Insights^

Welcome back to Washington, DC the town which continues to provide as much drama as Hollywood but without the glitz and glamour.  The weather remains mild, but the heat is on for the Biden Administration and Congress to come to an agreement on a supplemental funding package for Ukraine, Israel, and Taiwan.  As per the usual, this weekend your author took his four-year-old daughter to the movies, this time to see Trolls Band Together.  The theme focused on a music group overlooking its differences and working together during an emergency to save one of their own from a potentially fatal outcome.  If only Congress could take a cue from the third installment of the animated trilogy and work together to end the year on a successful note.  Some say it happened this past week with the ousting of the disgraced George Santos from the House, but we here in Washington know there is much more to be done.  We are in December and much more needs to be done!  Welcome to the Week Ahead!

The Administration

As the end of the year approaches, we are beginning to see priorities of the Biden Administration being challenged by a divided government. The Biden Administration will continue this week to focus on pushing for its war supplemental focusing on aid to America’s allies.  Much remains to be seen on this matter as congressional Republicans are demanding border security measures be coupled with the supplemental.  Of particular concern remains additional funding to Ukraine, which could see Congress pass for a third time on providing additional resources.  In a memo to Congress, Budget Director Shalanda Young expressed the urgency of providing additional funding to Ukraine, as she expressed no more funds exist to support Ukraine. Around 60% of the funding has remained here at home to improve military preparedness here at home, while shipping out equipment to Ukraine.

Among other White House initiatives, House Republicans are pushing back on the Supplemental Nutrition Program for Women, Infants and Children.  The House failed to include extra aid money for the WIC program which helps low-income moms and babies.  The program usually enjoys bipartisan support, but House Republicans are pushing to cut spending for the program this year.  The Biden Administration has requested an additional $1 billion in funding for the program.

The Senate

Majority Leader Schumer is looking to move this week on putting the war supplemental on the Senate floor.  The sticking point for the package, as mentioned previously, is that Republicans want to make any funding package contingent on border security reform measures.  While both Senate and House Democrats agree some border reform measures are needed, Republicans are pushing for more aggressive measures on the border front.  They want to include language from HR2, which Democrats view as a non-starter. Weekend talks on working together fell apart, but we can hope lawmakers return to work together to resolve the disagreement as the world is watching.

In notable committee activity this week, the Senate Finance Committee plans will hold a hearing entitled, “Drug Shortages: Examining Supply Challenges, Impacts, and Policy Solutions from a Federal Health Perspective.”  The hearing will touch on drug shortages in light of critical diseases to include cancer drugs.

The House

The never-ending drama continues to drag out in the House. Last week Congressman Santos was expelled from Congress for ethical violations, (and there were a lot of them), and next the Speaker is saying he has enough votes to bring up articles of impeachment against President Biden. Deep divides remain in the narrowly controlled Republican House and more retirements are rumored by the end of the year (including former Speaker McCarthy).

With only two more weeks to go, Speaker Johnson’s honeymoon is over. The Republican majority narrows to three with Santos out and the government shutdown is looming after the holidays. The Speaker said last week they need to fund Ukraine, which sent the Freedom Caucus in an uproar. The rest of the conference is not even close to agreeing on a foreign aid package that funds Israel, Taiwan, and the border. Speaker Johnson has his work cut out for him finishing up the rest of the year and going into next. There are even rumblings they might even call to vacate the Chair on HIM!

As last week, much of Congress’s attention this week will continue to be on matters other than health care. While health policy won’t be on the floor, and even though Congress extended several expiring health provisions and programs into January, that doesn’t mean that work on important health policy matters won’t be happening.  The House Energy and Commerce Committee announced that it will hold a markup of 44 pieces of legislation, with over 20 being of health policy in nature, on Tuesday. Tuesday’s markup could provide an insight into what additional provisions Congress might include in health-related legislation early next year as Congress had extended several health programs and provided protections from potential cuts into January as well.

Among the legislation being considered on Tuesday will be legislation aimed at lowering prescription drug costs and targeting pharmacy benefit managers and certain PBM practices. In addition, the Committee will consider measures to extend the work Geographic Practice Cost Index floor, to revise the phase in of certain payment changes for lab services, and an extension of certain expiring incentive payments for alternative payment models. In addition, of particular interest, will be the Committee’s consideration of legislation that H.R. 6545, the Physician Fee Schedule Update and Improvements Act, which would not only include a provision providing an additional relief of 1.75%, over current law, to mitigate the 3.4% cuts in Medicare physician payments in 2024, but it would also reform and update how budget neutrality requirements impact Medicare payment rates to physicians and other providers as well. While previous indications pointe to the fact it was doubtful that Congress would take action to provide any relief from cuts to Medicare physician payments, assuming Committee approval this week, along with Senate Finance Committee’s action last month, there seems to be growing interest in providing some relief from pending Medicare physician payment cuts in 2024—even if that relief may need to be retroactive.

Create a great week!

Good morning from Washington, DC where we continue to simultaneously inspire and disappoint. This past weekend we honored our nation’s veterans.  Chamber Hill Strategies would like to thank all of those currently serving, as well as all of those who served.  We salute you!

We are just a few days away from running out of government funding, and the House and Senate appear to be operating in different orbits. Sound familiar?  This past weekend your author did not bother to watch the New York football Giants lose to the Dallas Cowboys. The Giants started a quarterback who just two weeks ago was on the practice squad, and he was put in the difficult situation of trying to lead his team to victory in such a short period of time.  One can only think of the similarity to our new Speaker thrusted into the limelight with very little experience as he attempts to lead the House to a satisfactory resolution for funding the government – while balancing internal strife and external dissonance from an opposing party.  The clock continues to tick as we are in the last two minutes of the government funding game!  Welcome to the Week Ahead!

The Administration

President Biden continues to push for an emergency supplemental package for funding to Israel, Ukraine, and Taiwan with additional funding for border security included.  The varying pace of the Senate and the House on funding the government, coupled with varying viewpoints makes for any passage of a supplemental more likely to occur later in the month and not in time for a continuing resolution. The President continues to face challenging poll numbers as he attempts to assist with peace in other areas of the world.

The Administration scored a win last week with the confirmation of the National Institutes for Health Director Monica Bertagnolli, MD.  On Tuesday, the Centers on Medicare and Medicaid Services will hold a webinar on its finalized updates to the Calendar Year 2024 Home Health Prospective Payment System (PPS).  On Wednesday, CMS will host its conference on optimizing healthcare delivery.

The Senate

Over the weekend, a bipartisan group of senators continued discussions to develop a stopgap agreement which would include supplemental funding for Israel, Taiwan, Ukraine, and increased border funding. However, with limited time available until the November 17^th, the only option in town might be a clean CR to fund the government until January.  This would leave any supplemental funding until after Thanksgiving.  The Senate is in session beginning today and will continue confirming judges. The upper chamber is waiting to see if the House can pass the “laddered” approach put forth by Speaker Johnson as it relates to government funding. The Senate is scheduled to meet this evening to hold a procedural vote on the legislative vehicle for its funding proposal.  It is unclear if Senate Democrats have enough votes currently to pass it.

On the healthcare front, Leader Schumer is hearing from advocates in the drug pricing industry to move forward with a pharmacy benefit manager package which reflects the work of the Senate Finance and HELP Committees.  Senator Schumer is running out of time to produce any bipartisan health package as the upper chamber faces uncertainty around government funding.  This Tuesday, the Senate Finance Committee, Health Care Subcommittee will hold a hearing on telehealth permanency in Medicare to continue beneficiary access.  On Wednesday, the Senate Foreign Relations Committee will hold a [he]hearing on artificial intelligence.  On Wednesday the Committee on Veterans’ Affairs will hold a hearing on emergency preparedness and response.

The House

It appears to be the same old song in the House. Speaker Johnson is facing the same problems as his predecessor. The Speaker realized the honeymoon period is over as last week an appropriations push failed to yield significant results. The Speaker had to pull the Legislative and Financial Services appropriations from the floor because of explosive amendments ranging from defunding the FBI headquarters to abortion issues. He is no closer to the self-imposed Thanksgiving deadline than he was when he took the gavel.

More importantly, government funding runs out on Friday and the Republican conference is not any closer in producing a solution for a stopgap bill that would prevent a government shutdown. Speaker Johnson and his team have floated out a “laddered” plan that would separate different parts of government spending and funding some parts till January 19^th and other parts till February 2^nd.  The proposal would leave government funding at its current levels – which some hardline conservatives oppose. No supplemental funding for Israel, Ukraine, boarder security, or Taiwan is included. Three Republican House members have already come out publicly opposing the approach.  House Democrat leadership has not publicly stated whether they would oppose the laddered approach.

In terms of health-related provisions, the bill would extend funding for community health centers, teaching health centers and the National Health Service Corps through January 19.  The bill also aims to delay cuts to safety-net hospitals under Medicaid through January 19.

At this point, the Speaker is facing a similar dilemma as former Speaker McCarthy – a good chance exists that he will need Democrats to support his proposal to get it passed. Time continues to tick… Can the Speaker run a successful two-minute drill and take his team down the field for a score?

In notable House Committee meetings this week, the House Committee on Rules will conduct a hearing H.R. 5894 – Labor, Health and Human Services, Education, and Related Agencies Appropriations Act for FY 2024 on Monday.  Tuesday will see the Health Energy and Commerce Committee Communications and Technology Subcommittee hold a hearing on “Leveraging AI to Enhance American Communications.”  Also on Tuesday the House Committee on Veterans Affairs, Health Oversight Subcommittee will hold a hearing on emerging therapies to prevent suicide.

Create a great week!

Welcome from Washington, DC where the leaves continue to fall, and the temperature remains much like Congress – a mystery as to what happens next.  This weekend saw a round of football where your author did not bother to watch his failing New York Giants lose again, but he did get pleasure in watching the Cowboys fall to the Eagles.  With the cheers from my jubilant four-year-old daughter, I watched the second Paw Patrol Movie this weekend: The Mighty Pups, on a big screen while both wanting the movie to end quickly but also fearing what will happen with my daughter’s behavior once the movie concluded (I got her to focus her energy after the movie by bribing her with Chick-Fil-A).  Of course, the entire situation reminded me of Congress and funding the government – facing an unsatisfactory continuing resolution which can make the average person cringe as lawmakers will most likely go home and blame the other side for a failure to produce a working budget. We are 12 days away from the government running out of money… no need to worry!  Welcome to the Week Ahead!

The Administration

The Biden Administration spent part of the weekend dismissing new polling which shows only 33% of Americans view Biden favorably, but it also shows only 29% view Trump in a favorable light.  The administration says polling one year away from Election Day is not representative of Election results.  The Biden Administration continues to move forward with its domestic policy agenda in health care following the release of its artificial intelligence (AI) executive order.  Health and Human Services Secretary Xavier Becerra will testify at a Senate Appropriations Full Committee Hearing on Wednesday to discuss the President’s supplemental request for HHS.  The Centers for Medicare and Medicaid Services will continue its patient focused listening sessions on Medicare drug pricing negotiations.  The listening sessions focus on input from patients, caregivers, and advocacy organizations on certain medications selected for drug pricing negotiations. This policy continues to be a top priority of the Biden Administration heading into 2024. The sessions are open to the public and will continue through November 15.

The Senate

The Senate is in session today and will hold a procedural vote for President Biden’s nominee to lead the National Institutes of Health, Monica Bertagnolli.  The nomination is expected to pass the upper chamber with bipartisan support with a final vote expected tomorrow.  Senators are also moving forward with conversations on a bipartisan supplemental appropriations package which could link border security funding to aid for Israel, Ukraine, and Taiwan.  Last week’s House passed package for Israel funding for $14.3 billion is considered a non-starter in the Senate due to opposition from the administration and Senate leadership.

As the Senate continues to track bipartisan policy issues such as mental health, the Senate Judiciary Committee, Subcommittee on Privacy, Technology, and the Law will conduct a hearing on “Social Media and the Teen Mental Health Crisis” on Tuesday.  As mentioned in previous reports, the Senate continues to take the lead on policy related to AI with two committee hearings scheduled this Wednesday.  The Committee on Homeland Security and Governmental Affairs will hold a hearing entitled, “The Philosophy of AI: Learning from History and Shaping Our Future”.  Additionally, the Senate Committee on Health, Education, Labor and Pensions, Subcommittee on Primary Health and Retirement Security, will hold a hearing entitled, “Avoiding a Cautionary Tale: Policy Considerations for Artificial Intelligence in Health Care.”  In other notable activity for this Wednesday, the Senate Finance Committee will hold a markup on mental health and a pharmacy benefit reform package.  The package includes language previously introduced in July on PBMs, as well as includes language on expanding mental health care under Medicare and Medicaid and reducing prescription drug costs for seniors. The package also includes Medicaid and Medicare provisions that will expire this year, as well as changes to Medicare payment to support physicians and other professionals.

The House

With 12 days remaining until government funding expires, all eyes remain on the House for what is to come on what happens next.  Newly anointed Speaker Johnson will look to move a funding bill this week to prevent a government shutdown.  The House Republican Conference meets tomorrow in a closed meeting and details are expected to emerge as to next steps after the gathering. Intel from the Hill suggests the Speaker favors a clean government funding bill through January 12^th.  This package could be the easiest to get through the House and provide the House to gather more time for a long-term spending package.  Other pathways for government funding mentions a “laddered approach CR” which would extend government funding for each agency for different periods of time, and funding that is tied to H.R. 2 – a GOP immigration bill.  These two approaches are guaranteed to go nowhere in the Senate and are also opposed by the administration.  In other appropriations business, the House passed its (FY) Interior-Environment spending bill last week and was held up on final passage of its Transportation-HUD appropriations bill as Republican members from the Empire State expressed concerns over cuts to public transit.

Create a great week!