Belated progress
Still a leap – Justice Jackson
HERstory is made
Publication Note: Congress is departing for a two week spring recess, and so is our newsletter! We will return to our regular publication schedule the week of April 25th.
For breaking news in the meantime, please follow us on Twitter @DukeGovRel or join the new Duke Health Advocacy Teams channel (more information below).
The Rundown
- COVID funding deal hits last minute snag before recess
- Ketanji Brown Jackson confirmed as Associate Justice of the US Supreme Court
- Biden administration proposes rule change to fix ACA “family glitch”
- Duke expert participates in another packed week of hearings on the Hill
- House E&C begins process to reauthorize SAMHSA and HRSA mental and behavioral health programs
- CMS delays start of Radiation Oncology Model
- Looking ahead to post-recess
- The latest from our desks
- You’re invited to join Duke Health GR and Duke in DC for a 4/11 virtual event
- Join the Duke Health Advocacy Network
Federal Updates
False start: COVID funding deal in limbo as Congress sprints toward recess
A deal reached this week between Senate Majority Leader Chuck Schumer (D-NY) and Senator Mitt Romney (R-UT), which was also informed by conversations between the White House and Senator Richard Burr (R-NC), on $10 billion in COVID-related support funding now faces an uncertain timeline and future over Senate Republican demands for votes on amendments.
The legislative agreement would provide $10 billion in funding to the Department of Health and Human Services (HHS) with $9.25 billion directed to the Biomedical Advanced Research and Development Authority (BARDA). Of the total amount of funding, not less than $5 billion must go to research, develop, manufacture, produce, purchase, and administer therapeutics, while not less than $750 million is designated for research and clinical trials for emerging coronavirus variants and to support the sustainment and expansion of vaccine manufacturing capacity. Missing from the legislation is any additional funding for the Health Resources and Services Administration (HRSA) to pay for COVID testing and treatment of uninsured individuals. HRSA is now no longer able to process any uninsured claims through its COVID fund.
Shortly after the announcement of the deal, Senate Republicans blocked floor consideration of the funding legislation over disagreements with Democratic leadership to allow votes on a number of amendments, including one on a key immigration policy recently rolled back by President Biden that had limited asylum claims at the U.S. border during the public health emergency.
With recess scheduled to begin today and other priorities on the docket this week, a new agreement to move forward on the bill may be delayed to the end of April. The White House has warned lawmakers that funding for the federal government’s COVID response would soon run out absent congressional action – and another COVID supplemental bill may be needed again this summer.
Our office continues to advocate members of the NC congressional delegation for swift passage of COVID funding.
That’s Justice Jackson: Senate holds historic vote to confirm the first Black woman to the Supreme Court
The Senate voted this week to confirm Judge Ketanji Brown Jackson as an Associate Justice to the United States Supreme Court. The historic final vote was bipartisan, with three Republicans joining all 50 Democrats in support of confirmation. Despite a challenging and mostly partisan committee process, as well as a couple of procedural hiccups, Democratic leaders were able to meet their self-imposed pre-recess deadline for a final confirmation vote. Justice Jackson replaces the retiring Justice Stephen Breyer, who announced his plans to step down earlier this year.
Biden administration announces rule to fix ACA “family glitch”
This week, the Biden Administration announced a proposal to fix a gap in the Affordable Care Act (ACA), known as the “family glitch” that inaccurately assesses the affordability of coverage and therefore affects Marketplace subsidy eligibility for some families. The administration estimates that nearly 5 million people have been impacted by this technical issue. In response to the White House announcement, the Treasury Department released proposed updated regulations that would enable more families to access health insurance subsidies through the Marketplace.
The decision to address the family glitch comes as the Biden administration continues to press Congress to make public health emergency-enhanced ACA subsidies permanent for individuals and families.
Duke expert participates in another packed week of hearings on the Hill
The final stretch run to the spring recess featured some extra time in congressional committee hearing rooms and included the testimony of a Duke Psychiatry and Behavioral Sciences clinician and researcher.
Dr. P. Murali Doraiswamy, Duke Professor of Psychiatry and Medicine, testified at a Senate Armed Services Committee's Subcommittee on Personnel hearing on Wednesday. The hearing focused on suicide prevention and related behavioral health interventions in the Department of Defense. Dr. Doraiswamy discussed his experience with digital health, including the use of smart phones and web-based tools, for treating mental health in young adults and how tele-mental health best practices can be applied to military and underserved populations.
Senate Finance Committee members on Tuesday questioned HHS Secretary Xavier Becerra on the budget request for health-related agencies. Secretary Becerra answered a number of questions to justify programs and initiatives that President Biden has prioritized for the department’s FY 2023 budget. Questions focused on budget items related to telehealth, mental health, improvements to long-term care, and solutions to the healthcare industry’s workforce shortages. Regarding telehealth, Committee Chairman Ron Wyden (D-OR) stated that there is bipartisan interest in building on that progress on a permanent basis and making sure that the clock doesn’t get turned back on patients who’ve come to rely on telehealth for basic services once the public health emergency ends.
Additionally, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on the reauthorization of user fees for the Food and Drug Administration.
House E&C begins process to reauthorize SAMHSA and HRSA mental and behavioral health programs
On Tuesday, the Energy and Commerce Subcommittee on Health held a hearing entitled “Communities in Need: Legislation to Support Mental Health and Well-Being." The hearing focused on various pieces of legislation to support reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) mental and behavioral health programs.
As highlighted by Chairman Frank Pallone (D-NJ) in his remarks, 30 SAMHSA programs and 2 HRSA programs will expire in September. Legislation including the “Helping Kids Cope Act of 2021” would provide HRSA grants to support provider training in pediatric behavioral health care and to support pediatric behavioral health integration and coordination within communities; the “Strengthen Kids’ Mental Health Now Act of 2021” would require state Medicaid programs and Medicaid managed care organizations to reimburse certain pediatric behavioral health services at the Medicare rate through 2027; and the “Substance Use Prevention, Treatment, and Recovery Services Block Grant Act of 2022” would reauthorize and rename this block grant at SAMHSA. A full list and description of all the bills considered at the hearing is available here.
Witnesses for the panel included Dr. Miriam E. Delphin-Rittmon, Assistant Secretary for Mental Health and Substance Use, and Carole Johnson, Administrator for HRSA. In her testimony, Dr. Delphin-Rittmon discussed the five core near-term priorities for SAMHSA, which are:
- Preventing overdose;
- Enhancing access to suicide prevention and crisis care;
- Promoting child and youth behavioral health;
- Integrating primary and behavioral healthcare; and
- Using performance measures, data, and evaluation.
She also outlined four critical cross-cutting principles to bolster SAMHSA’s work on near-term priorities, including:
- Greater equity within the behavioral health system;
- Enhancing the behavioral health workforce;
- Promoting and supporting recovery practices; and
- Working to ensure financing of a robust array of behavioral health services.
Leadership for the Committee and Subcommittee noted this was the first step in a move toward a comprehensive legislative package anticipated in the coming months.
CMS delays start of Radiation Oncology Model
This week, the Centers for Medicare and Medicaid Services announced in a proposed rule that it is delaying the start of the Radiation Oncology Model from January 1, 2023 “to a date to be determined through future rulemaking.” The announcement from CMS indicated its belief that the RO Model is still needed. The announcement in the federal register can be viewed here.
What’s left; what’s coming up
Congress was not able to get to everything on its to-do list before the spring recess, and there are some things that won’t really kick off in earnest until they return. Here’s the latest on a few key priorities:
- FY 2023 federal budget and appropriations – The FY 2023 federal funding process is moving forward, with the House Appropriations Committee releasing tentative dates in June for subcommittee and full committee markups of its 12 bills. Our office has been working diligently to meet the fast approaching North Carolina member deadlines to submit Duke Health’s funding priorities, which includes funding for public health, biomedical and health services research, workforce, and defense health.
This week, our office also coordinated support for Duke Health to join the Ad Hoc Group for Medical Research’s letter supporting a program level of at least $49 billion for the NIH’s base budget, which is a $4.1 billion increase above the FY 2022 enacted level. Our office also coordinated support for Duke Health to join a letter with other national, state, and local organizations in support of $60 million in federal gun violence prevention research funding to the CDC and NIH in FY 2023.
It’s too soon to know if work on FY 2023 will be wrapped by the beginning of the new fiscal year on October 1. History suggests that a continuing resolution through the midterm elections may be needed, but appropriations leaders in both parties seem motivated to get as much work done as possible over the summer.
- Medicare sequester – As we have previously reported, a phased-in Medicare payment cut officially took effect on April 1. There have been little signs on movement in Congress to delay or address the sequester retroactively – for now. Stakeholders are continuing their advocacy, and we may have a better sense of what is and isn’t possible after the spring recess. This remains a priority for our office.
- “Skinny” reconciliation – With the confirmation of Judge Ketanji Brown Jackson to the Supreme Court now complete, some congressional Democrats believe a window is now open to revisit the reconciliation package formerly known as the Build Back Better Act. Assuming a package is actually able to come together, it won’t look anything like the original $1.7 trillion plan. Instead, expect a smaller bill focused on raising taxes on the rich and big corporations, prescription drug reform, climate spending, and some measure of deficit reduction.
- Innovation legislation – Post-recess, expect House and Senate negotiators to spend more time on finding agreement toward a final Bipartisan Innovation Act, a legislative package aimed at boosting research, including for STEM disciplines, and innovation in the United States. This is an important administration priority that could require not so insignificant amount of capital from the White House to see the legislation cross the finish line. The timeline here will have ripple effects for a number of other agenda items. There’s only so much calendar and so much time before Congress will turn greater attention to the midterm elections.
We continue to advocate for Duke Health federal priorities and will stay closely engaged with the NC congressional delegation and our partners in regional and national coalitions.
From our desk(s): Duke Health GR this week
Members of our team joined a group of our OB/GYN colleagues to discuss effective advocacy conversations. We participated in a roleplaying exercise where we assumed the roles of elected officials allowing our colleagues to practice making their advocacy pitches in a low-stakes environment. If you or your team is ever interested in practicing advocating, let us know!
This week, our office also participated in a Friends of AHRQ meeting to hear from the agency’s director, Dr. Bob Valdez, about his priorities for AHRQ and the President’s Budget for FY 2023.
Our office also joined Dr. Danny Benjamin in a meeting with Senator Burr’s HELP Committee staff to discuss the Pediatric Trials Network (PTN). Additionally, we met with leadership of the UCLA-Duke National Center for Child Traumatic Stress to discuss FY 2023 funding and the federal landscape.
Members of our team will also be visiting Duke Regional Hospital today; if you see us, please say hi!
You’re Invited: Vaccines and Countermeasures to Prepare for Future Pandemics
Hosted by Duke in DC and Duke Health Government Relations, you're invited to attend "Vaccines and Countermeasures to Prepare for Future Pandemics" on April 11 at 2:00PM.
In a short period of time, the world has gone through an unbelievable process of acknowledging, responding, and acclimating to the global pandemic. Now, we are investigating what transpired and how we can better prepare for the future as Congress works on bipartisan legislation to strengthen the nation’s public health infrastructure and outlines its next round of supplemental pandemic aid.
Vaccines, testing, screening, and technology are all critical to the COVID-19 response. The Duke Human Vaccine Institute has been a global leader in vaccine research since the 1980s and has recently been awarded a grant to develop the next-generation of pan-coronavirus vaccines. Meanwhile, the Duke Margolis Center for Health Policy offers pioneering policy expertise to address the COVID-19 pandemic and to create a pathway to reopen the nation successfully and create a more secure health care system.
In this conversation, Duke experts will discuss the importance of federal investment in research, the impacts they already see from their work, and additional recommendations for the recently introduced PREVENT Pandemics Act to bolster our nation’s public health and medical preparedness and response systems in the aftermath of the COVID-19 pandemic. Register now!
Join the Duke Health Advocacy Network!
Looking for more opportunities to connect with fellow advocates and professionals interested in public policy across the health system? Join the Duke Health Advocacy Teams Channel!
Managed and moderated by Duke Health Government Relations and Duke State Relations, the purpose of the platform is for you to connect with your colleagues throughout the health system who are engaged and/or interested in public policy advocacy. We hope the channel will be used as a space for sharing ideas, collaboration, and engaging with the government relations teams on the issues most important to your work.
We encourage you to explore the channel, as we will post relevant news items, policy updates, questions, advocacy resources, and opportunities for engagement. As importantly, this is your space to do the same and to help grow the community.
Click to Join
(Note: This is only open to Duke Health employees. By joining this teams channel, you acknowledge that the platform and your participation are intended for information sharing and connections/relationship building and is not an inducement by Duke Health Government Relations and Duke State Relations, or the channel’s participants, to act as an unauthorized advocacy and/or lobbying representative of Duke Health or Duke University).