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Week Ahead: Congress Loves Rural

After a frenzied finish to last week that included a last-minute vote on legislation to reauthorize the Federal Aviation Administration in the Senate, and the bipartisan tabling of the motion to vacate House Speaker Mike Johnson in the House, the Congress reconvenes this week with only 2 work weeks before the Memorial Day break.  So, let’s get into it. Welcome to the Week Ahead!

The Administration

Cybersecurity Standards for Hospitals on the Horizon 

Deputy National Security Advisor for Cyber and Emerging Technology Anne Neuberger said that the Biden Administration plans to release a rule requiring hospitals to meet minimum cybersecurity standards in response to the Change Healthcare cyberattack in February, according to a Bloomberg News article republished on govtech.com.  She also said the administration plans to provide free training to small, rural hospitals who may have trouble meeting the standards.

Will the industry go along? We will be watching how stakeholders in the health care industry react to the news. An article published in the Record notes that Ms. Neuberger has argued that the industry has been asked to address cybersecurity concerns for more than a decade. But these arguments might be a moot point if the industry can find enough sympathy from members of Congress who have not been shy when it comes to pushing back on the administration’s rulemaking authority.

New DOJ Health Care Task Force Joins the Anti-Trust Parade

The Department of Justice (DOJ) Antitrust Division announced a new task force dedicated to addressing concerns about anti-competitive behavior in health care markets.  DOJ is also working with the Federal Trade Commission (FTC) and the Department of Health and Human Services (HHS) to extend the comment period for an investigation into how corporate ownership affects health care.

One big question: Will this task force impact voters’ perceptions of Biden’s handling of the economy? As this task force gets going, we know President Biden must be aware of polls such as this one from Gallup that shows him fairing the worst of any president on the question of economic management since 2001. We expect the President to continue to tout his efforts to increase competition and break up trusts – including in health care. But will it be enough to capture the support of November voters?

Bird Flu on the Brain

HHS announced several actions it is taking actions to respond to a recent outbreak of the avian flu (H591) along with the U.S. Department of Agriculture (USDA). The actions announced by HHS to address the avian flu threat do not come cheap. According to the agency, the CDC and FDA investments announced on May 10  will cost more than $100 million.

What we will be watching for: Politico reported on discussions between FDA Commissioner Califf and Ranking Member Hoeven (R-ND) regarding a potential avian flu supplemental funding request.  If such a request comes, how will the President handle negotiations with a Republican House that has been skeptical of spending requests and public health proposals from this administration?

The Senate

Schumer Provides Update on AI Legislation 

When asked about the specific timelines for AI legislation, Senate Majority Leader Chuck Schumer (D-NY) shared at a recent event that the committees are all over the map:
•    Homeland Security, Commerce, and Rules committees are “pretty well along on this.”
•    The Senate committees with jurisdiction over health care and education as being “a little further back.”
He said the hope is to have legislation start to come out “within a few weeks throughout the summer and fall.”

Senate Health Hearings

The big hearing this week on health is at Senate Finance Committee entitled “Rural Health Care: Supporting Lives and Improving Communities on May 16.  Both the House and Senate committees have been working behind the scenes and with the administration on rural health policy, and this hearing will set the stage for further legislating this summer. Other hearings include:
•    May 15: Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies hearing entitled “A Review of the President’s Fiscal Year 2025 Budget Request for Indian Country.
•    May 15: Senate Veterans Affairs’ Committee hearing entitled “Frontier Health Care: Ensuring Veterans’ Access No Matter Where They Live.”
•    May 15: Senate Homeland Security and Government Affairs hearing to markup legislation, including S.4035, the FEHB Protection Act, which would direct the Director of the Office of Personnel Management to take certain steps to address concerns about improper enrollment in the health insurance program for federal employees.
•    May 16: Senate HELP Committee hearing entitled “Examining the Dental Care Crisis in America: How Can We Make Dental Care More Affordable and More Available?”

The House

Ways and Means Continues to Work on Rural  

House Ways and Means Committee took the first bite on a rural health package with the markup of telehealth and rural health legislation.  Telehealth was the only bill with a bipartisan vote, even though both Democrats and Republicans support improvements to rural health care.  Not to be outdone, House Energy and Commerce may be marking up telehealth legislation this week. Both the House and Senate would like to advance rural health legislation ahead of the August district work periods where they can tout legislative accomplishments to their constituents.
 
Becerra in the Hot Seat….Again 

HHS Secretary Xavier Becerra is once again returning to his old stomping grounds in the House when he testifies at a May 15 hearing at the House Education and Workforce Committee.   Other House health-related hearings include:
•    May 13: House Veterans’ Affairs Health Subcommittee field hearing entitled “Iowa: A Leader in Veteran Healthcare Innovation.”
•    May 16: House Oversight & Accountability Select Subcommittee on the Coronavirus Pandemic hearing entitled “Overseeing the Overseers: A Hearing with NIH Deputy Director Lawrence Tabak.” 

There You Have It

It’s going to be a busy one!  We want to join with those who have come to D.C. to honor our law enforcement officers for National Police Week and Peace Officers Memorial Day on May 15. Be sure to thank a police officer this week for what they do to keep our families and communities safe.

Here’s to a great week ahead – let us know your questions and feedback!

The Horses Are Not the Only Ones Racing

Over the weekend, fans of horse racing enjoyed an exciting Kentucky Derby that ended with a narrow win for Mystik Dan! As Congress returns, members are already lining up for their own race to the Memorial Day recess and looking ahead to the big race of the 2024 elections. Welcome to the Week Ahead!

The Administration

Medicare Drug Negotiation: Round 2

The Centers for Medicare and Medicaid Services (CMS) published a notice alerting the public about an opportunity to comment on the agency’s draft guidance for the 2nd round of Medicare price negotiations as authorized by the Inflation Reduction Act (IRA). This round of negotiations will add another 15 drugs to the 10 drugs currently moving through the negotiation process. These 15 drugs are scheduled to be announced by February 1, 2025, and any negotiated prices will be effective by 2027.

There are some potential roadblocks in the way even as the Biden Administration is moving confidently along with implementing the IRA, including:

•    Legal challenges: Pharmaceutical companies and trade associations have brought several lawsuits to stop the negotiations, claiming that the action is unconstitutional and leaves drug manufacturers with little bargaining power because they either have to accept the government’s price or choose not to participate in the Medicare program.
•    A 2nd Trump Administration: It’s not clear that Trump’s return to the White House would spell the death of Medicare price negotiations. After all, during his first administration, Trump signed an executive order to direct Medicare to pay no more than the lowest price at which the drug is sold in any other developed nation. However, a 2nd Trump Administration would face tremendous pressure from congressional Republicans to end the program.

The Senate

Health Care Stowaway on FAA Bill

This week, the Senate is scheduled to resume consideration of H.R.3935, a bill to reauthorize the Federal Aviation Administration (FAA) through FY2028. Obviously, this is not a health care bill, but a little bit of what might be considered health care policy managed to sneak aboard the bill before it passed the House. Specifically, the bill bans the FAA from imposing mask or COVID-19 vaccine mandates on passengers, air carrier employees, or FAA employees. Not too long ago, such a provision would have probably caused a bit more of an uproar among Democratic members of Congress. But it appears Captain Schumer is planning for clear skies ahead.

FDA Chief to Defend Budget

Food and Drug Administration (FDA) head Dr. Robert Califf, is scheduled to testify before the Senate Appropriations Ag-FDA Subcommittee on May 8. Although the hearing is about the President’s FY25 budget request, we will also be listening to other topics related to the FDA, such as the recently finalized rule that gives the FDA the authority to regulate lab-developed tests or the delayed rule to ban menthol-flavored cigarettes

Also on Our Radar

•    The Senate Budget Committee will hold a hearing on Administrative Burdens in Health Care on May 8.
•    The Senate Armed Services Subcommittee on Personnel will hold a hearing on May 8 where Assistant Secretary of Defense for Health Affairs Lester Martinez-Lopez will be testifying.

The House

To Legislate or Motion to Vacate?  

The House has a full agenda on the floor but the question is, will House Republican leadership be able to keep things on track, or will they be derailed by Rep. Marjorie Taylor Greene’s (R-GA) motion to vacate against House Speaker Mike Johnson (R-LA)?

The good news for the Speaker: House Democratic leadership has announced they will table Rep. Greene’s motion to vacate the Chair. So, he is probably safe. For now.

The bad news for the Speaker: If Rep. Greene or someone else brings up another motion to vacate, will House Democrats step up again, and if so, what will they ask for in return?

Ways and Means Makes a Way on Health Care

Last week, we saw a lot of health care action from the House Energy and Commerce Committee with subcommittee hearings on Medicaid and the Change Healthcare cyberattack. Not to be outdone, the House Ways and Means Committee is expected to hold a full committee markup this week to consider legislation to extend telehealth flexibilities initiated during the COVID-19 public health emergency, along with some additional reforms and flexibilities.

So what? The markup on telehealth legislation will be the first time this year that a committee has marked up legislation to extend the telehealth flexibilities granted during the COVID-19 pandemic.

Other Health Care Hearings in the House  

Just in case you thought Ways and Means was going to have all the fun this week, here are some other health care hearings we are tracking in the House this week:

•    May 8: House Small Business Committee hearing on regulatory burdens on small businesses in healthcare
•    May 8: House Homeland Security Subcommittee on Counterterrorism, Law Enforcement, and Intelligence hearing on foreign anomalous health incidents
•    May 8: House Natural Resources Indian and Insular Affairs Subcommittee hearing on the FY25 Budget Request for the Bureau of Indian Affairs, Indian Health Service, and Office of Insular Affairs

There You Have It

Did you watch the big race? If so, did you get dressed up? If you didn’t watch, how did you spend your Saturday? Reach out and let us know. Here’s to a great week!

Week Ahead: Congress Comes Back to Approps Season

Unseasonably cool weather in Washington last week left us feeling less than springy. However, we did see a thawing of relations between Republicans and Democrats on a foreign aid package. Additionally, the endorsement of Speaker Mike Johnson (R-LA) by former President Trump likely brings some feelings of rejuvenation to the embattled Speaker. The forecast this week calls for a return of Congress, a response to the Biden administration’s nursing home staffing mandate, and a possible rule on lab-developed tests (LDTs). Welcome to the Week Ahead!

The Administration

While Congress was out of session, the Administration dispatched several highly-anticipated final rules, including the nursing home staffing ratio rule, the Medicaid managed care rule, the Medicaid access rule, and an FTC ban on non-compete agreements, among others.

Banning menthol in cigarettes did not get finalized.  On April 26, Health and Human Services (HHS) Secretary Xavier Becerra acknowledged the need for more time, likely in part due to concerns that the rule would lead to increased law enforcement activity in minority communities.

4-1-1 on LDTs:  Despite all the regulatory activity, we are still waiting on a proposed rule granting the Food and Drug Administration (FDA) explicit authority to regulate LDTs. We expect that rule any day now.

The Senate

UnitedHealth Group CEO Comes to Town

United Healthcare Group CEO Andrew Witty testifies before Congress about the Change Healthcare cyberattack. His first stop will be a Senate Finance Committee hearing.

Some things we will be watching: 
•    Will GOP members use the hearing to criticize the Biden Administration’s response to the cyberattack, or will they focus their attention on UnitedHealth Group’s response?
•    Will any members discuss or propose legislative action to address broader concerns about cybersecurity? In particular, we will be watching to see if Sen. Mark Warner (D-VA) uses the hearing to advocate for legislation he introduced earlier this year that would tie federal payments to health care providers after a cyberattack to the adoption of cybersecurity standards.
•    How will Mr. Witty respond to allegations that United Healthcare has not done enough to help providers in the wake of the attack?

Other Notable Senate Hearings

  • April 30: Senate Armed Services Subcommittee on Personnel hearing on access to pharmaceuticals
  • May 2: Senate HELP Committee hearing on the shortage of minority health care professionals and the maternal health crisis

The House

Movement on Appropriations 

What’s happening: Last week, the House Appropriations Committee released guidance for members on FY 2025 Community Project Funding (earmarks). This comes as the House just finished FY 2024 appropriations only one month ago.

The House Labor, Health and Human Services Appropriations Subcommittee holds its Member Day on April 30.

What it means: The pace is quick: members must submit programmatic and language requests by May 1 and Community Project Funding Requests by May 3. We know how deadlines drive activity in DC!

House Energy and Commerce GOP Looks to Strike Back on Nursing Home Staffing Rule

What’s happening: On April 30, The House Energy and Commerce Health Subcommittee will consider the Protecting America’s Seniors Access to Care Act (H.R. 7513), which would block the implementation of the recently finalized minimum staffing rule during its legislative hearing entitled “Legislative Proposals to Increase Medicaid Access and Improve Program Integrity.”

Some Democrats have crossed the aisle to support this bill. Rep. Jared Golden (D-ME) is one of the bill’s cosponsors, and Rep. Terry Sewell (D-AL) supported the bill’s passage out of Ways and Means. That being said, most Democratic members are supporting the administration’s action. Given the small majority Republicans hold in the House, not to mention the Democratic majority in the Senate and Democratic President, getting this bill across the finish line may be a tall order.

In Other House Committee News 

  • The House Oversight Select Subcommittee on the Coronavirus Pandemic will hold a hearing on May 1 with the president of EcoHealth Alliance. EcoHealth Alliance has been accused by some House GOP members of funding risky gain-of-function research so this hearing will certainly be feisty.
  • After his appearance before the Senate Finance Committee on the morning of May 1, UnitedHealth Group CEO Andrew Witty will be crossing over to the House for an Energy and Commerce Oversight Subcommittee hearing about the Change Healthcare cyberattack.

There You Have It

What are your favorite springtime activities? Did you get to do any spring break traveling this year? Reach out to share and compare. Here’s to a great Week!

Bucking the Leadership: Tracking Congressional Departures

Rep. Ken Buck (R-CO) announced his plans to resign from Congress on March 22 rather than stick it out through the rest of his term.   While it wasn’t an earthquake that upset the balance of power, the announcement certainly sent tremors pointing to the increasingly challenging environment facing Speaker of the House Mike Johnson (R-LA) and Republican congressional leaders. Rep. Buck joins several other House GOP members on the list of resignations that have occurred this year. In conversations with the press, Buck hinted other similar retirements of House Republicans might be following. The current House Republican majority sits at 219 members to 213 for House Democrats. With Buck’s departure, that margin will shrink to 218-213. The margin will likely shrink to 218-214 when New Yorkers go to the polls on April 30 to select a replacement, likely a Democrat, for the recently retired Rep. Brian Higgins (D-NY).  

Hope for Bipartisanship  

All of these resignations and retirements from Congress come with numerous political and policy ramifications.  Beyond the spectacle of it all, the narrow margins and volatility, combined with a divided Congress, mean that now more than ever, there is a need for bipartisanship to find policy solutions that can actually become law. Congress recently showed that bipartisanship is not dead in Washington D.C. and one area where we are seeing it occur is in health care policy. Congress (narrowly) avoided a government shutdown with an appropriations bill that included a “skinny” health care package. This package included an increase to partially address Medicare physician reimbursement rate cuts and reauthorizations for several health care programs. Some stakeholders expressed disappointment in what was not included in the legislation, such as reforms to address concerns about the practices of pharmacy benefit managers (PBMs). However, this bill showed signs that partisans in Congress still share some priorities in the health care space.  A March 12 Energy and Commerce Markup of 19 bipartisan health care bills also provides  hope for moving bipartisan health legislation addressing a range of issues such as  maternal health, mental health, dementia care, cancer screenings, and more. Adding additional cause for hope were comments from Rep. Larry Bucshon, MD (R-IN), expressing a positive outlook for bipartisan legislation to address nagging issues facing physicians under Medicare.  

What this Means for Stakeholders Looking for Action 

The recent resignations and retirements from Congress make it unlikely we will see the “big health care stuff” passed before the election. However, the weeks and months ahead will be crucial in laying the groundwork for additional health care legislation, including possible payment reforms, PBM reforms, the addressing of varying reimbursement rates for hospitals, and providing for the mental health needs of physicians. If you have a priority health issue, the time is now for stakeholders to get their message out to lawmakers and congressional staff. If you have a such an issue and need to navigate both sides of the aisle, please feel free to reach out to our team; we would be happy to talk about how we can help. 

Bucking the Leadership: Tracking Congressional Departures

AI is Taking Over the Capital

In the ever-evolving landscape of technological advancement, the discourse surrounding artificial intelligence (AI) regulation has quickly emerged as the focal point of the global conversation. The unprecedented summit between President Joe Biden and President Xi Jinping added a new chapter to this narrative, igniting discussions that transcend borders and underscore the critical importance of shaping the future of AI. The two leaders agreed that using AI in nuclear or other military operations creates many risks, however, the senior U.S. official said neither was ready for any mutual declaration banning the use.  

The Senate also showed concern regarding AI innovation on a global scale. Earlier this month, they held a hearing on how the U.S. can influence allies and non-allies to ensure that the development of AI systems globally doesn’t empower digital authoritarianism. A worry for the committee was how to handle Chinese innovation in AI technology; Witness Nathaniel Fick from the Department of State explained that the best way to hinder Chinese innovation is to continue to foster innovation among allies at home and abroad. Fick refers to President Joe Biden’sVoluntary Commitments as an example of partnerships at home fostering innovation. 

However, the Senate isn’t just interested in AI’s effect on foreign affairs; the Senate Health, Education, Labor, and Pensions Committee (HELP) and the Homeland Security Committee held hearings on domestic concerns regarding AI. The Senate HELP Committee focused on AI’s positive and negative impact on the healthcare system as a whole. Members discussed three bills addressing the negative positive impacts of AI in healthcare:  the Artificial Intelligence & Biosecurity Risk Assessment Act; the Securing Gene Synthesis Act; and a new bill from Sen. Mike Braun (R-IN), the Medicare Transaction Fraud Prevention Act. (The final bill is aimed at preventing the elderly population from being victims of fraud.)  

The Committee on Homeland Security met to discuss the Philosophy of AI and as interesting as it sounds, the Senators indicated that the hearing was to explore what action(s) should be taken rather than introducing solutions. The witnesses included various professors and their testimonies urged the Senate to pass laws that regulate AI rather than letting AI dictate the regulations. An interesting point brought up during this hearing was by Prof. Daron Acemoğlu, he claims that even though he doesn’t believe that AI will/does automate white-collar jobs, it will most likely automate the IT and IT security jobs. 

Lastly, going back to Biden’s Voluntary Commitments from Leading Artificial Intelligence Companies to Manage the Risks Posed by AI, it very much just reads like a pact of promises that may or may not do anything, we will have to see some time pass before we have a definitive answer on their viability. Nonetheless, it’s good to see that AI is on the list of priorities for the Administration. 

This isn’t the end for AI on the Hill either, even just this week there is a House Energy and Commerce, Health Subcommittee hearing on Understanding How AI is Changing Health Care. Now even though AI is taking over the Capital, you can count on us listening and watching with our own human, eyes and ears. 

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