ADVOCACY Archives

The Weekly Update: Congress’s Last-Minute Save

Posted In ADVOCACY, The Week Ahead

Good morning and welcome from Washington, DC where Congress averted a government shutdown just in time for government employees to return to work today (and actually get paid for it). Only in Washington can you meet the minimum standards of your basic job and somehow attempt to take credit for it. In other developments, today former President Trump begins his civil trial in New York for fraud as a judge last week determined he is liable for inflating the value of his properties to secure and obtain business loans. You know what is not overinflated? The 400% increase in jersey sales for the Kansas City Chiefs tight end, Travis Kelce, since Taylor Swift appeared at Arrowhead Stadium a little over a week ago. Last night Swiftie was in the Meadowlands as the Chiefs beat the Jets and all remained well in the football world. Other celebs filled the owner’s box to include Ryan Reynolds and Blake Lively which probably worked in their schedules since actors remain on strike in Hollywood. Other strikes remain to include the United Auto Workers, and a potential upcoming three-day strike by 75,000 workers from Kaiser Permanente which will begin Wednesday. The workers demand a resolution to the staffing shortage in the health system. Speaking of resolutions, now that the continuing resolution was passed, we only have until November 17^th to fund the government – as my four-year-old daughter would say – “for real life” this time. Welcome to the Week Ahead!

The Administration

President Biden signed the continuing resolution this weekend to fund the government for 45 days. The CR included disaster relief funding, FAA reauthorization, and an extension of the federal flood insurance program. One priority for the Biden administration which was not included was additional funding for Ukraine. President Biden spoke on Saturday and blasted “extreme House Republicans” for wanting drastic funding cuts and not supporting funding efforts for Ukraine. He wants Speaker McCarthy to secure a commitment from the House to provide funding for Ukraine moving forward – something to watch as the next rounds of negotiations continue.

The Senate

The Senate played its part this past weekend in helping to avert the government shutdown. As we previously reported, the Senate was looking to take the lead in the government funding drama by attempting to pass its own bipartisan package. Both the House and Senate were in a race for a collision course, until the House passed their package (details below). However, the proposed CR drama did reveal that Minority Leader Mitch McConnell experienced a slight setback as Republican senators refused to include additional funding for Ukraine in their version of the CR.

With the passing of Senator Feinstein last week, California Governor Newsom appointed Laphonza Butler to fill her seat. Butler is the head of EMILY’s List, and she will not work for the organization now that she will fill the vacant seat. This of course is not the end of the story, with a series of special elections schedule to take place next year in the Golden State.

The Senate Committee on Veterans Affairs will hold a [hearing]hearing entitled, “VA Accountability and Transparency: A Cornerstone of Quality Care and Benefits for Veterans” this Wednesday at 3pm. Last week, the Senate Finance Committee leaders introduced bipartisan legislation entitled the Modernizing and Ensuring PBM Accountability Act (MEPA) which largely reflects the Chairman’s Mark from July.

The House

Over the weekend Speaker McCarthy cut a deal with House Democrats to avert government shutdown. The continuing resolution (CR) passed both the House and Senate on Saturday and funded the government for the next 45 days. The measure was passed, 334-92, with 200 Democrats supporting the bill 334-92. The legislation did not include funding for Ukraine. The CR Includes funding to keep community health centers, teaching health centers, and the National Health Service Corps open through November 17th. Additionally, the bill would maintain funding for health centers that offer services to underrepresented communities.

Oh – but the fun continues. Speaker McCarthy is in hot water with the Freedom Caucus as threatening Matt Gaetz aims to bring up the motion to vacate the Chair along with four or five other members of the far-right wing of the Republican party. This is going to be interesting politics as Speaker McCarthy is the number one fundraiser and Gaetz would need Democrat support to overthrow the Speaker. Democrats have yet to signal how they will move in this House Republican civil war.

Additionally, Congress will continue the same fight for the next forty-five days as the government shutdown will be threatened again on November 17^th. This will be the ultimate title fight as McCarthy tries to hang on to his Speakership along with avoiding another possible shutdown.

Create a great week!

The Weekly Update 9/25/2023

Posted In ADVOCACY

Good morning from Washington (Texas style) where we had a hurricane sitting on the DMV area and the Commanders and Cowboys both lost games in which they should have been more competitive. The fall blues are coming to Congress fast, as doom and gloom appears imminent as the government is set to shut down on September 30^th. Any progress on any legislation other than government funding is at a complete standstill. Welcome to a government funding update on the Week Ahead!

Administration

All weekend long the Administration has advised federal agencies to prepare for a long shutdown. The President was at a Congressional Black Caucus event casting blame to the “extreme” Republicans on holding up the funding of the government, as well as casting blame at Speaker McCarthy because he agreed to the budget framework and his party is not delivering. The irony of course is McCarthy needed Democrat support to pass the budget resolution and the bipartisan agreement was not supported by the “extreme” Republicans. The shutdown could affect thousands of workers throughout the federal government as both sides continue to play a game of political chicken – leaving a government shutdown an almost certain event.

House

Here is the latest from the trenches in the House of Representatives. There has been no progress on avoiding a government shutdown before September 30^th. Last week the House brought up TWICE the Defense Funding bill and it was immediately voted down on the Rule to hear the bill on the floor. The Freedom Caucus had a rotation of five different members that constantly would interfere with the bill passing. This is important because it is the vehicle the Senate would use to send back to the House a CR that would last till December.

The Freedom Caucus is still holding up the process to move any appropriations bills from the House chamber and demanding a 30% across the board government cut to all agencies. These proposed cuts are deeper cuts than the initial Budget agreement. More significantly, the Freedom Caucus has promised to hold the line on not voting on any type of continuing resolution.

The latest plan from the Republicans to advert shutdown comes from Congressman Matt Gaetz (R-FL). His plan would package all 12 appropriations bills into 4 separate packages. McCarthy is running full steam ahead with the plan as he wants to show some progress to the American people and put the Senate on watch. The House Rules Committee met Friday before Congress left town to work on the rule to start voting these bills out on Tuesday. Even with Congressman Gaetz leading the charge, it does not guarantee any of these packages would pass the House.

Senate

Members of the Senate have openly stated they want to take control of the budget process, as House efforts continue to fail. The upper chamber continues to work in a bipartisan manner on a CR that would fund the government right up to Christmas recess. The Senate plans to take this measure up as soon as Tuesday or Wednesday and send it over to the House. Senate Leadership has been working with the Administration behind the scenes to get a bill through even though no one knows what is in the bill itself. The Senate also has told House Leadership that Congressman Gaetz’s plan is a non-starter in the upper chamber. According to House Leadership sources the Senate plan is a non-starter in the lower chamber. So – there’s that…

Create a great week!

The Weekly Update 9/18/2023

Posted In ADVOCACY

Good morning from Washington where in September there’s nothing like wearing long sleeves, jackets, and pants in the morning just to wear t-shirts and shorts after 1pm. The up and down weather is indicative of the topsy turvy nature of the current state of play of government funding. To demonstrate their ability to strengthen their hand in budget negotiations with the White House and the Senate, we reported last night that House Republicans are looking to vote on a short-term spending plan with little chance of passing the Senate – and now is facing an uphill battle in the House. In other news, President Biden authorized the Department of Homeland Security and FEMA to coordinate the disaster relief and assistance for communities impacted by the Lee aftermath which continued to knock out power and cause havoc this past weekend. In sports, week 2 of the NFL is almost complete with the New York football Giants making a fantastic comeback to redeem themselves from their embarrassing loss last week. Can Congress comeback from the literal and figurative deficit which they find themselves in – or is a shutdown a foregone conclusion? Welcome to the Week Ahead!!

The Administration

President Biden is also facing a tough September with Republicans getting the go ahead to begin an impeachment inquiry, as well as the Auto Workers strike which President Biden thought would not happen. Biden continues to work to improve access in a variety of facets in healthcare – this time focusing on mental health parity. HHS issued proposed regulations focusing on addressing gaps in coverage of mental health by insurance companies compared to that of other care. The administration hopes the proposed regulations will make insurance companies comply with providing mental health coverage and is ready to impose hefty fines for those insurers who fail to comply. Insurers believe a lack of qualified mental health professionals is a key problem. The regulations are open to comment until October 2.

The Senate

For weeks we’ve spoken about the exemplary bipartisanship in the Senate as it relates to the appropriations process. Well, it appears that the smooth sailing has hit a rough patch. Senator Ron Johnson (R-Wis) is currently blocking a bipartisan amendment package relating to the $280 billion minibus (the package contains the FY2024 MilCon-VA, Agriculture-FDA, Transportation-HUD appropriations). The senator believes the bill should be voted on its individual components as opposed to one larger package. Majority Leader Schumer and Minority Leader McConnell will work to see if the package can come to the floor this week.

The Senate Health, Education, Labor, and Pensions committee will meet in Executive Session on Thursday to consider three bills: the Bipartisan Primary Care and Health Workforce Act, the Preventing Maternal Deaths Reauthorization Act of 2023, and the Gabriella Miller Kids Research Act 2.0. The Senate Finance Health Care Subcommittee will meet on Tuesday to hold a hearing on “Aging in Place: The Vital Role of Home Health in Access to Care”. According to staff, the hearing is framed around promoting aging in place through the lens of beneficiaries being able to access the Medicare home health benefit. The discussion will focus on some of the current barriers in Medicare and the relationship with Medicaid HCBS for duals. There will be a discussion on urban/rural differences and the costs to beneficiaries when there are access challenges. The Senate will also continue hearings on the use of artificial intelligence (AI) this week.

The House

House Energy and Commerce Chairwoman Rodgers’ price transparency bill, which we reported last week, is up on the floor tomorrow – but it remains to be seen how much Democrat support it will receive. The Senate will not take it up.

Energy and Commerce has a hearing scheduled Tuesday at 10 am on seniors’ access to innovative drugs and devices and it some PBM bills. Many of the bills are purely messaging and somewhat ironic given their cost and impact to the Medicare Trust Fund. Also Tuesday at 2 pm, is the Member Day hearing, where members will be able to air grievances and try to rally support for their pet projects. Many members on the health subcommittee will focus on cost, access, rural access, generic pricing, and the supply chain challenges of the drug and device ecosystems. Fentanyl proliferation and abuse mitigation will also be hot topics.

Ways and Means is holding a hearing on “Reduced Care for Patients: Fallout from the Flawed Implementation of Surprise Medical Billing Protections” and its impact on patients’ care and pricing. This hearing will be partisan, and the witnesses will have their work cut out for them as Democrats and Republicans will blame each other for the failed implementation and impact on pricing for their constituents.

The government funding (or lack thereof?) is the key piece, with Speaker McCarthy’s future as the usual bit of palace intrigue holding everything else in limbo.

Government Funding

As we reported last night, House Republicans have agreed to put a stopgap spending measure on the floor for this Thursday. However, the votes are currently not there within the Republican conference to get the bill across the finish line. The proposed CR is set to fund the government through the end of October, but it cuts government spending by eight per cent and does not include Hurricane Lee relief funding or funding for Ukraine requested by the President. The CR as it is currently drafted is being opposed by several Freedom Caucus Members and has no chance of passing the Senate. House Democrats will not support the package. With limited time remaining before a government shutdown, Congress continues to have an uphill battle in coming to a palatable CR which both sides will agree to before the funding deadline.

Create a great week!

The Weekly Update, September 11

Posted In ADVOCACY

Good morning from Washington where we hope you are off to a great start for the week. Today marks the 22^nd anniversary of the September 11, 2001 terrorist attacks where nearly 3,000 lives were claimed. Many Americans will take a moment to reflect on the events which transpired on that day. Efforts continue to this day to recover the remains of unidentified victims. Never forget the lives lost.

In other events, Novak Djokovic won his 24^th grand slam singles event by winning the US Open. However, the real story was the 19-year-old American Coco Gauff winning the women’s singles drawing praise from world leaders and celebrities alike. I can tell you who did not draw praise, my New York football Giants as they lost last night in their season opener to the Cowboys 40-0. I am hoping things will get better – something I am sure Speaker McCarthy is telling himself as the House returns to session today with a government shutdown looming. He is facing tough opposition from the Freedom Caucus, as previously reported and right now a government shutdown is on the horizon! Welcome to the Week Ahead!

The Administration

The White House wants a $40 billion supplemental budget request with $24 billion for Ukraine and $16 billion for disaster relief for Hawaii, Florida, and Vermont, among others. The supplemental request is sure to be met differently by the House than the Senate. Speaker McCarthy may try to include the disaster relief funding portion and send that along to the Senate, where it will be sent back to him with the Ukraine money included. The Administration also wants $3.7 billion to be included in a continuing resolution (CR) for the Centers for Medicare and Medicaid Services (CMS) to assist with eligibility verifications of Medicaid and marketplace programs. With millions set to lose coverage in states as pandemic funding erodes, the Administration and several states are working to ensure eligibility verifications across the country. A government shutdown would still allow essential services to run, and the exchanges would remain open. If a shutdown occurs, HHS expects to furlough 40 percent of its employees, but those staff who work on Medicare, Medicaid, and other mandatory programs will still work.

The Senate

In contrast to the House, the Senate continues to work in bipartisan fashion on appropriations. The Senate will likely vote on a “minibus” for MilCon-Agriculture-Transportation/HUD on Wednesday following a procedural vote tomorrow. The Senate will give the Biden nominee to head up the National Institutes of Health a hearing in October. The Senate HELP Committee chair, Bernie Sanders (I-Vt.), lifted the hold after expressing concerns that President Biden needed to do more to lower drug prices. Senator Sanders had the hold on since spring, but he feels better considering recent actions taken by HHS and a White House commitment to continue the fight on lowering the price of prescription drugs.

Majority Leader Schumer will move forward with his briefing sessions on cybersecurity and artificial intelligence (AI) hosting the leaders of Meta, Alphabet, and Tesla among others. Leader Schumer wants senators to get smart quickly on the use of AI in a variety of contexts, as reports have already come out on China using AI to spread disinformation for the upcoming 2024 elections. The Senate will begin hearings on the various uses of AI this week.

The House

The Energy and Commerce Health Subcommittee will host a hearing entitled, “Legislative Proposals to Prevent and Respond to Generic Drug Shortages” on 9/14 at 10 am to debate 5 bills. This is a follow up to a Chair Rodgers (R-Wa.) RFP on the topic in August and has been a somewhat bipartisan topic of concern this year. Rodgers’s angle will be about the shortage of cancer drugs and the ingredients in generic drugs that are not readily available. Ranking Member Pallone (D-Nj.) will probably discuss his disdain for the drug industry and practices that he sees as anticompetitive and counter to patient safety.

The Ways and Means Committee will have a Member Day on 9/14 at 9 am. This is the first such member day and comes after months of grumbling about the issue from down dais members, who do not believe that the Committee is doing enough legislatively. The Committee has essentially cleared its health agenda after approving bills related to price transparency, PBM regulations and hospital consolidation. Members will have an opportunity to publicly express their concerns.

Government Funding

With only limited time remaining, we remain on course for a government shutdown. Speaker McCarthy is not receiving cooperation from the Freedom Caucus whose members have openly expressed their willingness to shutdown the government. The Speaker knows a shutdown could be perilous for Republicans headed into the 2024 election. Supporters and detractors of the Speaker have expressed their willingness to shut down the government unless an impeachment vote on President Biden occurs. Moderate Republicans feel not enough evidence exists for such a vote and want to move forward with the Speaker in passing a CR that gets us into November.

Create a great week!

The Weekly Update 9/5/2023

Posted In ADVOCACY

Good morning, everyone! We hope you enjoyed the Labor Day weekend and were able to find some time to relax. Your author enjoyed the closing of his community pool and the kids returning to school. Speaking of which, much like my fantasy football draft this week, the Senate returns to action today and is in session, while the House returns next week. The upper chamber has not cast a vote in 40 days. With much to do in the remaining days of September, the countdown on a government shutdown continues. In other news, the First Lady has tested positive for COVID under the new variant BA.2.86 – which I believe is close to a name of a Stars Wars droid. So far President Biden tested negative. With the Senate moving forward on appropriations and the House returning next week…. Welcome to the Week Ahead!

The Administration

As we mentioned last week, the Administration named the first ten Part D drugs to be negotiated by Medicare in 2026 under the Inflation Reduction Act’s (IRA) Medicare Drug Negotiation Program. CMS stated these drugs represent over $50 billion in Part D gross prescription drug costs. The next step is for manufacturers of these drugs to enter negotiations with the Centers for Medicare and Medicaid Services (CMS). After the negotiations, CMS will publish the negotiated prices for the selected drugs no later than September 1, 2024. The negotiated prices will go into effect on January 1, 2026.

On September 1, CMS also released their anticipated proposed rule outlining nursing home staffing requirements. Among other requirements, according to CMS, the proposed rule consists of three core staffing proposals: 1) minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 HPRD for Nurse Aides (NAs); 2) a requirement to have an RN onsite 24 hours a day, seven days a week; and 3) enhanced facility assessment requirements. There will be a 60-day comment period for the proposed rule. All comments must be submitted no later than November 6.

The Senate

The Senate is in session this week and looks to get into several legislative items this month. On Friday, Majority Leader Schumer sent a Dear Colleague Letter outlining his plans for the upper chamber in September. The Senate plans to lead the way in the government funding salvo by working on passage of a continuing resolution (CR) to fund the government. The hope is to bring to the floor noncontroversial appropriation bills this week to include Military Construction-VA, Transportation-HUD and Agriculture-FDA. On September 13, the Senate will begin its forums on understanding artificial intelligence (AI) by convening AI developers, advocates, researchers, and others. The forums plan to address the potential use of AI in a myriad of environments to include healthcare, among others. Other topics Schumer planned to address include in a bipartisan manner include lowering the cost of insulin and prescription drugs, online safety, aiding Ukraine, addressing rail safety, and artificial intelligence.

The House

The House remains out until Tuesday, September 12 but the Energy and Commerce Committee continues to work behind the scenes on informal PAHPA discussions with Senate HELP staff. The lack of a government funding agreement does mean that health legislation will have to be down the priority list for members and leadership in September. Energy and Commerce does have a lot of hearings and markups scheduled, which will cover the entire jurisdiction of the committee. Notable healthcare markups include one on drug shortages (9/14 at 10am), Medicare innovation (9/19 at 10am) and the Inflation Reduction Act (IRA) Implementation (9/20 at 2pm). More clarity on health bills will likely materialize once members return, so we will continue talking with staff and members and keep you apprised of information on pertinent items.

No further action has taken place with regards to the government funding intrigue in the House Republicans Caucus. The House and Senate remain at odds with timing for a potential CR as well as the likelihood of a government shutdown. Please stay tuned as the story continues to develop!

Create a great week!

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The Weekly Update: Congress’s Last-Minute Save

The Weekly Update 9/25/2023

The Weekly Update 9/18/2023

The Weekly Update, September 11

The Weekly Update 9/5/2023

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