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!