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The Week Ahead

Stay informed with our weekly buzz about what’s going on in Washington, DC.

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!

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March Madness Comes to an End… Or Does It?

Well the Gamecocks of South Carolina finish their 10th undefeated women’s basketball season, beating the Iowa Hawkeyes in double digits.  We have the men facing off tonight with Purdue being in the finals for the 1st time since 1969.  And we have the only total solar eclipse in the 21st century where totality will be visible in Mexico, the U.S., and Canada EVER.  It will be an amazing week in DC – let’s get to it!

The Administration

What’s Happening: Much like the players getting ready for the big game tonight, President Biden is getting ready for his upcoming rematch with former President Trump. One way he is doing that is by outlining his Administration’s positions on health care and contrasting those positions with the former president and Republicans. In the last two weeks, President Biden

  • Published a document attacking the House Republican Study Committee’s Budget for cuts to Medicare and Social Security
  • Hosted and spoke at a White House event on health care with Senator Bernie Sanders (I-VT)
  • Held a campaign event in North Carolina and gave remarks focused on health care policy

Why It Matters: Polls show that the American people want to hear from 2024 presidential candidates about health care policy even if other issues may be ranked higher in importance. President Biden’s recent flurry of activity around health care tells us that he and his team are working to respond to that call. We expect this activity to continue, if not increase, as the campaign heats up.

Rule-o-Rama: Even though Congress has been on recess, the Administration has been busy publishing and finalizing several health care-related rules. Some highlights include:

  • A rule with the goal of making it easier for eligible individuals to maintain Medicaid coverage during the unwinding process.
  • A rule aimed at what the president has labeled “junk health insurance plans”
  • The Contract Year (CY) 2025 Medicare Advantage and Part D final rule
  • The 2025 Notice of Benefit and Payment Parameters final rule

Why It Matters: Rules finalized thus far have generally been focused on protecting and improving existing programs (i.e. the rule making it easier for individuals to maintain Medicaid coverage). However, what we find more interesting are the rules that have not been introduced such as the nursing home staffing mandate or the ban on menthol cigarettes and flavored cigars.  We are watching to see if President Biden will try to score a few more regulation points before the final buzzer goes off and the other team can use the Congressional Review Act to more quickly undo recent agency action.

We also expect the Hospital Inpatient Prospective Payment Rule to come out in the next week or so. It will be interesting to see if CMS follows MedPAC’s advice to increase payments by market basket update plus 1.5% or if CMS will be more austere.

The Senate

What’s Happening: The Senate is skipping the warm-up drills and going right into the game his week with two prime-time hearings.

Why It Matters: The Senate Finance Committee hearings both focus on issues which have garnered support from both sides of the aisle. This makes sense given how difficult it is to move partisan priorities with a divided Congress. Here are some things we will be watching for:

  • Will committee members show support for efforts like those in the House to reform how physicians are paid under Medicare?
  • Will the committee stay focused on physician payments or go off on tangents related to other Medicare priorities?
  • Will the GOP members use the subcommittee hearing on oversight of SUD care to criticize the Administration’s efforts to utilize harm reduction strategies?
  • Will Democratic members follow the White House’s line of attack against House Republicans for proposed reductions in opioid response programs?

Don’t Forget:  Senate Finance is also expected to hold a hearing to examine the Change Healthcare cyberattack.  Advocacy groups have been critical of UnitedHealth’s and the federal government’s response so far.

The House

A Ukraine funding bill is expected this week:  Speaker Mike Johnson (R-LA) said he would introduce legislation this week to aid Ukraine in its war against Russia.  The Senate passed $60 billion to support Ukraine in February but nothing has been resolved because of opposition in the House.

Will the Next Appropriations Chair Please Stand Up:  House Appropriations Committee Chair Kay Granger (R-TX) announced she would be stepping down from her post after the completion of the FY24 appropriations bills. She sent a letter to Speaker Johnson asking that the GOP Steering Committee and Conference begin the process of choosing a new chair.

Why it Matters: Only 1 member has officially put his hat in the ring, Rep. Tom Cole (R-OK). However, Rep. Robert Aderholt (R-AL), who has seniority over Rep. Cole on the committee, has called for a time out in the selection process. Any delay over choosing a new appropriations chair has consequences, including:

  • Time taken away from working on FY25 appropriations
  • Time taken away from legislating on other issues, such as telehealth

What’s Happening on Health Care: The House Energy & Commerce Committee Health Subcommittee will hold a hearing on April 10 titled “Legislative Proposals to Support Patient Access to Telehealth Services.” Next week, we are looking ahead to a House Oversight Committee hearing on the FDA, where Commissioner Califf will testify.

Overtime: MedPAC and MACPAC Meet

Both MedPAC and MACPAC will be working on their June reports to Congress. These reports provide recommendations for improvements or innovations to the program. We will be especially interested in the following:

  • MedPAC’s looking into telehealth and also Medicare physician fee schedule – just like the House
  • MACPAC’s scheduled vote on Friday morning on recommendations for the June report to Congress

Here’s to a great week ahead – were you disappointed by Caitlin Clark’s loss even as she played amazingly, did you see the last eclipse in the US in 2017, are you looking forward to the Master’s golf tournament this week – let us know your questions and feedback!

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The Week Ahead: March Madness – Washington, DC Version

Let’s start with 3 questions about timing this week.  See if you can guess the answers! 

  • What happened on time?   Selection Sunday for the NCAA Men’s and Women’s Basketball Tourneys – one of our favorite events of the year! 
  • What happened early?  Cherry blossoms.  The National Park Service declared peak blooms hit on March 17 – the second earliest peak on record. 
  • What happened late? Well, sort of, we still don’t have a clear path to fund the government past March 22.  Better late than never?! 

  

The Administration 

Health and Human Services Sec. Xavier Becerra will makes a second set of appearances this week on the President’s Budget.  His testimony before the Senate Finance Committee last week touted the Administration’s efforts to lower prescription drug costs and increase the number of people insured under the Affordable Care Act.  Expect more pointed questions in the House Appropriations Committee about funding priorities and the House Ways and Means Committee about Medicare and health savings accounts on March 20. 

  

What hasn’t yet come up in these hearings is the Administration’s response to the cyberattack on Change Healthcare, a unit of UnitedHealth Group that processes 15 billion health care transactions annually and touches 1 in every 3 patient records.  CMS, the HHS Office of Civil Rights, and the Department of Labor have all sent out notices of assistance within their jurisdiction.  The American Hospital Association has indicated the response to date has been woefully inadequate. 

  

The Senate 

The mad dash this week is to make sure the government remains funded past March 22 and before both the Senate and House will go back to their states and districts for a 2-week district work period.  While appropriations leaders have been working through the weekend, there’s no paper yet.  

  

We will be keeping our eyes peeled for any updates on the AI front, as the Gang of Four was predicting releasing their lessons learned from the various AI Insight Forums held over the last few months.  While the leaders will release a set of findings and suggested direction, the work of legislating will be left to the committees. 

  

The House 

If it feels like déjà vu all over again, you’re not alone.  We have 1 week to go to fund 6 major departments including HHS, Education, Labor, Homeland Security, Defense, State, and Treasury.  Funding for Homeland Security is one of the sticking points.  We had been anticipating the possibility of certain health care policy riders being attached, such as pharmacy benefit manager reform, hospital price transparency, and community health center funding, but it looks like these proposals may have to wait until after the election. 

  

  • Don’t forget – Rep. Ken Buck (R-CO-4) is retiring on March 22 – shrinking the GOP majority to a mere 5 votes (218-213). The margin will likely shrink further 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-26).  

  

Besides Sec. Becerra’s appearance before the House Ways and Means Committee, we will be watching closely as the House Energy and Commerce Health Subcommittee rips into FDA’s controversial proposed rule to regulate lab developed tests on March 21. The full Committee may also be marking up a number of health and non-health bills. 

  

So, here we go – March Madness – DC style.  If you have a free minute, don’t forget that MedPAC and MACPAC sent up their annual March Reports to Congress!  If you remember being able to receive those pubs by mail, let us know….  

 

 

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The Week Ahead: President’s Budget Release and More

The daffodils are in full bloom in Washington and Congress and the administration are trying to make the most of the next 2 weeks before taking a break for the Easter holiday.  There’s a lot going on in DC, so let’s get to it!

The Administration

All eyes on are the President’s annual budget release which will set out the President’s priorities for the government heading into the November elections.

  • Pay attention to what the President is proposing that can be done through Executive Order or regulation vs. what needs Congressional action.  While the “dead on arrival” phrase is often used in Washington, some things will be deader than dead, if that’s a thing, but anything the President can do on his own is fair game.

On March 1, President Biden gave his third State of the Union address, leaning into issues that energize the Democratic base and remind viewers and voters of his accomplishments.  For health care, he:

  • promised to restore Roe v. Wade as the law of the land, noting how red states have restricted access to IVF
  • expressed his desire to extend the Medicare insulin cap at $35/month to those with commercial insurance
  • made the case for expanding the number of prescription drugs subject to Medicare negotiations beyond current law

The Senate

The Senate took a victory lap over the weekend by passing a package of 6 bills to fund the government through September, including the Food and Drug Administration.  Congress now has 2 weeks to figure out how to fund the rest of the government before the March 22 deadline to avoid a partial government shutdown.

  • As an aside, how many times have we typed those words – avoiding a government shutdown – in the last few years?  We’ve lost count….

With immigration remaining at the forefront, the next set of bills, including Defense, Homeland Security, and Health and Human Services, won’t come so easily.

For health care, the Senate Finance Committee will host Sec. Becerra for a discussion of the President’s budget on March 14.  Yes, there will be partisanship but that isn’t what most interests us….

  • Watch for Senators’ priorities as they comment on the budget – this shows what each is championing and what might be able to move forward yet this year.

The House

The House comes back to take up 11 bipartisan bills coming out of the Transportation and Infrastructure Committee under suspension of the rules. But partisan tensions are sure to resume later in the week as the House brings up a resolution denouncing the Biden Administration’s immigration policy.

For health care, the focus is on the committees this week.  On March 12, the House Energy & Commerce Committee will be meeting to markup and move 19 bipartisan health-related bills, covering a wide range of issues, including maternal health, dementia treatment, cancer screening and a host of other initiatives. One bill of note that has garnered considerable attention is the “Dr. Lorna Breen Health Care Provider Protection Reauthorization Act” (H.R. 7153), which seeks to raise awareness and provide resources to address the mental health issues facing the health care workforce.

Also, on March 12, the House Ways & Means Committee will hold a full committee hearing titled, “Enhancing Access to Care at Home in Rural and Underserved Communities,” which will include testimony from both patients and providers about the challenges in improving access to in-home care and to modernizing the delivery of care in rural and other underserved communities.

There You Have It

We at Chamber Hill Strategies, are counting down the days:

  • 10 days left of winter
  • 11 days till the men’s NCAA basketball tourney starts
  • 12 days to avoid a government shutdown
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Week Ahead: Full House – Approps and SOTU This Week

Kicking of Women’s History Month, Nikki Haley won the primary in the District of Columbia, making her the first woman to win a Republican primary in US history. The other big news of the weekend was that congressional leadership, along with congressional appropriators, released a bipartisan package of six bills to stave off a government shutdown.  The goal of both chambers is to pass the spending bills by Friday’s partial government funding deadline.

The Administration

President Biden will deliver the State of the Union this Thursday, as the administration hopes to land a winning message with voters.  The President will focus on his accomplishments to include infrastructure and others, while he makes the case for another term. The President will rally around staying the course to continue steady progress as opposed to new leadership. Themes will focus on corporations paying their fair share, protecting democracy, and ending cancer among others.  Despite having the bully pulpit, many polls show President Biden losing to Donald Trump if the election was held today.

The Senate

The Senate will take up the bipartisan appropriations bills once they are passed by the House to avoid a partial government shutdown on March 8.  All signs appear to point to passage, but we can never be too certain in this environment.  The bills included are Agriculture-FDA, Commerce-Justice-Science, Energy-Water Development, Interior-Environment, Military Construction-VA, and Transportation-HUD.  Both sides of the aisle are claiming victory on this package, as funding in many areas largely remains flat.  Funding for the remaining bills will run through March 22 per the earlier passed continuing resolution.

 

Healthcare

On Wednesday, March 6, the Senate Budget Committee will hold a hearing on how primary care improves health efficiency.  Additionally on Thursday, the Senate HELP Committee will hold full committee hearing on the Older Americans Act.  The OAA is usually met with bipartisan support.

The House 

The House is back in on Tuesday, with 5 bipartisan health policy-related bills on the schedule for the week, covering issues including maternal health, pediatric research, dental health, promoting primary care in Medicaid, and reauthorizing the Firefighter Cancer Registry.

 

Drawing more attention though will be the House’s consideration of a legislative package that was released Sunday that will finalize funding for government programs and agencies through the remainder of Fiscal Year 2024.  In the closely divided Congress, the package gives both parties victories to champion while there will certainly be detractors among their ranks as well. While Republicans are celebrating certain cuts and law enforcement provisions, Democrats are touting their own success in stopping many cuts and policy riders that Freedom Caucus members had been pushing. Even with some naysayers, the House is expected to pass the legislation by a large margin before sending it to the Senate later this week.

 

Healthcare

In addition to funding these agencies and programs, the appropriations package includes expiring programs included the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC). House Energy & Commerce Ranking Member Frank Pallone (D-NJ) praised the agreement which includes a 10 percent increase for CHCs, a 17% increase for the NHSC, and a 56% increase in THC GME. In addition, after much back and forth, the legislation also provides a 1.68% increase in Medicare physician payments to help mitigate the 3.34% cut in Medicare payments that took effect on January 1.

 

While the final package also includes measures to reauthorize substance abuse programs under the SUPPORT Act, despite previous optimism, negotiators were unable to reach an agreement on larger health legislation on pharmacy benefit manager reforms, site neutral payment policies, and a reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA). Conversations continue on these measures with action later this year still very much a possibility.

 

With a busy week for health policy on the House floor, it will be a little quieter week in most House committees. That said, the House Oversight & Accountability Committee’s Select Subcommittee on the Coronavirus Pandemic will hold what could be an interesting hearing on Wednesday, March 6, titled the “White House Role in Pandemic Preparedness and Response,” where it will hear testimony from Maj. Gen. Paul Friedrichs, M.D. (ret.), the White House’s Director of the Office of Pandemic Preparedness and Response Policy.

 

As always, please reach out with any questions as we continue to track the developments of this week!

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