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The Week Ahead

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

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The Week Ahead: Congress Shovels Out of Snow to Punt for Six Weeks

Good morning from Washington, where we are looking to get out of the snow to rise again in the sun this week. The last few days of snow caused people to shovel their driveways a few days ago, just to get more snow a day or two later. The whole scene is akin to Congress barely passing a bill in time to fund the government to just punt the real problem down the line to March 1 and March 8. While we can celebrate the baseline accomplishment of well, you know, the ability to keep the doors open – we still know more issues are set to pile on in six weeks. The House is in recess this week because they’ve worked so incredibly hard, and the Senate is in session and looks to roll up their sleeves. Welcome to the Week Ahead!!

The Administration

Last week President Biden signed legislation to avoid a partial government shutdown and continue the laddered approach under the continued resolution Congress passed last year. The President also met with lawmakers to reach mutually agreeable ground on issues surrounding the administration’s supplemental funding request. Issues remain around border security. This past week also marked Republican presidential hopefuls leaving the Iowa caucus and moving their sights onto New Hampshire. It now appears to be a two-person race with former President Trump and Nikki Haley.

Healthcare

The Center for Medicare and Medicaid Services (CMS) will hold a national stakeholder conference call this Tuesday at 1pm featuring CMS Administrator Chiquita Brooks-Lasure to discuss the CMS Strategic Plan. As a reminder, the plan focuses on expanding access to care, advancing equity, and driving innovation, among others. 

The Senate

The Senate is in session this week and will be churning through a few nominations early in the week. The real action will continue behind the scenes as a group of bipartisan senators continue to work on details around a supplemental funding package. As we reported earlier, the package would provide funding to allies including Ukraine, Israel, and Taiwan. The package is also believed to have border security changes included in it, but as we also previously mentioned to what extent remains to be seen. It’s not quite clear yet when Majority Leader Schumer will begin the process of bringing this to the floor as many pieces remain in play. Minority Leader McConnell will work to bring Senate Republicans along to demonstrate support for Ukraine, but he still has a big task ahead of him. Senate Republicans are not in a rush to have this legislation jammed through the process despite these issues being in play for months. In related news, Senate appropriators remain concerned about allocations despite topline numbers being agreed to as part of funding the government. Complicating the matter is whether the supplemental will pass and what money may be included for the Department of Homeland Security.

Healthcare 

The Senate Aging Committee will hold a hearing on Thursday at 10am on long-term care options for older adults. The hearing will focus on assisted living facilities. Lawmakers from both the House and Senate continue discussions on a potential large health care package that would include opioid support programs, doc payments, telehealth, and price transparency.

The House 

After passing legislation (H.R. 2872) to avert a partial government shutdown and extend the government funding deadlines into March, members of the House of Representatives return to their home states for a district work period. Under the legislation, Congress continued the “laddered approach” under the continuing resolution (H.R. 6363) that Congress passed late last year, bumping out the new funding deadlines from January 19 and February 2 to March 1 and March 8 respectively.

Health Care

Under H.R. 2872, multiple health extender deadlines that were previously set for either January 19 or 20 were now extended to either March 8 or 9. Among the expiring provisions that were extended included payments under 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).

It still remains to be seen if Congress will be able to reach an agreement on larger health legislation, but House leaders are expected to push for including provisions that were included in the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act that the House passed with broad bipartisan support late last year.

In addition, as expected, Congress failed to provide relief to physicians and other clinicians who were hit with a 3.37% Medicare payment cut on January 1 in the H.R. 2872, but members of the House Republican Doctors Caucus and physician organizations are continuing the push to include some form of relief in the appropriations legislation and health extenders that Congress will have to address in advance of the March 8 deadline. At the beginning of last week, there appeared to be little possibility for relief from the cuts this year, but physician and allied health groups and their champions in Congress are continuing to hold out hope.

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The Week Ahead: CR or Not to CR… this is the Question

Welcome from Washington DC, where a few inches of snow canceled schools and closed the federal government leaving parents gazing into the horizon for relief and confirmation schools will open in the next day or so. As we stare into the legislative horizon, we wonder if Republicans and Democrats can come together to fund the government to avoid a shutdown. During the Martin Luther King, Jr. holiday weekend a deal was struck on a stopgap measure to extend spending authority until March 1 and March 8, keeping intact Speaker Johnson’s laddered approach. However, with time being of the essence, can Congress act quickly (not its best trait) to pass the measure through both bodies in time? Welcome to the Week Ahead – where the 118th Congress continues to struggle to meet the most basic legislative tasks.

The Administration

The Border. Negotiations on border security continue but seem to be stuck at the same time. As we reported earlier, border security is being tied into any additional funding for Ukraine, Taiwan, and Israel by Speaker Johnson and other Republicans. The issue at hand appears to be the ability for the administration to continue to use parole authority. This power allows the government to grant the ability for migrants to have temporary permission to live and work in the United States even though a path to citizenship may not exist. Parole authority is a must have for the Biden administration, but Republicans see this tool as a way for immigrants to get around Congress when they otherwise cannot gain access into the country. It remains a sticking point and could tie up foreign aid to America’s allies.

Healthcare 

Medicare Advantage. A MedPAC presentation and report Friday states the federal government will pay $88 billion more than it should this year because they attract healthier lower-cost beneficiaries thus driving sicker beneficiaries into traditional Medicare. The report also mentions complicated upcoding procedures used to drive up payments to plans.

The Senate

The Continuing Resolution. The Senate is scheduled to hold a vote on the legislative vehicle short-term continuing resolution to extend the government funding deadlines to March 1 and March 8. Despite the snow, the vote is on! Senators who wish to oppose the CR can do so until Sunday, but the Senate really needs to move on this to avoid a shutdown. Both Leader Schumer and Senator McConnell will work to address any concerns members have to prevent this from happening. The CR does not address major issues like funding for our allies or the border security issue, but it does give more time for appropriators to pass their bills before automatic spending cuts come to fruition in mid-April.

Healthcare

The Senate Health, Education, Labor and Pensions Committee will hold a hearing addressing long COVID on January 18th at 10am.

The House 

On the Clock. The House is scheduled to hold votes tonight to encourage members to be back in town despite the weather. It is thought Speaker Johnson may have to work this week to get the proposed CR to pass via suspension which requires a two-third majority, Democrats appear to be united behind passing the CR and helping get this across the finish line. However, it will not come without asks from the Democrats – so let the negotiating begin! (https://jensen-jensen.com)

Healthcare 

The House returns after the Martin Luther King, Jr. holiday with a slate of bills and resolutions to consider, but the most pressing question as the House reconvenes will be whether enough House Republicans will vote to join Democrats later in the week and avert a partial government shutdown before the first funding deadline under the “laddered” continuing resolution (H.R. 6363) that Congress passed late last year hits on January 19.

While an agreement has been reached between Speaker of the House Mike Johnson (R-LA) and House Majority Leader Charles Schumer (D-NY) on topline spending numbers, much remains to be determined—not only on final appropriations for the rest of the fiscal year but on health policy priorities as well. Under the “laddered” agreement agreed to by Speaker Johnson and Leader Schumer reached late last week, a final agreement on significant health legislation is now not expected until at least March as multiple health extender deadlines that were previously set for either January 19 or 20 will now be extended to either March 8 or 9. Expiring provisions pending to be renewed include payments under 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).

Prior to adjourning in December, the House passed both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act with broad bipartisan support, and House leaders are pushing for inclusion of many of the bills’ provisions including measures on price transparency, pharmacy benefit manager reform, and hospital payments in a final government funding package for 2024.

The largest health policy casualty of Congress failing to reach an agreement on government funding and larger health hit physicians and other clinicians under Medicare. When Congress adjourned in December, momentum appeared to be building for Congress to provide at least partial relief from the 3.37% cut in Medicare physician payments that took effect on January 1, but Congress failed to reach an agreement on additional relief from Medicare payment cuts in 2024. As a result, Medicare payment rates resulting from the 3.37 percent cut are expected to remain throughout 2024.

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The Week Ahead 12/18/23: Bah Humbug! The Senate in One More Week – No Real Traction on Supplemental

Good morning from Washington DC, where like much of the east coast we were battered with rainstorms last night.  Fortunately, we woke to sunny skies coupled with forceful winds. The turbulence remined me of the push and pull taking place over the war supplemental request tied to border security measures, as conservatives are angling to slow roll the process and liberals are expressing concerns over actions in Gaza. We continue the conversation below as President Biden is being pulled in both directions, while also battling troubling poll numbers. As we conclude a turbulent political year which saw the ousting of a House Speaker, surprise retirements, and the expulsion of a perpetually lying congressman, we can only hope the administration and a divided congressional body learn to work together to fund the government and pass meaningful legislation in 2024. We can all learn something new – as I read an article last night clarifying the true cause behind the Boston Tea Party. It was caused over a corporate tax decrease (not an increase on tea tax) which would have enticed the colonists to buy lower-cost taxed tea thereby giving up the principle of no taxation without representation. The Senate is in this week and President Biden dodged a car crashing into his motorcade!  Welcome to the Week Ahead!

The Administration

What a past few days President Biden experienced.  Last night, a car crashed into a SUV in his motorcade right after he answered questions from reporters about why he is trailing Trump in the polls.  Fortunately, the President and First Lady were fine.  In addition to polling headaches, the President continues to face an uphill battle in terms of his war supplemental request. As we’ve mentioned in past weeks, the administration wants to provide funding to Israel, Ukraine, and Taiwan, but the House wants to link any funding request to changes in border security measures. The President, feeling much like the Stealers Wheel Song – Stuck in the Middle With You, is feeling clowns to the left of him and jokers to the right. Conservative opposition to funding Ukraine without reforming border security measures continues to mount and stall the process, while members of the Congressional Hispanic Caucus voiced concerns about the Biden Administration not communicating with them regarding negotiations which took place this weekend.

In healthcare news, the Center for Medicare and Medicaid Services released a voluntary payment model to improve maternal health in the US, a pillar of the Biden Administration’s goals in healthcare. The Transforming Maternal Health Model (TMaH) plans to partner with state Medicaid agencies to lower maternal mortality rates while reducing associated health disparities. The initiative will develop a value-based alterative payment model which will improve health outcomes and quality.  TMaH will focus on three main pillars: 1. Access to care, infrastructure, workforce capacity; 2. Quality and safety, 3. Whole-person delivery.  The program aims to work with participating states to address gaps in maternal health care by supporting access to midwives and doulas, improving perinatal care for chronic conditions like diabetes and hypertension, and reducing c-sections for low-risk mothers.

 

The Senate

Senate Majority Leader Schumer made sure he received less holiday cards this season as he called the Senate in session this week.  Senator Schumer hoped this week would allow for a negotiated package to come to the floor this week.  However, negotiators on the supplemental request, while making progress, failed to come to agreement on a package.  The White House was directly involved, and it is reported that some provisions were agreed to but that large hurdles remain.  Senate Republicans are in no rush to have a vote, and Senator Chris Murphy stated no legislative text exists for members to vote on at this time.  Senator Ron Johnson led a group letter of conservatives requesting a conference-wide meeting to discuss what they felt were “secret” negotiations with Democrats. All this to say, it is unlikely a floor vote on a supplemental request without legislative text will pass this week.  This sets up a particularly busy early part of January which also runs into the first tranche of government funding.  The Senate is also moving on stalled military nominations this week.

Senators are moving in a bipartisan work on health transparency with new legislation that requires insurers, hospitals, and other health facilities to disclose more pricing information.  The legislation entitled, The Health Care Price Transparency Act, 2.0, aims to be more stringent than its House counterpart by requiring hospitals to post the actual price for a service, rather than the median price. Like the House passed Lower Costs More Transparency Act, the measure extends transparency requirements to imaging centers and clinical labs, among others.

The House

The House finished its business last week and is out until next year.

Things will pick up quickly come January 8 as the House will only have eight legislative days before the first set of appropriations and health extender deadlines hit on January 19.  The House will only have an additional 4 legislative days before the second set of appropriations deadlines hits on February 2.  Rumors have started to percolate the House could extend the appropriations bills set to expire on January 19 to February 2, and a very likely scenario is a year-long continuing resolution to fund the government at current levels through Fiscal Year 2024 will be the result in February.

With multiple health extender deadlines hitting on either January 19 or 20, whatever government funding package is passed to fund the government past January 19 is expected to include health extenders. With the House having passed the Support for Patients and Communities Reauthorization Act last week with broad bipartisan support, it is rumored that the legislation could be packaged and passed along with provisions to provide partial relief from a scheduled 3.37% cut in Medicare physician payments and extend incentive payments for alternative payment models that would closely align with provisions passed the House Energy and Commerce Committee and by the Senate Finance Committee. Other provisions to be included would extend payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, an extension of the Work Geographic Practice Cost Index (GPCI) Floor, and extensions of funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).

While the House did also pass the Lower Costs, More Transparency Act with bipartisan support last week, it seems less likely that the pharmacy benefit manager reforms and other measures, including site neutral payments for certain services, will be in play for moving in a January package because why include things to which everyone agrees?

As always, we value your insights and look forward to hearing from you!  This will most likely be the last Week Ahead for 2023.  Thank you for making this a wonderful year, and from all of us at Chamber Hill Strategies we wish you happy holidays and a fantastic New Year!

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A Whirlwind Week in Washington D.C. – From Political Storms to Legislative Waves

Good morning from Washington DC where the weather changed from rain, to snow, to warmer temperatures and sun in a matter of 36 hours.  The dramatic shift in weather cycles reminds us of the recently announced retirement of former House Speaker Kevin McCarthy.  Where else can you go from being Speaker, to being removed by your own party, to retiring all in one year?  Here in Washington of course!  Rep. McCarthy is not the only one to announce retirement for this term, and we do expect many more to leave before filing for another term.  With the slight majority Republicans hold in the House, each retirement and expulsion (Santos) makes the holiday season more enjoyable for House Democrats looking to take control next session.  In addition, we only have one week left of legislative business, and we still have no agreement reached on aid for Ukraine and Israel.  Congress returns this week to what could be a very busy time! Welcome to the Week Ahead!

The Administration

President Biden continues to work behind the scenes with Senate negotiators on the White House supplemental request for funding to Israel, Ukraine, and Taiwan.  As previously mentioned, Republicans in Congress want to tie any aid for these countries to increased border security measures.  The administration publicly stated reforms are needed at the border, but at this time, no agreement has been reached for foreign aid. President Biden will host Ukrainian President Zelensky this week.  With time running out and House Republicans becoming increasingly skeptical of funding Ukraine, President Zelensky returns to Congress for a last-minute plea to the Senate.

In health care news, and in line with its priorities, the White House celebrated the announcement that the FDA announced the approval of gene therapies to treat sickle-cell disease via its statement.  To address health inequities and improve on treatment of sickle-cell disease which disproportionately impacts African Americans and Hispanic Americans, the Biden Administration believes this breakthrough can save and improve the lives of millions.

The Senate

The Senate will welcome Ukrainian President Zelensky for a speech on the importance of funding to Ukraine.  The invite was extended by both Majority Leader Schumer and Minority Leader McConnell.  Behind the scenes negotiations will need to resume on border security measures to couple with potential funding on the war supplemental.

With an eye on health care for moving into 2024, the Senate will look to the following this week:

The upper chamber will look to conclude the year by finishing off its health care priorities, although they lack a bipartisan larger “package” which Leader Schumer expressed desire to complete this year.

The House

Retirement season has officially kicked off on Capitol Hill. Former Speaker McCarthy is leaving at the end of the year, Chairman Patrick Mc Henry (R-NC) is in his final term, and we expect several more are going to leave before they must file to run for another term. Many members are citing (shocker) dysfunction and just want to go back to their private lives.  With one week remaining, major fireworks remain on emergency packages for Ukraine, Israel, Taiwan, and the border wall. The Senate continues to negotiate, but the Senate package still must pass the House and must include border security.

In the area of artificial intelligence, the House Energy and Commerce Committee will hold a hearing on Wednesday leveraging agency expertise across the economy to position America as a leader in AI.

Health Care

As Congress looks to close its work for 2023, the House will be taking steps to move health legislation forward with an eye to positioning themselves going into 2024.

  • The House will consider 14 bills, including:
    • Lower Costs, More Transparency Act (H.R. 5378), which would establish increased transparency for insurers hospitals and PBMs.
    • Support for Patients and Communities Reauthorization Act (H.R. 4531)
    • PREEMIE Reauthorization Act of 2023 (H.R. 3226).

Each of the bills will be considered under the suspension of the rules signaling House leadership’s belief that the bipartisan bills will garner enough support to pass with the required two-thirds majority needed under the procedure. By moving the legislation with strong bipartisan support, the House leadership will be asserting a strong position on several health issues, including pharmacy benefit manager reforms and provider payments, as House and Senate are expected to work to reach an agreement on health legislation in 2024.

Beyond this public work on health care, we also expect work and conversations to continue behind the scenes, as leadership and committee staff on both sides of the Capitol work with an eye toward drafting legislation to address several expiring health care provisions and programs in January. As readers are likely aware, the House Energy & Commerce Committee moved 19 pieces of health-related legislation last week, including measures to extend the work Geographic Practice Cost Index floor, to revise the phase in of certain payment changes for lab services, an extension of expiring incentive payments for alternative payment models, and additional relief to help mitigate the 3.4% cuts in Medicare physician payments scheduled for January 1, 2024. At this time, we do not anticipate seeing a final agreement on these provisions before Congress adjourns in 2023, but it is expected that these other health provisions could be included in a legislative package in January.

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Navigating the Capitol: A Look Ahead at Congress’s December Agenda

Good morning and welcome from Washington, DC where Members of Congress return to work this week to face a few weeks of varying agendas depending on whether they sit in the Senate or the House. We hope our readers enjoyed a restful week and are back energized and ready to go!  Your author was able to avoid any travel this past week but unfortunately experienced his first taste of Disney princess fatigue, as I took my young daughter to see the movie Wish.  As the movie has a nice premise of free will and establishing one’s own destiny while not falling victim to a charismatic and selfish leader, I was reminded at times, however, it is good to have a collective group think – and we can only aspire that Congress exhibit this ethos to work together this month to avoid a government shutdown come January 19th.  Now that the holiday meals have settled, it is time to get to work!  Welcome to the Week Ahead!

The Administration

The Biden administration is moving forward to work with the Senate on its supplemental funding strategy which includes funding for Ukraine, Taiwan, and Israel.  The administration sees this as imperative to remaining a trusted leader on the world stage with America’s allies and must work this week to make it happen.  Timing is of the essence as only a few weeks remain until the end of the legislative calendar for 2023.  The deal will basically hinge on border security measure and asylum policies to address migrant issues at our shared border with Mexico.

It was announced this weekend that President Biden will not be attending the upcoming United Nations Climate Summit known as COP28.  The President attended the summit over past two years, but the ongoing war between Israel and Hamas has taken much of the President’s time, as he continues to pursue a ceasefire and the release of hostages.  John Kerry, President Biden’s special envoy for climate change will attend the summit in his place.

The Senate

Majority Leader Chuck Schumer issued a Dear Colleague letter outlining the Senate’s ambitious agenda for the remainder of the calendar year.  The Senate will aim to tackle a variety of challenging policy areas to include leading with President Biden’s supplemental funding request as early as next week.  Several Senate offices have stated that a deal must be worked out this week to successfully place the request on the Senate floor during the week of December 4th.  Again, any funding request would most likely be paired with border policy changes.  Senate Democrats realize that some policy changes are required to get a deal completed in time.  In addition to the funding request, the Senate will work with the House on the first set of appropriations bills to keep the government funded past the January 19th deadline.  The Senate will also look to pass the NDAA, confirm further judicial nominations, and work to overcome the legislative blockade of Senator Tuberville on military promotions.  With all that is happening on the national stage this month, what passes with regards to health care remains to be seen.

The House

As the House shifts focus to holiday parties and fundraisers, there is still plenty of drama remaining in the lower chamber.  With the potential ousting of Rep. George Santos, it will be interesting to see who else retires and how the battle for the House heats up.  Since Speaker Johnson cut a deal on the budget, it is holiday season around Washington D.C.!!! Christmas and holiday parties begin this week with a slew of fundraising before the final quarter of this year’s fundraising cycle. Congress has punted the budget to next year, and the town will feel the pressure start to cook once they get back from break.

The House will need to work with the Senate to come to a consensus before recess on the President’s supplemental request. This will be quite tricky as the House has already passed Israeli aide with a pay-for. The House may adjourn by December 8th, pending an agreement with the Senate on this request.

With Congress coming back from the Thanksgiving break, we expect a light week in Washington with few hearings and a focus on legislation largely related to issues other than health care. That said, the House Energy and Commerce Committee will hold two separate health-related topics. First, on Wednesday, the E&C Health Subcommittee will hold a hearing titled “Understanding How AI is Changing Health Care,” which is expected to be a broad hearing covering the potential and concerns surrounding AI in health care delivery. On Thursday, the E&C Subcommittee on Oversight and Investigations hearing will hold a hearing titled “Unmasking Challenges CDC Faces in Rebuilding Public Trust Amid Respiratory Illness Season,” where the Subcommittee will hear from Mandy Cohen, M.D., Director, Centers for Disease Control and Prevention and is expected to pursue questioning regarding the origins of COVID-19 and communications during the pandemic.

Also, with the passage of the continuing resolution to fund the government into next year, Congress also extended several health programs and provided protections from potential cuts into January as well. By taking action to prevent pending cuts under the Medicaid Disproportionate Share Hospital (DSH) program, extending the Work Geographic Practice Cost Index floor, and providing an extension of the Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and National Health Service Corps (NHSC) programs to January 19, Congress effectively punted on addressing larger health-related legislation until at least January—if not later in 2024.

In addition to pushing off the likelihood of any action on legislation targeted at pharmacy benefit managers, mental health or opioids, the extensions of these programs into January also means that Congress is unlikely to take any action to address a scheduled cut of 3.4% in Medicare payments to physicians that is set to take effect on January 1 as well. Readers may recall that in late 2022, Congress passed legislation to provide relief from projected physician payment cuts in 2023 and 2024. While the Senate Finance Committee included a provision to mitigate the cuts in the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, which it cleared earlier this month, the House seems to have little appetite to provide additional relief to physicians in Medicare and the 3.4% cut is likely to take effect in January.

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