Health Care Policy Update – Weekly Wrap-Up and What’s Ahead – July 24, 2017


 What’s Ahead: This Week

Hearings/Markups –

  • Wednesday July 26
    • House Energy & Commerce Committee, Subcommittee on Health, “Examining the Extension of Special Needs Plans.”
    • House Oversight & Government Reform Committee, “Office of National Drug Control Policy: Reauthorization in the 115th”
    • Senate Special Committee on Aging, “Progress Toward a Cure for Type I Diabetes: Research and the Artificial Pancreas.”

Notable Policy Events –

  • Monday, July 24
    • HHS Office of the National Coordinator for Health IT (ONC), “21st Century Cures Act Trusted Exchange Framework and Common Agreement Kick-Off Meeting.” Additional information: http://bit.ly/2vICBY0
  • Tuesday, July 25
    • Friends of the National Institute on Drug Abuse (NIDA), Congressional Addiction, Treatment and Recovery Caucus, and the Bipartisan Heroin Task Force, “Preventing Opioid Use Disorders: Community Based Approaches that Work.” Additional information: http://bit.ly/2vfrFBZ
    • Bipartisan Policy Center (BPC), “The Future of Comparative Effectiveness Research.” Additional information: http://bit.ly/2uEC2Sx
  • Wednesday, July 26
    • ONC, “Interoperability in Action Day #2: Advancing Interoperable Social Determinants of Health.” Additional information: http://bit.ly/2uDSv9y
    • The Hill, “Health Rx: Building Affordability and Access.” Additional information: http://bit.ly/2vjmWiy
    • Bloomberg Government, “The Cost of Health Care.” Additional information: http://bit.ly/2tsoUvK
  • Friday, July 28
    • Alliance for Health Policy, “Prescription Medicine Affordability & Innovation: Policy Options & Stakeholder Views.” Additional information: http://bit.ly/2vJ5dR0

 Weekly Wrap-Up: Notable Health Care Developments From Last Week

 Budget & Appropriations –

  • On July 18, House Budget Committee released the Fiscal Year (FY) 2018 Budget Resolution, which seeks to balance the budget within 10 years “by cutting spending, reforming government, and growing the economy.” The Resolution also incorporates the House-passed American Health Care Act (H.R. 1628) and its projected savings, and would move Medicare to a premium support system. Press release: http://bit.ly/2vfwN9f Summary: http://bit.ly/2vfOUvs Blueprint: http://bit.ly/2vfx387 Bill text: http://bit.ly/2vfwFGN
  • On July 19, House Appropriations Committee approved the Labor, Health and Human Services, and Education FY 2018 spending bill; the bill includes $77.6 billion in discretionary funding for HHS, a decrease of $542 million from FY2017. The bill now moves to the full House for consideration. Press release: http://bit.ly/2ts0iTR Summary: http://bit.ly/2v1vTwV Bill report: http://bit.ly/2tso6qQ Bill text: http://bit.ly/2v1ksoX

 Legislative Activity –

  • On July 17, Reps. Burgess (R-TX), Dingell (D-MI), Roskam (R-IL), and Thompson (D-CA) introduced the Independence at Home Act of 2017 (H.R. 3263), which would extend the Medicare independence at home medical practice demonstration program. Press release: http://bit.ly/2vGy094
  • Also on July 17, Reps. DeGette (D-CO), Brooks (R-IN), and Reed (R-NY) introduced the Protecting Access to Diabetes Supplies Act (H.R. 3271), which would strengthen rules in case of competition for diabetic testing strips. Press release: http://bit.ly/2vG4390
  • On July 19, House Veterans Affairs Committee advanced 11 bills, including the Veterans Urgent Access to Mental Healthcare Act (H.R. 918), the VA Provider Equity Act (H.R. 1058), the Ensuring Veteran Enterprise Participation in Strategic Sourcing Act (H.R. 2781), and the VA Procurement Efficiency and Transparency Act (H.R. 2006). The bills now move to the full House for consideration. Press release: http://bit.ly/2vkymTr
  • Also on July 19, Reps. Renacci (R-OH) and Bera (D-OH) introduced the Protecting Consumer Access to Vision Care Act of 2017 (H.R. 3315), which would exclude limited scope vision insurance coverage from health insurance coverage subject to the health insurance provider annual fee. Press release: http://bit.ly/2vG1mEf
  • On July 20, Reps. Barton (R-TX) and Castor (D-FL) introduced the Advancing Care for Exceptional Kids Act of 2017 (ACE Kids Act) (H.R. 3325), which would provides states with the option of providing coordinated care for children with complex medical conditions through a health home. Sen. Grassley (R-IA) previously introduced a similar bill in the Senate (S. 428). Press release: http://bit.ly/2tspIAB

 ACA Repeal and Replacement Activity –

  • On July 17, Senate Minority Leader Schumer (D-NY), Finance Committee Ranking Member Wyden (D-OR) and HELP Committee Ranking Member Murray (D-WA) sent a letter to Majority Leader McConnell (R-KY), Finance Committee Chair Hatch (R-UT) and HELP Committee Chair Alexander (R-TN) formally requesting that leadership hold public hearings so Senators can hear the impact of the Better Care Reconciliation Act (BCRA) directly from experts. Press release with text of letter: http://bit.ly/2vfRQbs
  • On July 18, a bipartisan group of governors released a statement urging that “The Senate should immediately reject efforts to ‘repeal’ the current system and replace sometime later…the best next step for both parties is to come together and do what we agree on: fix our unstable insurance markets.” Statement: http://bit.ly/2vfW034
  • Also on July 18, Rep. Biggs (R-AZ) introduced three bills that would repeal the ACA and stabilize the marketplaces: the Responsible Path to Full Obamacare Repeal Act (H.R. 3276) would repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, H.R. 3277 would allow an above-the-line deduction for health insurance premiums, and H.R. 3278 would provide for cooperative governing of individual health insurance coverage. Press release: http://bit.ly/2vlaoXV
  • On July 19, Senate Budget Committee released text for the new Obamacare Repeal Reconciliation Act (ORRA), which would repeal – with a two year delay in effective date – large pieces of the ACA, including premium tax credits, the individual and employer mandates, the ACA’s taxes, and Medicaid expansion. The bill also provides $750 million for each of fiscal years 2018 and 2019 to states for substance abuse and urgent mental health needs. Summary: http://bit.ly/2vkMc7Z Bill text: http://bit.ly/2vk9L0X
  • Also on July 19, HHS released an analysis of Sen. Cruz’ss “Consumer Freedom” amendment to the BCRA, which finds that the amendment would expand coverage by more than two million individuals and would reduce premiums by more than $7000 per year, as compared to current law. Sen. Cruz Press release: http://bit.ly/2vl72UY Summary: http://bit.ly/2vkF7Es Report: http://bit.ly/2tsw5UQ
  • Also on July 19, Congressional Budget Office (CBO) released its analysis of the ORRA, finding that the number of people who are uninsured would increase by 17 million in 2018 and would reach 32 million in 2026. The bill would also result in an average 25% increase in premiums in 2018, and would double by 2026. Summary with link to report: http://bit.ly/2vkvbuL
  • Also on July 19, Reps. Langevin (D-RI), Chu (D-CA), and Ruiz (D-CA) introduced the Individual Health Insurance Marketplace Improvement Act (H.R. 3311), which would establish an individual market reinsurance fund to provide funding for state individual market stabilization reinsurance programs. Press release: http://bit.ly/2vGwmnQ
  • On July 20, CBO released an updated analysis for the BCRA, finding that the bill would leave 22 million more Americans uninsured by 2026, but would reduce the deficit by $420 billion. In comparison, the CBO had originally found that an earlier version of BCRA would reduce coverage by 22 million and would reduce the deficit by $119 billion. Analysis: http://bit.ly/2uDKUYx
  • Also on July 20, Senate Budget Committee released an updated version of BCRA, which removes Sen. Cruz’s amendment and makes small technical revisions. Press release: http://bit.ly/2tyHHpL Section-by-section: http://bit.ly/2uD5isA Bill text: http://bit.ly/2uDcwwT
  • On July 21, Democrats from the Senate Budget Committee released a summary of a briefing provided by the Senate Parliamentarian on the provisions of the BCRA that violate the Senate’s Byrd Rule. Flagged provisions included defunding Planned Parenthood, funding for cost-sharing reductions, and the 6-month lock out continuous coverage provision. Summary: http://bit.ly/2tseOLw
  • Also on July 21, Senate HELP Committee Ranking Member Murray (D-WA) and seven Democrats sent a letter to Centers for Disease Control and Prevention (CDC) Director Fitzgerald requesting information on the impact of the BCRA on critical public health efforts and work currently underway at CDC. Press release: http://bit.ly/2uOCzRu Letter: http://bit.ly/2uOCAVy

ACA Implementation –

  • On July 18, CMS released guidance regarding third-party auditor operational readiness reviews for the new proxy direct enrollment pathway for enrollment. Guidance: http://go.cms.gov/2uEstTB
  • On July 19, New Hampshire announced a section 1332 waiver proposal to establish a new state-based reinsurance program. Proposal: http://bit.ly/2vkswBh
  • Also on July 19, the Centers for Medicare & Medicaid Services (CMS) posted an update to the Health Insurance Exchanges Issuer County Map, finding that 40 counties across the country are projected to have no issuer participation on the exchanges in 2018. Press release: http://go.cms.gov/2vJaece
  • On July 20, Indiana sent a letter to HHS Secretary Price requesting an amendment to its pending section 1115 extension application, in which it seeks to require member participation in its Gateway to Work program as a condition of eligibility, amends its premium contribution requirements, and ends HIP 2.0’s HIP Employer Link program. Letter with summary of amendments: http://bit.ly/2tsdJ6q

 Medicare –

  • On July 17, U.S. Government Accountability Office (GAO) published a report recommending that CMS evaluate providing coverage for disposable medical devices that could substitute for durable medical equipment. Summary with link to report: http://bit.ly/2vGE80O
  • On July 19, GAO published a report describing several issues with CMS’s efforts to ensure proper payments in Medicare Advantage and recommending that CMS improve the accuracy of its methodology for identifying contracts with the greatest potential for improper payments recovery for review. Report: http://bit.ly/2vGnDBT

Medicaid –

  • On July 19, CMS released guidance to states on the conditions under which CMS may approve waivers under section 1902€(14)(A) of the Social Security Act to authorize states to rely on finding from the Supplemental Nutrition Assistance Program (SNAP) to support Medicaid eligibility determinations at application and renewal for certain populations. Guidance: http://bit.ly/2uHOgK7
  • On July 21, CMS published a notice announcing states’ final allotments available to pay Medicare Part B premiums for qualifying individuals for federal fiscal year (FY) 2014 and the preliminary qualifying individual allotments for federal FY 2015 which is extended through CY 2015 by MACRA. Notice: http://bit.ly/2vJdzIi

 Health IT –

  • On July 20, GAO published a report on telehealth use in Medicare and Medicaid, finding that telehealth use varies among the two programs and rural states use telehealth more frequently than urban ones. Report: http://bit.ly/2vG6Cb8

 Mental Health and Substance Abuse –

  • On July 17, CDC announced the award of more than $12 million to 23 states and the District of Columbia to support responses to the opioid overdose epidemic. The funds will be used to strengthen prevention efforts and to better track opioid-related overdoses. Press release: http://bit.ly/2vIUCWj
  • On July 20, CMS announced a one-day summit on September 8, 2017 to discuss ideas for a potential behavioral health model to improve access, quality, and cost of care for beneficiaries with behavioral health conditions. Press release: http://bit.ly/2vIQjua
  • On July 20, Substance Abuse and Mental Health Services Administration (SAMHSA) published a report on the state and sub-state estimates of any mental illness from the 2012 – 2014 national surveys on drug use and health. Report: http://bit.ly/2vIXwKH
  • On July 21, GAO published a report on behavioral health treatment use by Medicaid expansion in selected states in 2014, finding that up to 1 in 3 Medicaid expansion enrollees received behavioral health treatment. Summary with link to report: http://bit.ly/2vITphy

 Drug Prices –

  • On July 18, GAO published a report describing progress in addressing earlier GAO recommendations on HHS’ oversight of the 340B program. Report: http://bit.ly/2vGDNey
  • On July 20, Senate Judiciary Committee Chair Grassley (R-IA), and Sens. Leahy (D-VT), Lee (R-UT), and Klobuchar (D-MT) sent a letter to Food and Drug Administration (FDA) Commissioner Gottlieb, urging him to address anticompetitive practices currently used by some brand-name pharmaceutical companies to delay the manufacture and introduction of brand-name generic drugs in the market. Press release: http://bit.ly/2tsdyrt Letter: http://bit.ly/2tsq8XH

Misc. –

  • On July 17, FDA published a blog post on its plans to expand its hiring process to fill hundreds of empty staff positions. Blog post: http://bit.ly/2vJnHAY
  • On July 18, Centers for Disease Control and Prevention (CDC) published a report finding that in 2015, more than 100 million Americans were estimated to have diabetes or prediabetes. Press release: http://bit.ly/2vJ7LP3 Report: http://bit.ly/2vISFcn
  • Also on July 18, U.S. Preventive Services Task Force issued a draft recommendation statement on screening for ovarian cancer. Press release: http://bit.ly/2uHIU1f
  • On July 19, HHS recognized ten states for the outstanding quality performance of their Critical Access Hospitals (CAHs), and for achieving high reporting rates and levels of improvement over the past year. Press release: http://bit.ly/2vJ8obD