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Federal Health Policy Updates for the Week of April 15, 2024

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Trouble in DC? 
Joust. Oust? In the People’s House? 
Speakers walk fine lines.


The Rundown

  • New uncertainty in the House over the schedule and the Speaker 
  • Committee updates – ERISA, improper payments, and Change Healthcare attack 
  • What’s up NC delegation  
  • The latest from our desks  
  •  Join the Duke Health Advocacy Network! 

Federal Updates

Plans change; will the speaker?
Sometimes your best laid plans have to give way to circumstances outside your control. In what was expected to be a quiet week for House Republican leaders – who had planned to pass messaging bills opposing the Biden administration’s energy-efficiency standards – instead turned to consideration of foreign aid legislation after last weekend’s events in the Middle East.  

On Wednesday, House Speaker Mike Johnson (R-LA) released bills to send $95 billion in defense, economic, and humanitarian funding to Israel, Ukraine, and the Indo-Pacific. The legislation, which is expected to come up for a vote on Saturday, is similar to what the Senate approved two months ago. While it appears a majority of Republicans and Democrats are in favor of passing this legislation quickly, it remains to be seen whether a vote on the bill will bring to fruition a previously threatened motion to vacate from Rep. Marjorie Taylor Greene (R-GA) against the Speaker, setting up another leadership crisis in the House. However, word on the Hill is that the Speaker might get support from across the aisle to keep his spot as leader if he brings the bill to a vote. What’s the saying? Like motions to vacate, so are the days of our lives?  

You’ll recall that the last time this happened this past fall, the House of Representatives went without a speaker for three weeks, leaving the chamber effectively paralyzed. Thankfully no concurrent government shutdown deadline also exists, but any delay threatens to create a backlog in what is already a tight schedule in an election year.   

Heard on the Hill: Committee updates 
Happy Anniversary, ERISA 
On Tuesday, the House Education and Workforce’s Health, Employment, Labor, and Pensions Subcommittee held a hearing entitled, “ERISA’s 50th Anniversary: The Path to Higher Quality, Lower Cost Health Care.” The hearing is in anticipation of the 50th anniversary of the Employee Retirement Income Security Act of 1974 (ERISA). 

In his opening statement, Subcommittee Chair Bob Good (R-VA) said that “Congress has a responsibility to not merely create laws but to conduct genuine oversight and better understand how the laws we pass impact the lives of our constituents. Today’s hearing is a response to feedback from nearly 100 stakeholders on ERISA’s implementation. As we prepare to discuss ways to improve the law, we should first recognize the vital role ERISA plays in ensuring access to employer sponsored benefits, especially as it relates to health care.”  

Ahead of the hearing, the American Hospital Association submitted testimony addressing issues of vertical integration and consolidation, hospital price transparency, cybersecurity, oversight of ERISA-regulated insurers, and medical loss ratio requirements. AHA urged Congress “to prevent commercial insurer practices that harm patients and small providers, such as steering patients to their own health care providers or plans and circumventing medical loss ratio requirements; legislation that would complicate providers’ ability to provide meaningful price estimates; HIPAA changes that would create more challenges than benefits; inappropriate care denials that harm patients; and payment delays that compound the fiscal challenges plaguing the health care system.”   

Oversight on Improper Payments  
On Tuesday, the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing entitled, “Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid."  

The hearing included witnesses from the Medicaid and CHIP Payment and Access Commission (MACPAC), Medicare Payment Advisory Commission (MedPAC), as well as the Comptroller General from the Government Accountability Office and the HHS Inspector General. Witnesses addressed a range of topics related to improper payments. Dr. Michael Chernew, MedPAC’s Commissioner, discussed recent recommendations including aligning FFS payment rates across ambulatory settings and eliminating “incident to” billing in certain cases. He noted that improper payments have a specific statutory definition that is used in coordination with other agencies, and changing it is not within MedPAC’s scope. Instead, he commented on the work of MedPAC improving the accuracy and adequacy of Medicare’s payments to providers and health plans to promote efficient use of Medicare’s resources. 

Both full committee Chair Cathy McMorris Rodgers (R-WA) and Subcommittee Chair Morgan Griffith (R-VA) discussed the scope and impact of improper payments, expressing frustration with HHS and its oversight. In his statement, Energy and Commerce Committee Ranking Member Frank Pallone (D-NJ) discussed the importance of paying attention to preventing payments to ineligible recipients and protecting benefits for those eligible for coverage. He said that he has joined Senate Finance Committee Chair Wyden (D-OR) in leading an investigation into denial rates across Medicaid managed care plans that can cut off access to medically necessary services. In October, Senator Wyden and Rep. Pallone launched an investigation into Medicaid Managed Care plan prior authorization practices. 

Congress starts to examine the Change Healthcare Attack 
On Tuesday, the House Energy and Commerce Health Subcommittee Health a hearing entitled, “Examining Health Sector Cybersecurity in the Wake of the Change Healthcare Attack.”  

John Riggi, the American Hospital Association’s National Advisor for Cybersecurity and Risk, testified to the commitment by hospitals and health systems to cyber security. He also commented on different cyber proposals stating “to make meaningful progress in the war on cybercrime, Congress and the Administration should focus on the entire health care sector and not just hospitals…Furthermore, for any defensive strategy imposed on the health care sector, Congress should call on federal agencies to protect hospitals and health systems — and the patients they care for — by deploying a strong and sustained offensive cyber strategy to combat this ongoing and unresolved national security threat.”  

Notably absent from the hearing was a witness from United Health Group. On April 15, full committee and subcommittee leadership on both sides of the aisle wrote to the CEO of UnitedHealth Group, Inc. seeking information about the cyberattack on Change Healthcare.  

The hearing was the first examination by Congress into the attack, but we expect more hearings in the coming weeks.  

What’s up, NC Delegation 
This week, Rep. Deborah Ross (D-NC-02) and Jeff Jackson (D-NC-14) led the North Carolina Democratic delegation in asking House Speaker Mike Johnson (R-LA) to protect the right to in vitro fertilization (IVF) and bring legislation to ensure access to assisted reproductive technologies to the House floor at the earliest opportunity. The letter can be viewed here

Also, this week, the House VA Health Subcommittee advanced Rep. Greg Murphy’s (R-NC-03) bill, the Veterans National Traumatic Brain Injury Treatment Act, which would establish a pilot program at the Department of Veterans Affairs to furnish hyperbaric oxygen therapy for Veterans who have post-traumatic stress disorder or a traumatic brain injury.”  Rep. Don Davis (D-NC-01) is also a cosponsor of this bill.  

Rep. Alama Adams (D-NC-12) joined Rep. Lauren Underwood (D-IL) and Senators Cory Booker (D-NJ) and Laphonza Butler (D-CA) to introduce a bicameral resolution recognizing April 11-17 as Black Maternal Health Week. In the press release, Rep. Adams said, “During Black Maternal Health Week we recognize maternal health disparities and recommit to creating a world where maternal justice and equality are a reality...We are working diligently to pass the full Momnibus Act package to comprehensively address existing gaps in policy solutions to the maternal health crisis.” 

From our desk(s): Duke Health GR this week 

Over the past two days, six subspecialty Medicine fellows visited congressional offices in Washington, D.C. as part of the School of Medicine’s Fellows Advocacy Curriculum (FAC). Designed for fellows who have an interest in health policy and advocacy, the fellows collaborated with our office to develop and present their own advocacy platform to congressional members and their staff. Our team enjoyed the opportunity to help these fellows prepare for advocacy meetings related to telehealth legislation under consideration by Congress. 

Our office continues to advocate for funding for FY 2025 Duke Health priorities. We encouraged NC members of the House and Senators Tillis and Budd to support a “Dear Colleague” letter requesting $530 million in FY 2025 for Title VIII Nursing Workforce Development programs. 

Our office met with senior staff for Rep. Valerie Foushee (D-NC-04), who represents Duke, to discuss funding priorities and new initiatives for support. Our team also participated in the Research!America 2024 annual meeting where we heard remarks about the research and funding landscape from speakers including Dr. Monica Bertagnolli, Director of the National Institutes of Health. Our office also participated in the National Association of Accountable Care Organizations monthly government relations meeting to hear updates and discuss policy. 

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