Insights^

Rep. Guthrie to Chair Health Subcommittee

Rep. Brett Guthrie will chair the House Energy and Commerce Subcommittee on Health in the 118^th Congress. Guthrie first became the Health Subcommittee’s top Republican at the start of the 117^th Congress in January 2021, replacing Rep. Michael Burgess (R-TX), who sought to become the top Republican on the full Energy and Commerce Committee.  As chair of the Health Subcommittee, Guthrie’s likely priorities will be price transparency, the fentanyl epidemic, telehealth, medical product innovation, and exploring the business practices of pharmacy benefit managers (PBMs).  The Health Subcommittee will hold its inaugural hearing of the new Congress on February 1 to review legislation to address the fentanyl crisis.

Bivalent Boosters Cut Risk of Infection by Half

The new bivalent COVID-19 booster reduces the risk of symptomatic infection of the dominant Omicron XBB/XBB.1.5 subvariants by about 48%, according to new data from the Centers for Disease Control and Prevention (CDC).  Considered the most transmissible subvariant to date, XBB.1.5 is currently responsible for 49% of new COVID-19 infections nationwide.  The study found that the bivalent boosters were slightly more effective in preventing symptomatic infection in adults ages 18 to 49 than adults ages 50 and older.  However, most Americans are not benefitting from the added protection of a bivalent booster, as only about 15% of eligible Americans have received the new booster.

HHS: Insulin Price Caps Mean Savings for Seniors

1.5 million seniors in the US could save up to $500 per person annually thanks to new insulin price caps, according to a new report from the Department of Health and Human Services (HHS).  The report analyzed the impact of the $35 monthly insulin price cap in the Inflation Reduction Act, which went into effect for Medicare Part D beneficiaries on January 1, 2023.  According to the report, the average out-of-pocket cost per insulin fill for Part D beneficiaries in 2019 was $58 per insulin fill, while people with private insurance or Medicare coverage paid about $63 per fill.  The report also found that Medicare beneficiaries in Texas, California, Florida, North Dakota, Iowa, and South Dakota are likely to incur the most annual savings at $700-$800 per person.

JAMA: Telehealth Didn’t Help with Opioid Treatment

There was no significant difference in outcomes between people who sought treatment for opioid use disorder via telehealth or in-person via a clinician, according to a new study from the Journal of the American Medical Association (JAMA).  Since the start of the COVID-19 pandemic, emergency waivers have allowed people struggling with opioid addition to virtually receive prescriptions for treatments like buprenorphine.  One of the reasons why telehealth may not have resulted in better outcomes for substance use disorder patients is the limited access to broadband internet, particularly in low-income or rural communities.

ICYMI: Diversity Lags among Congressional Staff

While the 118^th Congress is the most diverse in history, diversity amongst congressional staff is still playing catch-up, according to a report from the Joint Center for Political and Economic Studies.  The report found that only 18% of top congressional staffers are people of color, compared to 40% of Americans nationwide.  However, the report did note some recent areas of improvement, such as the fact that top staff working for returning members of Congress are more diverse than ever before.  Some of the obstacles preventing people of color from working in Congress include relatively low pay rates and the Washington, DC area’s high housing costs.

A new era begins with a new Congress on January 3, 2023.  For the first time since 2007, Rep. Nancy Pelosi (D-CA) will no longer serve as the leader of House Democrats.  However, it remains unclear who will succeed Pelosi as Speaker, as several Republican House members are refusing to support Rep. Kevin McCarthy (R-CA), the current top Republican in the House.  For most other leadership positions and top committee spots, selections for the 118^th Congress are expected to be non-controversial and generally follow lines of seniority. This blog post takes a look at who is expected to assume top leadership and committee roles in the new Congress, and why some selections have yet to be determined.

Senate Advances $1.7 Trillion Omnibus Spending Bill

The Senate passed a massive Fiscal Year (FY) 2023 spending package on Thursday by a 68-29 vote.  The legislation to fund the government through September 30, 2024, includes supplemental aid for natural disaster victims and the the war in Ukraine, as well as a bevy of policies related to electoral reform and how states can spend COVID-19 relief dollars.  Key health care items included in the bill are an extension of Medicare telehealth waivers through 2024, new requirements to improve clinical trial diversity, and a reduction in Medicare payment cuts that doctors are facing over the next two years.

New Report Criticizes FDA’s Tobacco Oversight Operations

The Center for Tobacco Products (CTP) of the Food and Drug Administration (FDA) operates in a “reactive state” and lacks clarity in its policies and processes, according to a new report from the Reagan-Udall Foundation.  While the report found that the CTP performs well when it comes to public health messaging and communication, the agency’s inconsistency of enforcing actions and lack of standard operating procedure has contributed to millions of tobacco products being sold without authorization.  Among the recommendations the report suggested are the creation of a detailed strategic agenda, the creation of an Office of Policy, and the establishment of an interagency task force to prioritize enforcement of tobacco laws.

CDC: COVID-19 Caused US Life Expectancy to Drop

A baby born in 2021 can expect to live two fewer years than a baby born in 2019, according to new data from the Centers for Disease Control and Prevention (CDC) on US life expectancy. The CDC attributed the drop to the COVID-19 pandemic, which exacerbated an existing substance abuse crisis by driving more vulnerable individuals to drug and alcohol misuse.  The new life expectancy of 76.4 years represents the lowest since 1996, having undone a quarter century of progress. (dunkinbahamas.com)   The CDC also released a report this week on drug overdose deaths which found that overdose deaths for all drugs have increased, except heroin.

KFF: Public Support for Childhood Vaccine Requirements Wanes

Public support for childhood vaccine requirements has declined since the start of the COVID-19 pandemic, according to a new survey from the Kaiser Family Foundation (KFF).  The survey found that 71% of adults say children should be required to get vaccinated for measles, mumps, and rubella (MMR) to attend school, which is down from 82% of adults in an October 2019 Pew Research Center poll.   Additionally, 28% said parents should be able to decide not to vaccinate their children, up from 16% in 2019.  The survey also found that about one-third of adults were concerned they will get seriously sick from COVID-19, although older adults and members of racial and ethnic minority groups voiced greater concern about becoming seriously ill.

ICYMI: Modernization Committee Releases Its Final Report

After four years of information gathering, the House Select Committee on the Modernization of Congress issued its final report that details what’s wrong with Congress and how to fix it.  Across 16 chapters, the report details more than 200 recommendations that aim to professionalize internships and fellowships, improve the retention of congressional staff, and modernize the legislative process.  The report also recommends that the committee continue its important work through the establishment of a new Subcommittee on Modernization within the House Administration Committee.

The holiday rush commences today on Capitol Hill, with Congress back in session for the first time in several weeks. Following a midterm election that defied expectations, lawmakers face a lengthy to-do list to address this year’s unfinished business before a new Congress begins in January. Here are five items important to health care that lawmakers are likely to address in the coming weeks.

FY 2023 Appropriations

The current continuing resolution (CR) for Fiscal Year (FY) 2023 appropriations expires on December 16. With Republicans set to take control of the House with a narrow majority in January, Democrats will be keen to use their narrow majorities in the current Congress to complete work on a FY 2023 omnibus before the year’s end. While leading House and Senate appropriators have expressed an interest in completing an omnibus bill fully funding the government through FY 2023 by the December 16 deadline, factors such as the December 6 Senate runoff election in Georgia could delay negotiations a bit. With that in mind, Congress may need to enact a short-term CR ahead of December 16, perhaps even for a week, to ensure government funding continues while it presses on with negotiations on a final year end bill.

Although lawmakers could punt an omnibus spending bill into the next Congress, most have a preference for avoiding that outcome. Both top Senate appropriators Patrick Leahy (D-VT) and Richard Shelby (R-AL) are retiring, which adds pressure to make a bipartisan deal on their final spending bill. Contributing to the need to finish FY 2023 appropriations work in the current Congress is the fact that the next Congress will feature a narrow GOP majority, which will make it much harder to pass spending bills.

Medicare Cuts

Health care providers are facing several difficult Medicare cuts next year, most notably being a 4.5% cut to Physician Fee Schedule (PFS) reimbursement, a 4% cut in Medicare payments under the Pay-As-You-Go Act of 2010 (PAYGO) Act of 2010-mandated sequester, and an expiration of a 5% bonus payment for participation in alternative payment models. Congress is under intense pressure by health care providers to address all three in the forthcoming year end spending bill. In addition, funding for the Low-Volume Adjustment and Medicare-Dependent Hospital program was extended under the current CR and would need to be further extended. the Medicare-Dependent Hospital program, and the Low-Volume Adjustment.

FDA Reform

Members of both parties are eager to pass riders to the Food and Drug Administration (FDA) user fee reauthorization bill that were ultimately dropped from language that was included on the CR. . Some of the riders being debated are changes to the accelerated approvalof drugs, provisions to increase diversity in clinical trials, and regulation of diagnostic testing, cosmetics, and dietary supplements. These riders represent a number of bipartisan provisions that were included in either the House-passed user fee bill as well as the Senate Health, Education, Labor, and Pensions (HELP) Committee bill passed out of committee earlier this year, however, agreement between the two chambers could not be reached. .

Medicaid

December 16 is another important deadline, as it marks the expiration of matching federal dollars for the US territories’ Medicaid programs. On top of this deadline, Puerto Rican government officials are calling for more federal funding to address the damage from Hurricane Fiona. Furthermore, there is significant pressure by stakeholders, including the National Association of Medicaid Directors, on Congress to address the need for certainty around the end of the Medicaid continuous enrollment requirement per the public health emergency. In addition, several top Democrats are pushing to make 12 months of postpartum Medicaid coverage mandatory and permanent for states. Already over half of states have opted for the temporary extension of Medicaid postpartum benefits from 60 day to 12 months as made possible by the American Rescue Plan Act.

ARPA-H

Congress officially created the Advanced Research Projects Agency-Health (ARPA-H) in its FY 2022 omnibus, but specific details on the new agency remain unclear as work continues on authorizing legislation. While both the House and Senate bills to authorize ARPA-H contain many similarities, they differ in one key area – the Senate bill would make ARPA-H a part of the National Institutes of Health (NIH), while the House bill calls for making ARPA-H an independent agency within the Department of Health and Human Services (HHS). Despite differences on the structure of the new agency, Democratic leaders of the House and Senate health committee remain highly interested in finishing ARPA-H authorizing legislation this year.