Category: CMS

Health Spending to Make Up One-Fifth of US Economy 

National health expenditures will comprise 20% of the US economy, or $7.1 trillion, by 2031, according to the latest projections from the Centers for Medicare and Medicaid Services (CMS).  While health care spending actually grew at a slower rate than the national gross domestic product (GDP) in 2021 and 2022, the latest figures project that health care spending will once again outpace GDP growth starting this year, due to the aging population and people seeking medical services that were delayed during the pandemic.  CMS also found that the insured portion of the population reached a historic high of 92% in 2022, although that portion is expected to drop to 90.5% by 2031 due to people losing Medicaid coverage as the redetermination process resumes.   

Biden Administration Reaches Deal to Preserve Preventative Services Coverage 

The Biden administration finalized a deal with the 5th US Circuit Court of Appeals to preserve the federal mandate for health insurers to fully cover preventative care services like HIV prevention drugs and cancer screening.   The agreement thus keeps in place the Affordable Care Act’s (ACA) preventative services coverage mandate while a lawsuit that challenges the mandate proceeds.  Of note, the agreement allows the plaintiff in the case, Brainwood Management, to stop covering preventative services without co-payments for its employees.  Brainwood and other plaintiffs are challenging the mandate because they believe it challenges their religious beliefs by supporting homosexuality and drug use.  The Biden administration will continue to appeal the lawsuit. 

Sanders Blocks Bertagnolli’s Nomination over Drug Pricing 

Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Bernie Sanders (I-VT) says he’ll oppose National Cancer Institute (NCI) Director Dr. Monica Bertagnolli’s nomination to lead the National Institutes of Health (NIH) until the Biden administration issues a plan to lower prescription drug prices.  Sanders’ support is critical for Bertangnolli’s nomination to move forward, as he chairs the Senate panel responsible for confirming the nomination.  In a statement, the White House pointed to the drug pricing provisions of the Inflation Reduction Act as a sign that the administration shares Sanders’ dedication to lowering drug costs without committing to releasing further plans.  Meanwhile, organizations in the medical research community are urging Sanders and other key Senate Democrats to quickly confirm Bertagnolli to ensure the nation does not lose momentum on scientific research. 

FDA Advisers Recommend Monovalent COVID-19 Boosters for Fall 

Members of the Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee voted unanimously on Thursday to recommend that the 2023-2024 formula of the COVID-19 vaccines be updated to a monovalent XBB Omicron subvariant.  According to the Centers for Disease Control and Prevention, XXB is responsible for nearly all COVID-19 cases in the US.  The decision to go with a monovalent vaccine is a departure from the bivalent vaccines that included both the original strain of COVID-19 and the Omicron variant.  The FDA advisers also opted to roll out the boosters in the fall to align with the availability of annual flu shots, despite a noted lack of certainty on the degree to which COVID-19 is seasonal.   

ICYMI: Senators Celebrate Seeksucker Day 

The Senate celebrated Seersucker Day last week as it has for years, with various senators and their staff donning seersucker suits.  Senators took the occasion to the next level this year by approving a resolution from Sen. Bill Cassidy (R-LA) to make June 7 National Seeksucker Day, the month of June as National Seersucker Month, and every Thursday in June through August as Seersucker Thursday.  Then-Sen. Trett Lott (R-MO) first introduced Seeksucker Day in 1996, and since Lott’s retirement, Cassidy has served as the “coordinator” of Seersucker Day. 

CMS Proposes 2.8% Bump for Hospital Inpatient Reimbursement 

Eligible hospitals could see a 2.8% increase in Fiscal Year (FY) 2024, according to the recently proposed Inpatient Prospective Payment Systems (IPPS) rule.  Other provisions of the rule would allow graduate medical education (GME) payments for training in rural emergency hospitals, boost reimbursements for hospitals treating unhoused patients, and lower payments for hospitals with excess readmissions and hospital-acquired conditions.  Provider organizations have so far been critical of the proposed rule.  The American Hospital Association (AHA) called the reimbursement increase “inadequate” due to the continued impact of inflation on hospitals, while the Federation of American Hospitals (FAH) said the rule could cause rural hospitals to pull back on some services.   

White House Launches Successor to Operation Warp Speed 

A new Biden administration initiative called “Project Next Gen” aims to accelerate the development of new COVID-19 vaccines and treatments.  The $5 billion program is essentially a continuation of Operation Warp Speed, a Trump administration initiative that resulted in the development of the first successful vaccines and treatments.  Among the areas Project Next Gen will focus on include the creation of long-lasting monoclonal antibody treatments, vaccines that deliver mucosal immunity, and a pan-coronavirus vaccine.  To fund the new agency, the administration shifted around funding that was initially earmarked for COVID-19 tests and other priorities.   

Juul to Pay $462 Million in Settlement over Youth Marketing 

Electronic cigarette manufacturer Juul Labs has agreed to pay $462 million to six states to settle claims that the company illegally marketed its products to young people, particularly through social media.  Attorneys general in those states argued that Juul executives were aware that their initial marketing persuaded adolescent users into its vaping pens but did little to address the problem as teenage use of e-cigarettes grew considerably. As part of the settlement, Juul will stop using people under the age of 35 in promotional materials, restrict the number of purchases consumers can make, and limit free or discounted promotions.   

CDC: STIs Hit Record-High in 2021 

Sexually transmitted infections (STIs) rose to their highest level in 2021 and show no signs of slowing down, according to data released by the Centers for Disease Control and Prevention (CDC).  Over 2.5 million cases of STIs were reported that year, with more than half of all cases attributed to chlamydia.  Of note, Syphilis spiked 32% in one year, while Gonorrhea increased by nearly 5%.  The data also showed a concerning jump in infections passed from pregnant moms to infants developing in the womb.  While the CDC said there are multiple causes behind the surge in STIs, pandemic-related delays in screening are one likely culprit.  To address the rise in STIs, the CDC is calling for increased access to public health services and more research into vaccines and post-exposure treatments.   

Senators in Key Battleground States Announce Bids for Reelection 

This week, Sens. Bob Casey (D-PA) and Tammy Baldwin (D-WI) separately announced that they will be seeking reelection next year.  Their announcements are a positive development for Senate Democrats, who will be relying on incumbents in battleground states to maintain their narrow majority in the Senate in what’s expected to be a difficult election cycle.  While no Republicans have announced a bid for Baldwin’s Senate seat, Rep. Mike Gallagher (R-WI) left the door open for a possible run in a recent interview.   In Pennsylvania, hedge fund CEO Dave McCormick and former Republican gubernatorial candidate Doug Mastriano are viewed as possible GOP challengers to Casey in 2024.   

ICYMI: Irish President’s Dog Ignores Biden in President Visit 

President and dog-lover Joe Biden got the cold shoulder from Irish President Michael Higgins’ dog Misneach when the commander in chief tried to beckon him.  Instead, the Bernese Mountain dog barked at the president, causing members of the press pool to chuckle.  The encounter occurred at the Áras an Uachtaráin, the official residence of the president of Ireland, where Biden inspected a military honor guard, planted an oak tree, and rang the Bell of Peace. 

Number of ACA Marketplace Enrollees Reaches Record High 

A record-breaking 15.9 million people have enrolled for insurance coverage on the Affordable Care Act (ACA) marketplace through January 7, according to an announcement from the Centers for Medicare and Medicaid Services (CMS).  The new enrollment totals represent a 13% increase from the previous year.  In a press release, Health and Human Services (HHS) Secretary Xavier Becerra credited incentives in the Inflation Reduction Act (IRA) that expanded access to health care by lowering plan costs and offering more plan options for the enrollment boost.  The deadline to enroll in a plan on HealthCare.gov is January 15, although the deadline goes beyond Sunday in some states. 

Rep. Jason Smith Tapped to Chair Ways and Means 

Rep. Jason Smith (R-MO) prevailed over Reps. Adrian Smith (R-NE) and Vern Buchanan (R-FL) in his bid to chair the House Ways and Means Committee.  The committee’s jurisdiction over Medicaid and Medicare will give the Missouri congressman greater potential to affect health care policy.  Several factors helped Smith edge out his competitors, including his fundraising prowess and close relationship with Speaker Kevin McCarthy (R-CA). Known for his populist image, Smith has vowed to focus on rural health, telehealth, innovation, and price transparency.  He has also stated an interest in holding hearings to examine high health care costs.   

Medicaid Expansion Cause Post-Birth Hospitalizations to Decrease 

Medicaid expansion resulted in a 17% decline in postpartum hospitalizations in states that opted to expand the program, according to a new study from Health Affairs.  According to the data, the largest decrease in hospitalizations occurred during the first 60 days postpartum and a smaller decline in hospitalizations were observed for the period between 61 day and six months postpartum. Under the Consolidated Appropriations Act of 2023, the 12-month extended Medicaid postpartum coverage option has been made permanent. This has enabled 26 states and territories to expand Medicaid coverage for beneficiaries for up to one year postpartum. The results of the study are good news for the Biden administration, which is actively trying to improve maternal health. 

AHCA: 85% of Nursing Homes Face Staff Shortages 

Over eight in 10 nursing homes in the US are experiencing moderate to severe staffing shortages, according to a survey from the American Health Care Association (AHCA).  The survey also found that 96% of nursing homes are struggling to bring on additional staff.  Additionally, more than 60% of nursing homes said they’re worried about having to shut down due to the shortages.  To draw attention to the crisis, the ACHA launched a nationwide campaign to address staffing shortages that will help educate job seekers about opportunities in long-term care and help nursing homes recruit new employees. 

Porter, Lee Announce Bids for Senate 

Earlier this week, Reps. Katie Porter (D-CA) and Barbara Lee (D-CA) launched their campaigns for a Senate seat currently held by Sen. Dianne Feinstein (D-CA).  While the 89-year-old Feinstein filed paperwork in 2021 to run for re-election in 2024, the California senator has yet to publicly announce her bid for reelection.  Rep. Adam Schiff (D-CA) has also expressed an interest in running, although he has yet to make a formal announcement on his decision.  The likelihood of at least three House members seeking to represent California in the Senate will likely mean three competitive House races in the heavily Democratic San Francisco Bay Area and Los Angeles metropolitan area.   

ICYMI: Smoking Once Again Allowed in House Office Buildings 

House members are now allowed to use combustible tobacco products in their offices, according to new rules posted by the Speaker Pro Tempore on Tuesday.  While smoking is prohibited in nearly all office buildings in Washington, DC, the Capitol Complex is exempt from local rules.  However, smoking still remains off-limits on the House floor.  Since the rules were published earlier this week, noted cigar aficionado and new House Rules Committee Chairman Tom Cole (R-OK) has already been spotted smoking a cigar. 

CMS Finalizes Physician Fee Cuts for 2023 

Doctors face a nearly 4.5% payment cut from Medicare under the 2023 Physician Fee Schedule, which was finalized on Tuesday.  The final rule prompted strong criticism from provider organizations like the American Medical Association (AMA), who said the cuts “threaten patient access” to physicians who participate in Medicare.  The final rule will put pressure on Congress to enact legislation to counter the cuts in the coming months.  In addition to the payment cuts, the final rule will expand access to behavioral health care by allowing therapists to offer services under general supervision of a Medicare practitioner.  The rule will also allow Medicare to pay for opioid treatment programs that use telehealth to initiate medication-assisted treatment (MAT). 

Warner Lays Out Policy Options to Improve Health Care Cybersecurity 

Cyberattacks on the health sector affected 45 million Americans in 2021, according to a new report from Sen. Mark Warner (D-VA), who co-founded the Senate Cybersecurity Caucus.  To address the growing vulnerability of the health care sector, Warner offered several policy proposals, such as setting minimum security standards for health care providers, adding Medicare reimbursements for cybersecurity expenses, and creating a national stockpile with common equipment needed by hospitals facing cyberattacks.  The report is intended to solicit feedback from health care stakeholders on the proposed policy options.   

HHS Renews PHE for Monkeypox Outbreak 

Although new monkeypox case numbers continue to drop nationwide, Health and Human Services (HHS) Secretary Xavier Becerra renewed the monkeypox public health emergency (PHE) on Wednesday, which was initially declared on August 4^th,  to ensure the continuation of vaccine effectiveness studies and to maintain data-sharing with states and jurisdictions.  Monkeypox case numbers peaked in early August and have since declined to about 30 new cases per day.  Over 28,000 monkeypox cases and six related deaths have been confirmed in the US since the outbreak began in the summer.  Public health experts say the drop in cases can be attributed to changes in behavior, particularly among men who have sex with men, a demographic that has been disproportionately affected by the outbreak. 

BPC Offers Ways to Make Employer-Sponsored Insurance More Affordable 

High unit prices for individual health care services and products are contributing to the rising cost of employer-sponsored health insurance, according to a report released this week from the Bipartisan Policy Center.  To ensure the viability of employer-sponsored insurance, which is the largest source of health care coverage in the US, the report calls on Congress to develop new legislation to spur use of biosimilars and to lower the threshold of what the Affordable Care Act (ACA) deems “affordable” for employer-sponsored plans.  The report also emphasized the need to create a mandatory federal all-payer health care claims database and full electronic access to health plan data for all employees to increase transparency.  

Pfizer’s RSV Vaccine Trial Shows Promise 

Pfizer announced this week that its vaccine candidate for respiratory syncytial virus (RSV) is 80% effective at preventing severe disease in infants.  The announcement comes as the US faces an unusual spike in RSV cases, likely due to delayed immunity to the virus since the start of the COVID-19 pandemic.  Unlike other RSV vaccine candidates, Pfizer’s is administered during pregnancy to allow antibodies to be transferred from mother to infant.  Pfizer said that it plans to submit data to the Food and Drug Administration (FDA) on the vaccine by the end of the year, with the hope of having it available by next winter.  If approved, Pfizer’s vaccine will be the first against RSV and the first new product related to the virus in over 20 years. 

ICYMI: Calls for Ouster of Architect of the Capitol Grow 

A growing chorus of lawmakers are calling on the Architect of the Capitol (AOC) J. Brett Blanton to step down after an AOC Office of the Inspector General (OIG) report found that Blanton had abused his power.  Released on Tuesday, the report found that Blanton had regularly used his official vehicles for personal purposes and even impersonated a police officer.  However, ousting Blanton could be difficult, as the AOC serves a 10-year term, and there is no explicitly described process for removing the AOC.  Then-President Donald Trump appointed Blanton to the post in December 2019. 

Medicare Part B Premiums to Decrease Next Year 

Medicare beneficiaries will see lower Part B premiums in 2023, according to an announcement from the Centers for Medicare and Medicaid Services (CMS) on September 27. The upcoming premium drop follows a spike in 2022 premiums that was largely driven by the high projected cost of the new Alzheimer’s drug Aduhelm.  However, CMS was able to lower its estimates for 2023 after the cost of Aduhelm fell, paving the way for the agency to lower its Part B premiums for next year.  Lower-than-expecting spending on Part B services also factored into the agency’s decision to lower 2023 premiums.  CMS also announced earlier this week that Part A premiums will rise to $7 in 2023.  On Thursday, CMS also announced lower premiums for Medicare Advantage and Part D prescription drug plans in 2023.  

Pfizer Applies for EUA for Omicron Booster for Children Ages 5-11 

On Monday, Pfizer applied for an emergency use authorization (EUA) to the Food and Drug Administration (FDA) for its Omicron-targeted bivalent COVID-19 booster for children ages five to eleven years old.  The submission comes a week after Moderna filed an EUA application with the FDA for its own bivalent booster for children ages six to seventeen.  In a document released on September 20, the Centers for Disease Control and Prevention (CDC) said it expects to make a recommendation in early- to mid-October on the use of the new bivalent vaccines in children and adolescents, pending authorization by the FDA.  While human data on the efficacy of the new COVID-19 boosters won’t be available for another month or two, FDA and CDC officials are confident that the updated boosters offer better protection against infections and disease in the coming months. 

Experimental Alzheimer’s Drug Shows Promise 

Pharmaceutical companies Biogen and Esai announced on Tuesday that their experimental Alzheimer’s disease treatment slowed the rate of cognitive decline by 27% in a clinical trial.  The announcement increases the likelihood that the FDA could approve the drug as early as January 2023.  The clinical trial data also renews hope in the potential for anti-amyloid drugs, which work by clearing the buildup of amyloid proteins which are linked to development of Alzheimer’s disease.   The FDA greenlit Biogen’s first anti-amyloid drug known as Aduhelm last year, despite the little evidence demonstrating the drug’s efficacy.  According to both companies, the new drug began to show a benefit to patients about six months after they began taking it in clinical trial consisted of 1,800 participants with mild cognitive impairment or mild Alzheimer’s disease. 

White House Proposes Medicare-Covered Meals to End Hunger  

On Tuesday, President Joe Biden proposed Medicare coverage for medically tailored meals as a part of an overarching plan to end hunger that includes updates to nutrition labels and an expansion of food security programs.  The president also called for expanded access to nutrition and obesity counseling for people on Medicare and Medicaid as well as making the Medicare Diabetes Prevention Program a Medicare preventive services benefit.  However, many of the president’s proposals have an uncertain future, as most ideas would require the support of a polarized Congress.  

House to Vote on Stopgap Spending Bill Today 

The Senate voted 72-25 yesterday afternoon to approve a continuing resolution (CR) to keep the federal government open through December 16, setting the stage for the House to vote on the CR sometime today.  The CR notably includes a five-year extension of FDA user fee programs that lacks policy riders that were initially a part of previous user fee extension proposals.  Additionally, the CR includes disaster relief funding for Alaska, Florida, and Puerto Rico, as well as billions of dollars in aid to Ukraine.  Following today’s vote, lawmakers will return to the campaign trail for the 2022 midterm election.  While the House isn’t scheduled to return until after the election in November, the Senate will be reconvening in mid-October. 

ICYMI: Pop Star Performs with James Madison’s Flute 

At a concert in Washington, DC earlier this week, pop artist Lizzo performed with a crystal flute that once belonged to President James Madison. This was the first time the instrument had been played in over 200 years.  The flute was a part of a collection at the Library of Congress, which is allegedly the largest flute collection in the world.  A French flute designer originally gifted the fourth president the instrument in 1813 to commemorate Madison’s second inauguration.  Lizzo began training as a classical flutist at the age of 10 and had studied the instrument in college. 

States Regain Authority to Pay for Home Health Aides’ Insurance 

State Medicaid agencies can once again directly pay for independent home health aides’ benefits, according to a final rule the Centers for Medicare and Medicaid Services (CMS) issued Thursday.  The final rule overturns a 2019 rule that required states to pay the full Medicaid rate to home health aides, which made health coverage and other benefits more costly and created administrative barriers to enrollment.  Under the new rule, state Medicaid agencies can now allow home health aides not working with an agency to have employee benefit premiums and union dues deducted from their paychecks.  According to CMS, boosting benefits for home health workers can help address the industry’s workforce shortage.

FDA Open to Moving Up Meeting Dates on Vaccines for Young Kids

A top Food and Drug Administration (FDA) official told members of the Select Subcommittee on the Coronavirus Crisis during a May 9 briefing that the agency will move up an advisory panel’s meeting dates on vaccines for children under 6 if the FDA finishes reviewing vaccine data sooner than expected.  The briefing was convened after reports emerged that the FDA was delaying its review of COVID-19 vaccines for young kids until both Pfizer and Moderna had submitted clinical trial data.  Additionally, the subcommittee was informed that the FDA would not withhold authorization for a pediatric vaccine solely because it did not reach a 50% efficacy threshold at blocking symptomatic infection, which was previously required for COVID-19 vaccines.  FDA advisory panel meetings on vaccines for young kids are currently scheduled for June 2022.

Administration Officials Still Tight-Lipped on End of PHE

The Biden administration on Tuesday sent a letter to state governors to urge them to make preparations for the end of the COVID-19 public health emergency (PHE).  However, the administration declined to give any indication as to when it will let the PHE expire, although the letter did reiterate the administration’s commitment to provide states 60 days’ notice before pulling the plug on the PHE.  The PHE is currently set to end of July 16, which means the administration would have to communicate that it will let the current PHE end no later than Tuesday, May 17.  Numerous policies tied to the PHE are immensely important to the states, including Medicaid redetermination and telehealth waivers. 

Reed Officially Resigns from Congress, Takes Job with Lobbying Firm

Rep. Tom Reed (R-NY) officially resigned from Congress on Tuesday, and he will soon start a new role at Prime Policy Group, a government relations firm.  Reed announced in 2021 that he would not seek an additional term following allegations of sexual misconduct.  In a final floor speech, Reed decried “the current focus on extremism” in politics, and he called for “petty political posturing to end.”  Reed was the top Republican on the Social Security Subcommittee of the powerful House Ways and Means Committee, and Rep. David Schweikert (R-AZ) is likely to replace Reed as the subcommittee’s top Republican.  Reed’s resignation will trigger two special elections this year to determine who will succeed Reed in representing New York’s Southern Tier region in Congress.

ICYMI: Paris Hilton Returns to Washington

This week, media personality and businesswoman Paris Hilton was spotted on Capitol Hill and in the White House, where she advocated for legislation to improve the oversight of youth treatment facilities.  Hilton endured psychological abuse at one such facility as a child, and in October 2021, she shared her experiences while testifying before a Utah State Senate panel.  In April, Hilton’s media company began working with a lobbying firm to advance legislation to regulate congregate care facilities for teens.

CMS Issues Narrow Coverage Determination for New Alzheimer’s Drug

On January 11, the Centers for Medicare and Medicaid Services (CMS) proposed a national coverage determination for Alzheimer’s disease medication Aduhelm that will limit Medicare coverage to patients participating in relevant clinical trials.  The Food and Drug Administration (FDA) approved the Biogen-developed drug last year, despite conflicting data regarding the drug’s efficacy.  Aduhelm attracted significant controversy after Biogen announced a launch price of $56,000, which was later halved due to public outcry.  CMS is holding a 30-day public comment period and will announce its final decision by April 11.

Supreme Court Blocks Vaccine Mandate for Employers, but Not Health Care Providers

On Thursday, the Supreme Court struck down the Occupational Safety and Health Administration (OSHA) mandate for private sector employers to require workers to be vaccinated or regularly tested, on the basis that OSHA lacks the authority to “regulate public health more broadly.”  The high court’s vote to invalidate the vaccine mandate was 6-3, along ideological lines.  However, the Supreme Court did vote to uphold a CMS regulation that requires health care provider that receive money from the federal government to mandate that employees be vaccinated.  According to the majority opinion, CMS was justified to mandate vaccinations because unlike OHSA, the agency has long-standing authority to issue health care mandates.

Sinema Doubles Down on Opposition to Filibuster Reform

Sen. Kyrsten Sinema (D-AZ) strongly expressed her opposition to changing filibuster rules to pass a voting rights bill in an impassioned speech she delivered on the Senate floor yesterday.  While Sinema said she supports the Democrats’ voting rights legislation, she’d prefer to see it advance through more collaboration between Democrats and Republicans.  Sinema’s speech came just before President Joe Biden met with Senate Democrats on Capitol Hill in order to stir up support for voting rights reform.  Both Sinema and her West Virginia Democratic colleague Sen. Joe Manchin’s continued opposition to creating a filibuster carve out for the voting rights bill means Democrats’ hopes of passing the measure are facing an uphill battle and may not get done.   

Johnson Announces Reelection Bid, Perlmutter Announces Retirement

In a Wall Street Journal op-ed, Sen. Ron Johnson (R-WI) announced on January 8 his plans to run for a third term in the Senate, putting an end to months of speculation regarding his plans.  Johnson initially pledged in 2016 to not seek reelection in 2022; however, encouragement from constituents and the nation’s “unsustainable path” caused him to reconsider.  The Senate race in Wisconsin is expected to be close, as President Biden narrowly won the state in 2020.  Later in the week, Rep. Ed Perlmutter (D-CO) announced that he will not be seeking reelection in November.  Representing the north and west suburbs of Denver, Perlmutter served in the Colorado Senate for eight years before his election to Congress in 2006.  In a statement, Perlmutter said he is stepping aside to “explore other opportunities,” but did not specify what those would be. 

ICYMI: Harry Reid Lies In State at US Capitol Building

On Wednesday, former Senate Majority Leader Harry Reid (D-NV) lied in state in the Rotunda at the US Capitol, where President Joe Biden, Vice President Kamala Harris, and dozens of other elected officials paid tribute.   Reid, who worked as a Capitol Police officer while studying law at George Washington University, served for years in the Nevada state government before being elected to the House in 1982 and the Senate in 1986.  Reid’s 30-year Senate career included a decade as Majority Leader, during which he led the Democratic caucus in voting to end the filibuster for most presidential nominations, including federal judges.  Reid retired in 2017 but continued to stay active in the public eye despite his diagnosis of pancreatic cancer in 2018.