Greener pastures? Nah.
Different fertilizer
But the same terrain
Federal Updates
Prepare for ludicrous speed (in relative congressional terms)
With the House vote on COVID-19 relief, we are on the cusp of clearing another big hurdle on the pathway to the final passage of the American Rescue Plan. While the current reconciliation process won’t be the quickest in history for a single legislative package (that honor goes to the Omnibus Reconciliation Act of 1990 at 27 days), it will be well under the average of 100+ days. This is extremely fast for Congress under most any circumstance and underscores both the ongoing critical needs of the public health emergency response and the partisanship that will make governing with slim majorities difficult.
Even with political obstacles ahead for the White House and both Democrats and Republicans in Congress, don’t expect policymakers to rest on their laurels if COVID relief makes it across the finish line as anticipated. Before the ink is even dry on the President’s signature, focus will shift to infrastructure, immigration, and FY 2022 appropriations, among other priorities.
Hang on, we’re going plaid.
Legislative table tennis anyone? COVID bill will move to the Senate and then right back to the House
The House is expected today or tomorrow to pass the $1.9 trillion American Rescue Plan for COVID-19 relief under budget reconciliation rules and then send it to the Senate for consideration next week.
The legislation largely reflects the priorities outlined by the Biden administration soon after assuming office in January and includes, among other provisions, funding for vaccine distribution, testing, healthcare workforce grants, expansion of healthcare coverage, mental health and substance abuse, and economic stimulus for individuals and businesses.
Currently, the package does not include any additional funding for the Provider Relief Fund or language converting Medicare accelerated payments to grants or otherwise forgiving those loans enhanced by the CARES Act to providers. The American Hospital Association, among other stakeholders, is advocating for the Senate to adopt amendments to include these provisions and modify the House bill. Other efforts are also underway to advocate for changes to the legislation, including additional funding for the research enterprise and a provision to allow for national medical licensure for the duration of the COVID-19 public health emergency. All of these efforts will face significant procedural hurdles.
This brings us back to the fun of the “Byrd rule,” which forces parts of legislation considered in the Senate through reconciliation to meet certain spending and revenue requirements. If the Senate parliamentarian, who is the final adjudicator of any “Byrd” challenges to the bill, says no, the provision is out. This could mean that some Democratic priorities, such as the $15 federal minimum wage hike, will not survive Senate consideration of the American Rescue Plan. Other challenges are anticipated, and the bottom line is that the legislative package that ultimately gets voted on in the Senate will not mirror the bill arriving from the House next week.
Given this near certainty, House Speaker Nancy Pelosi (D-CA) is holding the week of March 8 for the House to take up the Senate passed bill and have it ready for President Biden’s signature by March 14. While the timeline set by Democrats is on track, obstacles still remain. The “Byrd” review process in the Senate can take time and there are concerns that a number of provisions may be stripped out of the final bill. With such razor thin majorities in both chambers and likely no Republican support, Democrats cannot afford any internal opposition to the final package.
As work on the next round of COVID relief continues, Duke Health Government Relations will continue to advocate for support for the research enterprise, provider relief, telehealth expansion, and other key Duke Health priorities – and position them for consideration in other legislative vehicles should they not be attached in reconciliation.
Biden reverses Trump-era green card ban
Following last week’s House and Senate introduction of the Biden administration’s American Citizenship Act, President Biden this week issued an executive order reversing a Trump administration policy pausing the issuance of new green cards for individuals outside of the United States. The policy, first issued by the Trump administration last April, had been extended by President Trump on December 31, 2020 and would have continued through mid-March if not for the reversal. The Biden administration is also reviewing other Trump administration immigration orders, including one restricting the issuance of certain new H-1B visas issued in June 2020 and set to expire in the next few weeks, and may issue additional reversal orders in the near future.
President Biden’s broad immigration reform plan has so far received a tepid reception on Capitol Hill as both parties have distinct ideas on modernizing the nation’s immigration system. At the same time, there are areas of agreement and interest that may allow for parts of the American Citizenship Act to be separated into individual bills. Of note, the broader legislation includes a provision that seeks to make it easier for graduates of U.S. universities with advanced STEM degrees to be exempt from visa caps and remain in the United States to contribute their expertise in the American workforce.
Our office is aware of the ongoing challenges facing students, faculty, and staff with respect to new visa applications and renewals. We are working with our Duke University government relations colleagues, professional associations, partners, and others to advocate and seek solutions on behalf of our international students and workforce while recognizing their substantial contributions to the medical workforce and research enterprise.
Becerra runs the committee gauntlet
This week, the Senate Health, Education, Labor and Pensions (HELP) Committee and the Senate Finance Committee held hearings on the nomination of California Attorney General Xavier Becerra, also a former member of the House of Representatives, to serve as the next Secretary of Health and Human Services (HHS). Senator Richard Burr (R-NC), now ranking member of the HELP Committee, as well as a member of the Finance Committee, said in his opening statement that he would keep an open mind about supporting Becerra’s confirmation but noted some concern about the nominees lack of direct healthcare administration experience. Burr also stressed that it would be devastating for Congress, the administration’s leadership at HHS, and the country if lessons were not learned and applied from our experiences with COVID-19 over the past year.
Over the two days of hearings, Becerra fielded a variety of questions from Members that reflect priorities for Duke Health, including graduate medical education, the 340B program, the response to COVID-19, telehealth, and access to healthcare. In particular, Becerra noted his support for making many of the current telehealth flexibilities under Medicare permanent beyond the public health emergency. He also pledged his support for the 340B program in both rural and urban communities.
The Senate Finance Committee will ultimately hold a vote to advance Becerra’s nomination for consideration by the full Senate.
Additional hearings for Biden administration nominees, including Chiquita Brooks-LaSure for Administrator of the Centers for Medicare and Medicaid Services (CMS), have not been scheduled but are expected in the coming weeks.
From our desk(s): Duke Health GR this week
As you might imagine, our office misses walking the halls of Congress, cramming into tinier-than-you-would-expect offices, talking policy face-to-face, and even getting stuck behind a tour group while waiting in the security line to enter an office building or the Capitol (okay, maybe not so much the last one) – and we look forward to when it’s safe to do so regularly again. Until, then, virtual Hill visits are booming and a great way to stay connected and build new relationships.
This week, members of the Duke Health Government Relations team participated in the Trauma Center Association of America’s (TCAA) virtual Hill Day (screenshot above!). Teams, divided by state, advocated for full funding for the MISSION Zero grant program, which would provide financial support for the integration of military trauma personnel into civilian trauma centers and emerging legislation to modernize the administration of other existing federal trauma programs. Our assigned team, which included trauma survivors and clinical and support staff from health systems throughout North Carolina, met with the offices of Rep. Patrick McHenry (R-NC-10), Rep. David Price (D-NC-04), Rep. G.K. Butterfield (D-NC-01), Sen. Thom Tillis (R-NC), and staff for Sen. Patty Murray (D-WA), chair of the HELP Committee, and Sen. Richard Burr (R-NC), ranking member of the HELP Committee.
At the request of Duke Health Government Relations, several members of the North Carolina congressional delegation, including Rep. Butterfield, Rep. Price, Rep. Alma Adams (D-12), and Rep. Kathy Manning (D-06), joined a bipartisan letter to HHS Secretary nominee Becerra urging him, if confirmed, to take actions to protect the 340B Program by ensuring that drug manufacturers are prohibited from imposing unilateral changes to the program. The letter highlights recent unlawful actions taken by manufacturers to undermine the program, including refusing to sell eligible drugs to hospitals at 340B prices when the drugs are distributed by community-based pharmacies and an effort to change how 340B rebates are processed.
Additionally, in coordination with Duke telehealth experts, our office is assisting staff for Rep. Butterfield in preparation for an Energy and Commerce Health Subcommittee hearing scheduled for March 2 that will examine the expansion of telehealth policies at the federal level. We are also preparing appropriations requests for several Duke Health priorities and continue to connect our leadership, clinicians, and researchers with policymakers engaged in COVID-19 response efforts, protecting the research enterprise, and health equity.