliable and meaningful data to support your position can be enormously helpful, and often required, in order to convince them to take action on your behalf. Finally, unlike lobbying before Congress, you can’t rely on arguing that a policy will be beneficial to constituents in a specific state or district because federal agencies and the White House have a national constituency. You really need to depend on the merits of the argument for the policy itself.

Are there any other things you think clients or prospective clients should know?

I would want clients and prospective clients to know that even though I am, first and foremost, a health care policy and advocacy specialist, I do have experience in other areas as well. I have worked on behalf of health care clients who do not have representation on other issues, such as those related to tax and education. I have also worked on appropriations both on off and Capitol Hill. I have used both the community project funding (or earmark) process and accompanying report language to achieve policy victories on behalf of clients. For example, I employed the community project funding mechanism to achieve $10 million in programs for a leading academic medical center in FY 2023.

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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Jen Holland: Leading with Purpose

Join us for an insightful conversation with Jen Holland, Chief of Staff at Chamber Hill Strategies, as she reflects on leadership philosophies and her unique journey to the dynamic world of politics and advocacy. 

What drew you to Chamber Hill Strategies?  

I was attracted to the firm by its founding partner Jennifer Bell, her vision, and the award-winning advocacy services that Chamber Hill Strategies provides for our clients. Jennifer embodies the qualities I value in a leader – integrity, passion and a deep commitment to excellence.  

The prospect of working for a woman-owned firm particularly appealed to me. As the firm expands into new service offerings, I am excited to play a central role in the firm’s continued growth and client success. 

What leadership styles do you value the most and how have they impacted you?  

Throughout my career, I’ve been fortunate to hold diverse positions that have provided me with an up-close perspective on senior leadership in various organizations. A valuable lesson I’ve gained is that the traits of a strong leader transcend industries. Excellence resides in the attention to detail and effective communication. Successful leaders articulate their vision with clarity and kindness. When combined, these qualities not only empower teams but also serve as powerful motivators. 

What’s some of the best career advice that you’ve received?  

Always recognize the significance of relationships. The most fulfilling aspects of my professional journey have revolved around connections—some developing into long-standing professional relationships, and some being brief and seemingly inconsequential, yet profoundly memorable. The world is teeming with fascinating individuals, and by taking the time to understand their stories, your life will be enriched. 

What do you like to do in your free time? 

I love kicking back with a good book in my free time—whether it’s a lazy weekend or a chill evening. It’s my go-to way to unwind and escape into different worlds, bringing a bit of joy and relaxation to my days. I especially like biographies which permit me to learn in detail about accomplished people. I also love to travel and recently traveled to Portugal, a lovely country with amazing food, centuries of history, and friendly people. 

 

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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The Week Ahead 12/18/23: Bah Humbug! The Senate in One More Week – No Real Traction on Supplemental

Good morning from Washington DC, where like much of the east coast we were battered with rainstorms last night.  Fortunately, we woke to sunny skies coupled with forceful winds. The turbulence remined me of the push and pull taking place over the war supplemental request tied to border security measures, as conservatives are angling to slow roll the process and liberals are expressing concerns over actions in Gaza. We continue the conversation below as President Biden is being pulled in both directions, while also battling troubling poll numbers. As we conclude a turbulent political year which saw the ousting of a House Speaker, surprise retirements, and the expulsion of a perpetually lying congressman, we can only hope the administration and a divided congressional body learn to work together to fund the government and pass meaningful legislation in 2024. We can all learn something new – as I read an article last night clarifying the true cause behind the Boston Tea Party. It was caused over a corporate tax decrease (not an increase on tea tax) which would have enticed the colonists to buy lower-cost taxed tea thereby giving up the principle of no taxation without representation. The Senate is in this week and President Biden dodged a car crashing into his motorcade!  Welcome to the Week Ahead!

The Administration

What a past few days President Biden experienced.  Last night, a car crashed into a SUV in his motorcade right after he answered questions from reporters about why he is trailing Trump in the polls.  Fortunately, the President and First Lady were fine.  In addition to polling headaches, the President continues to face an uphill battle in terms of his war supplemental request. As we’ve mentioned in past weeks, the administration wants to provide funding to Israel, Ukraine, and Taiwan, but the House wants to link any funding request to changes in border security measures. The President, feeling much like the Stealers Wheel Song – Stuck in the Middle With You, is feeling clowns to the left of him and jokers to the right. Conservative opposition to funding Ukraine without reforming border security measures continues to mount and stall the process, while members of the Congressional Hispanic Caucus voiced concerns about the Biden Administration not communicating with them regarding negotiations which took place this weekend.

In healthcare news, the Center for Medicare and Medicaid Services released a voluntary payment model to improve maternal health in the US, a pillar of the Biden Administration’s goals in healthcare. The Transforming Maternal Health Model (TMaH) plans to partner with state Medicaid agencies to lower maternal mortality rates while reducing associated health disparities. The initiative will develop a value-based alterative payment model which will improve health outcomes and quality.  TMaH will focus on three main pillars: 1. Access to care, infrastructure, workforce capacity; 2. Quality and safety, 3. Whole-person delivery.  The program aims to work with participating states to address gaps in maternal health care by supporting access to midwives and doulas, improving perinatal care for chronic conditions like diabetes and hypertension, and reducing c-sections for low-risk mothers.

 

The Senate

Senate Majority Leader Schumer made sure he received less holiday cards this season as he called the Senate in session this week.  Senator Schumer hoped this week would allow for a negotiated package to come to the floor this week.  However, negotiators on the supplemental request, while making progress, failed to come to agreement on a package.  The White House was directly involved, and it is reported that some provisions were agreed to but that large hurdles remain.  Senate Republicans are in no rush to have a vote, and Senator Chris Murphy stated no legislative text exists for members to vote on at this time.  Senator Ron Johnson led a group letter of conservatives requesting a conference-wide meeting to discuss what they felt were “secret” negotiations with Democrats. All this to say, it is unlikely a floor vote on a supplemental request without legislative text will pass this week.  This sets up a particularly busy early part of January which also runs into the first tranche of government funding.  The Senate is also moving on stalled military nominations this week.

Senators are moving in a bipartisan work on health transparency with new legislation that requires insurers, hospitals, and other health facilities to disclose more pricing information.  The legislation entitled, The Health Care Price Transparency Act, 2.0, aims to be more stringent than its House counterpart by requiring hospitals to post the actual price for a service, rather than the median price. Like the House passed Lower Costs More Transparency Act, the measure extends transparency requirements to imaging centers and clinical labs, among others.

The House

The House finished its business last week and is out until next year.

Things will pick up quickly come January 8 as the House will only have eight legislative days before the first set of appropriations and health extender deadlines hit on January 19.  The House will only have an additional 4 legislative days before the second set of appropriations deadlines hits on February 2.  Rumors have started to percolate the House could extend the appropriations bills set to expire on January 19 to February 2, and a very likely scenario is a year-long continuing resolution to fund the government at current levels through Fiscal Year 2024 will be the result in February.

With multiple health extender deadlines hitting on either January 19 or 20, whatever government funding package is passed to fund the government past January 19 is expected to include health extenders. With the House having passed the Support for Patients and Communities Reauthorization Act last week with broad bipartisan support, it is rumored that the legislation could be packaged and passed along with provisions to provide partial relief from a scheduled 3.37% cut in Medicare physician payments and extend incentive payments for alternative payment models that would closely align with provisions passed the House Energy and Commerce Committee and by the Senate Finance Committee. Other provisions to be included would extend payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, an extension of the Work Geographic Practice Cost Index (GPCI) Floor, and extensions of funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).

While the House did also pass the Lower Costs, More Transparency Act with bipartisan support last week, it seems less likely that the pharmacy benefit manager reforms and other measures, including site neutral payments for certain services, will be in play for moving in a January package because why include things to which everyone agrees?

As always, we value your insights and look forward to hearing from you!  This will most likely be the last Week Ahead for 2023.  Thank you for making this a wonderful year, and from all of us at Chamber Hill Strategies we wish you happy holidays and a fantastic New Year!

Create a great week!

How to Lobby Congress: Insights from a Leading DC Lobbying Firm 

Navigating the halls of Congress to influence policy decisions is both an art and a science. As an established lobbying firm in DC, Chamber Hill Strategies has honed the craft of effective lobbying. In this guide, we delve deeper into how to lobby Congress, drawing from our extensive experience as DC lobbyists. Whether you’re a seasoned advocate or new to the realm of political influence, these expanded strategies will empower you to make a meaningful impact.

Understanding the Legislative Process

Research and Preparation: A critical step in effective lobbying is understanding the legislative process. Resources such as Congress.gov provide a wealth of information about current bills, committee activities, and legislative procedures, essential for anyone engaging in lobbying in DC.

Building Relationships

  1. Community Engagement: Engaging in local politics, such as attending town halls and joining community groups, can be a valuable way to start. These settings offer opportunities to voice concerns and connect with local representatives, a common practice among lobbyists in Washington DC.
  2. Social Media Engagement: Platforms like Twitter and Facebook serve as modern tools for engaging with legislators. They allow for direct communication and offer a platform to participate in political discourse.

Crafting Your Message

Clear and Concise Messaging: Conveying your message clearly is essential. Incorporating personal stories and supplementing them with data can make your message more compelling. The Pew Research Center is a resource for finding relevant data to support your arguments.

Data and Evidence: Utilizing data to reinforce your message is a strategy commonly used by lobbyists. Accessible public data sources like Data.gov are invaluable for this purpose.

Effective Advocacy Strategies

Direct Lobbying: Direct communication with legislators can be highly effective. For those looking to engage in this manner, USA.gov provides guidelines on contacting elected officials.

Grassroots Mobilization:

  1. Community Meetings and Forums: Participating in or organizing local events can be an effective way to spread awareness and encourage collective advocacy efforts.
  2. Online Campaigns: Platforms like Change.org are increasingly used for mobilizing public support around various causes.

Engage with Our Experts at Chamber Hill Strategies

As an award-winning lobbying firm in DC, Chamber Hill Strategies is dedicated to providing expert assistance and strategic guidance in lobbying Congress. Whether you’re an individual advocate or represent an organization, we offer personalized support to help you navigate the complex landscape of Washington DC lobbying. For more information, please visit our Contact Us page.

How to Lobby Congress: Insights from a Leading DC Lobbying Firm

Zach Schulz: Passion for Policy and Public Service

We caught up with our associate Zach Schulz to learn what drives him and why he is so valuable to our clients.

1. What are some of the highlights of your career?

The primary focus of my career has always been centered around this question: What can I do to bring about the change I wish to see and help people? Running for the State House in Iowa provided me with a valuable experience. Despite not securing a victory, the journey allowed me to learn extensively about the needs of constituents and connect with a multitude of amazing individuals. During my tenure in Senator Grassley’s (R-IA) office, a notable aspect of my role involved managing constituents’ calls and correspondence. The direct interaction with constituents helped me gain a deeper understanding of their needs. Listening to constituents amplified the importance of our legislative work, making the process of passing legislation feel even more crucial and impactful.

2. At what age did you realize your passion for politics and advocacy, and what sparked that interest?

I’ve been interested in history for as long as I can remember, and so I think the jump from history to politics was natural. My interest in political advocacy began when I checked out a book from the library on how to impact change in your community, and it flipped a switch in me. I knew from that moment on that politics was where I wanted to be, and I’ve felt the same way since.

3. When thinking about work, what excites you?

Getting answers. I love to help clients by getting into the weeds of policy research and finding the answers to any questions they have. It’s the challenge of diving deep into the details, understanding the intricacies, and delivering valuable solutions that truly drives my passion for the work. The satisfaction of providing clients with the clarity and information they need keeps me motivated and enthusiastic about every project.

4. Why did you leave the Hill, what motivated you to join the private Industry?

Working for Senator Grassley’s office was an incredible experience; it was and is an exceptional office, and the work was more than fulfilling. Despite my deep appreciation for the work I did in government, I found myself seeking new avenues to expand my skills. I developed a profound interest in healthcare policy while working there. To explore this passion further, I made the

decision to transition to the private sector, eager to view healthcare policy through a different lens outside of the government.

5. What’s one important question that I haven’t asked you yet?

I would ask if I see myself finding a passion for a policy area other than healthcare. And to that, I answer that my passion for healthcare policy started as a passion for public policy in general. I find passion in healthcare because I found it’s a great avenue to help enact large-scale change that can help a lot of people. That doesn’t mean that healthcare is the only policy area I can do that with. I have recently found myself getting more into energy policy as well. So, I can see myself having a wider range of policy expertise in the future, but healthcare policy will always be something I love.

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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