A long December
Duritz did sing, but there’s hope
What new year may bring
This is our final scheduled newsletter of 2020. We look forward to welcoming the 117th Congress in our first publication of the new year the week of January 4th.
In the meantime, please follow us on Twitter - @DukeGovRel - for breaking news.
Federal Updates
<Opens present> Oh, it’s another CR (But there’s still more to unwrap)
In a script that has become so predictable that no film studio would buy it, Congress is likely going to need just a few more days to actually do and agree to things we all expected they would a couple of months ago. The good news? A deal really is in sight this time.
Congressional leaders close in on massive spending and COVID relief deal
This is not a drill. This is (probably) it. After protracted negotiations, congressional leaders are zeroing in on an omnibus FY 2021 spending and COVID-relief package. Work to finalize and hold votes on the legislation will spill over into the weekend and likely early next week, but first Congress will need to pass another short-term continuing resolution (CR) by midnight tonight to keep the lights on for just a few more days.
While final details of the package are not public at publication time this morning, it is expected to include $1.4 trillion in discretionary spending to fund the federal government through September 30, 2021, as well as a roughly $900 billion COVID relief and stimulus package. Among the reported provisions in consideration for the COVID measure include another round of stimulus checks for individuals, additional provider relief funding, support for small businesses and renters, money for vaccine distribution and testing, extended student loan relief, an extension of expanded federal telehealth flexibilities through 2021, and boosted federal unemployment insurance.
House Democratic and Senate Republican leaders dropped their demands for liability protections and direct funding to state and local governments to allow negotiations to proceed. It is unknown at this time whether a late agreement on surprise medical billing reached by the leadership of the House Ways and Means, House Energy and Commerce, House Education and Labor, and Senate Health, Education, Labor and Pensions Committees, which would establish a baseball-like arbitration process to settle out-of-network payment disputes between providers and insurers, will be included in the final package.
Unfortunately, the COVID relief language may ultimately not include additional support for the research enterprise, but there is a chance some emergency funding may be provided in the broader spending agreement. Legislation to make permanent additional telehealth flexibilities and to expand the healthcare workforce by tapping more international medical professionals through unused visas will need to be revisited in the 117th Congress.
The Biden administration is expected to push for another round of COVID relief shortly after taking office in January. Duke Health Government Relations will continue to advocate for support for the research enterprise, hospitals and the healthcare workforce, and greater certainty for the future of expanded telehealth policies in any future COVID legislation.
With the clock ticking, Trump maintains NDAA veto threat
Congress has passed the FY 2021 National Defense Authorization Act (NDAA) despite a threat from President Trump to veto the legislation over policy disputes. The NDAA is the primary defense policy authorization bill passed annually by Congress, which among other priorities includes the Department of Defense Medical Research Program. President Trump has yet to sign or veto the legislation, which will become law within 10 days of being reported to the White House anyway if Trump takes no action and Congress remains in session as expected to wrap up spending and COVID relief work. This means it is possible that Trump could veto the NDAA over the weekend and force Congress to hold votes early next week to override. While the House and Senate passed the legislation with veto-proof majorities, it is unclear how many Republicans would actually vote to override in a public rebuke of the President's wishes.
HHS nominee leads effort to restore 340B drug discounts
Current California Attorney General and President-elect Joe Biden’s nominee for Secretary of Health and Human Services (HHS), Xavier Becerra, is leading an effort by 29 state attorneys general (AGs) to compel the Health Resources and Services Administration (HRSA) to stop drug makers from limiting 340B discounts accessed by contract pharmacies. In a letter sent to HHS Secretary Alex Azar and HRSA Administrator Thomas Engels on December 14, the group of AGs argued that pharmaceutical companies’ actions are “flagrant and clear statutory violations by the drug manufacturers,” and that HRSA has the authority to intervene under the 340B Drug Pricing Program. The letter comes as three separate lawsuits have been filed to force multiple drug manufacturers to scrap plans to eliminate or limit drug discounts. If no action is taken prior to the inauguration on January 20, 2021, the letter suggests that Becerra will be poised to act as the incoming HHS Secretary once confirmed by the Senate.
Duke Health Government Relations continues to advocate in support of the 340B program and will monitor legislative and regulatory developments in 2021.
Dr. Geeta Swamy informs future COVID-19 maternal health legislation
This week, Dr. Geeta Swamy, Associate Vice President for Research for Duke University, Vice Dean for Scientific Integrity in the Duke University School of Medicine, and Vice Chair for Research and Faculty Development in the Department of Ob/Gyn, participated in a virtual meeting with congressional staff to discuss the Maternal Health Pandemic Response Act of 2020. This legislation, introduced by Senator Elizabeth Warren (D-MA) and Representative Lauren Underwood (D-IL-14), focuses on improving the inclusion of pregnant women in vaccine and therapeutic development, and providing federal resources and strengthening federal efforts to address maternal mortality and morbidity, specifically during COVID-19. The conversation will inform future efforts in support of this bill, which will need to be reintroduced in the 117th Congress next year.
Dr. Swamy has dedicated her career to advancing research in women’s health. She is an internationally recognized clinician-researcher, and an expert and nationally-recognized leader in the field of maternal immunization and vaccination in pregnancy. Dr. Swamy is also an active member of the American College of Obstetricians and Gynecologists (ACOG), the HHS National Vaccine Advisory Committee (NVAC), and FDA’s Vaccines & Related Biologic Products Advisory Committee (VRBPAC). She continues to be a valuable resource to our team and federal policymakers on issues affecting maternal health.
TL/DR – Thank you, and see you next year
As we close out our last newsletter of the year, we wanted to share some reflections and optimism for what’s ahead. Just a year ago, this office was a scrappy and formidable team of two. While embracing a legacy that helped make Duke Health Government Relations a trusted and respected health system advocate on Capitol Hill, our attention had turned to charting a path forward to even further expand our reach, expertise, and influence. Interviews were underway to begin piecing together the team that’s in place today; COVID-19 was a recently discovered pathogen of unknown origin, barely a blip in the daily news; and believe it or not, some of the issues covered in our weekly newsletters now, including disputes over federal funding and surprise medical billing, were making headlines for almost identical reasons then. We knew we were about to head into a tough election year, but we had a vision and plans. We felt ready for anything. Anything. Look what happened.
The way we live and work has changed sharply, and the adjustment has been jarring. A famous quote in the boxing world suggests that “everyone has a plan until they get punched in the mouth,” and there is no question we were all hit hard last spring. Yet, countless times, we picked ourselves up off the mat and kept going. This is a credit to planning and preparedness, but it is also reflective of the spirit, brilliance, and determination of all of our Duke Health colleagues. It is our privilege to be your voice in D.C., and we look forward to engaging with you even more and highlighting your work and contributions in the 117th Congress.
As a team, our days in the same location this year have been few and far between, but a sense of unity and purpose was immediate. We’ve worked to strengthen Duke Health’s capacity to respond to the public health emergency through supplemental funding, protect funding for medical research, joined with our campus-side government relations colleagues to speak up for our international students and workforce, and developed a partnership with our telehealth experts and clinicians to become a trusted resource on telehealth and digital medicine policy for congressional staff.
To be sure, there were just as many setbacks and incremental steps forward – but if we’ve learned anything this year, it is that there are no small victories in the face of such challenges. All are worth celebrating and remembering.
As the 116th Congress holds its last votes, our team is looking to the future, and we will share more with you about what to expect from a new Administration and the 117th Congress in our first newsletter of 2021. There are plans, of course, there always are – but for now, we pause for just a moment, grateful to be here, doing this work, and ready, really ready, for whatever comes next.
Peace and joy to you and yours –
Catherine, James, Julie, and Brian