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Federal Updates
Chuck Schumer and the Parliamentarian Funkadelic
It’s not quite the “nuclear” option, but a recent ruling from the Senate Parliamentarian on additional use of the reconciliation process may nonetheless be “atomic” for the Democratic agenda. Reconciliation, again? It’s not out of the question. Senate Majority Leader Chuck Schumer (D-NY) has said the ruling of the parliamentarian, the final arbiter of all Senate rules and procedures, opens the door under certain “parameters” to amend the current FY 2021 budget resolution to take another shot at a massive legislative package that could be passed by a simple majority.
Republican leaders are already signaling they have a different interpretation of the ruling, and it’s unclear whether the “parameters” referenced by the Majority Leader will provide further constraints outside of those already in place for the reconciliation process. But, with Senate Democrats seemingly no closer to filibuster reform, another round of reconciliation puts a host of policy priorities, from infrastructure and healthcare to tax reform and immigration, on the table without the need for Republican support, assuming all Democrats are on board.
Of course, another round of reconciliation is not yet assured. There are limitations and expected procedural challenges and requests for clarification ahead. There would also likely be some trade offs, including a potential slowing of the already delayed FY 2022 budget and appropriations process. There are several prominent Democrats, including President Biden, who would prefer the opportunity for bipartisan input on any number of key legislative issues.
Congress returns next week after a nearly three week recess with a lot on its plate. The White House may introduce its budget overview as soon as today. Federal appropriations conversations are heating up. There is immigration reform, climate change, voting rights, issues of ongoing violence and discrimination, and other key priorities to consider. But, infrastructure will likely not stray too far away from any headlines.
Whatever steps are taken next, this new development is setting the stage for quite the show in D.C. this summer.
Roads? Where we’re going… we still need roads (and a lot more)
Last week, the Biden administration released an outline of part one of its Build Back Better comprehensive infrastructure plan. The $2 trillion American Jobs Plan seeks to modernize much of the nation's physical, technological, and workforce infrastructure. The plan includes roads, bridges, and ports but also addresses resiliency, the climate crisis, broadband access, waterways, and investments in research and development.
Among the highlights include:
- $621 billion for bridges, roads, and highways
- $42 billion for airports and inland waterways
- $80 billion for rail service
- $100 billion to build broadband infrastructure (critical for the expansion of telehealth)
- $400 billion toward expanding access to quality, affordable home- or community-based care for aging relatives and people with disabilities
- $18 billion to modernize VA hospitals
- $100 billion in workforce development
- $50 billion to the National Science Foundation, including creating a technology directorate that will collaborate with and build on existing programs across the government
- $40 billion for research and laboratory modernization (half the funds dedicated to Historically Black Colleges and Universities)
- $100 billion for public schools
- $25 billion for child care facilities
- Investments in clean water, electric vehicles, and the nation’s power structure and electric grid
It’s a big swing, and to continue the metaphor, the response has been all over the field. It’s also important to note that at this point in time, it’s only a proposal – and incomplete. Part two of the administration’s infrastructure strategy, expected to be released in the coming weeks, will reportedly focus more directly on policies impacting families and healthcare.
There are a lot of details left to be filled in, and House Democrats on the Energy and Commerce Committee will likely be positioning their LIFT America Act (H.R. 1848) – highlighted in a recent newsletter – to make the case for the inclusion for more targeted investments in hospital and clinical research infrastructure needs. The good news is that so far, the White House and key Democratic leaders seem willing to negotiate to put together a truly bipartisan package.
At the same time, the path forward is not without complications. The administration is proposing to pay for much of the American Jobs Plan in part through changes to the corporate tax code. Proposals related to drug pricing reform may be included in the part two framework for families and healthcare. Both potential offsets have interparty and intraparty disagreements. If Democratic and Republican leaders get too far into the summer without much progress toward a compromise, the lure of another round of reconciliation (as noted above) may start seeming more attractive to those currently skeptical.
Bottom line? This is going to take time and a lot of input. Our office will be monitoring the release of proposals and legislation closely. We’ll also be working with our partners, associations, other stakeholders, and Duke leadership to advocate for robust infrastructure investment in academic medical and research institutions, hospitals, clinical and research laboratories, and technological investments supporting the delivery of and greater access to healthcare.
Stay tuned.
Crisis delayed: Medicare sequester fix passed by Senate
The Senate passed a modified version of House legislation that would, among other healthcare provisions, extend the moratorium on the 2 percent Medicare sequester cuts through the end of 2021. The House is expected to pass the Senate bill when it returns from recess next week. The prior moratorium, which was extended by the year-end omnibus spending and stimulus package in December 2020, expired on March 31. The Centers for Medicare and Medicaid Services (CMS) announced that it will hold the processing of claims data until after the House has passed the legislation.
The modified legislation does not include a waiver to prevent a separate 4 percent Medicare payment cut scheduled to begin in 2022 as a result of congressional pay-as-you-go (“PAYGO”) rules triggered by the passage of this year’s COVID-19 relief bill. Democratic leaders are expected to attempt to include the waiver in time sensitive legislation later this summer or early fall.
Duke Health Government Relations will continue working in support of efforts to pass the waiver to prevent further Medicare cuts under PAYGO.
Duke leaders headline research event with Rep. David Price
On April 1, Rep. David Price (D-NC-04) hosted a panel for his constituents entitled, COVID-19 Public Health Research in North Carolina’s 4th District. Experts from Duke, UNC-Chapel Hill, and North Carolina Central University (NCCU) shared updates on the role of research in fighting COVID-19 and what area universities are doing in the 4th district to lead the way, including addressing health equity issues in the pandemic response.
Kevin Saunders, PhD, who is an Associate Professor in Surgery and Director of the Laboratory of Protein Expression and Director of Research in the Duke Human Vaccine Institute, gave updates on what COVID-19 studies are underway for children under 12 and when we might know if the vaccine is safe and effective for them. He also detailed how mRNA vaccines can target specific proteins and their use in the future of healthcare.
Nadine J. Barrett, PhD, MA, MS, who is an Assistant Professor of Family Medicine and Community Health; Associate Director of Community and Stakeholder Strategy and Equity in the Duke Clinical and Translational Science Institute; and Associate Director of Community and Stakeholder Strategy in the Duke Cancer Institute, described effective ways to partner with communities on health access and equity. She shared her experience working to combat health disparities that have been exacerbated by the pandemic and highlighted the work underway at Duke and in partnership with NCCU.
A recording of the event is available on Rep. Price’s website.
From our desk(s): Duke Health GR this week
What comes to mind when you hear the term “congressional recess”? It’s been our experience that perception doesn’t always match with reality. Members often return home to engage directly with constituents, and their staff have time to refocus and prioritize. If executed well, the spring recess period can be a golden window of opportunity (not a pollen joke but understand if you got there).
In addition to working in partnership with Duke Health leaders and the office of Rep. Price on the April 1 virtual research event, the Duke Health Government Relations team coordinated a response to the Senate Health, Education, Labor and Pensions (HELP) Committee on policy ideas for workforce development. The Committee, which is led by Chair Patty Murray (D-WA) and Ranking Member Richard Burr (R-NC), intends to “develop bipartisan solutions to update and expand workforce training programs, support and expand the National Apprenticeship Act, and encourage innovation.” We will engage with the Committee as it develops this legislation.
Our office has been encouraging NC congressional delegation support for the Resident Physician Shortage Reduction Act of 2021 (S. 834/H.R. 2256). This bill would increase the number of Medicare supported Graduate Medical Education slots by 14,000 over 7 years. Rep. Price has signed on as a cosponsor.
As is custom during the beginnings of appropriations season, Members of Congress are beginning to circulate Dear Colleague Letters (DCLs) to support funding allocations for specific priorities. One such DCL requests at least $46.1 billion for the National Institutes of Health in FY 2022, recognizing the continued recovery of the research enterprise during the COVID-19 public health emergency and urging strong investments in biomedical research. Reps. Price, G.K. Butterfield (D-NC-01), Kathy Manning (D-NC-06), and Deborah Ross (D-NC-02) all joined the letter at our request.
Another DCL in support of the Department of Defense’s Peer-Reviewed Reconstructive Transplant Research Program began circulating this week. Funding for this program has greatly supported the work of Duke Health’s Dr. Linda Cendales and the Duke Vascular Composite Allotransplantation research program. Rep. Ross is the first member of the delegation to join the letter of support at the request of our office. We are also awaiting the release of a DCL in support of the MISSION Zero Military-Civilian Partnership for Trauma Readiness Program, as well as others supporting Duke Health priorities.
We continue to hold meetings with Duke Health experts and congressional and key committee staff to discuss the impact of federal funding on their clinical work and fields of research, build relationships and share Duke expertise with congressional offices developing legislation to permanently expand telehealth coverage for Medicare beyond the COVID-19 public health emergency, meet with coalition partners, and connect our leadership, clinicians, and researchers with policymakers engaged in COVID-19 response efforts, protecting the research enterprise, and health equity.