Hymn of the nation
Though the song remains the same
The lyrics have changed
With the swearing in of a new Congress and administration, our newsletter will continue to serve as a resource for you and will report on the notable happenings in Washington, D.C. as well as issues that directly affect the Duke Health mission.
Federal Updates
From the soul of Sam Cooke to the steps of the Capitol
Change has come. What is done with it and how it will ultimately shape the direction of policy decisions impacting healthcare access and delivery, the research enterprise, and many other priorities of interest to Duke Health is an open question. But, in an inauguration week somewhat lighter on pageantry, the Biden administration and newly formed Democratic majorities in Congress have instead channeled their energy into a quick start on their agendas.
New beginnings are often filled with optimism and affirmations, and rightly so, but we must also keep in mind that majority means “most” and not “all.” For many priorities over the next two years, bipartisan cooperation and buy-in will be necessities for progress.
Inauguration Day is a work day
Within hours of taking the oath of office on January 20, President Biden sat behind the Resolute Desk in the Oval Office for the first time as president, signing 17 Executive Orders designed to address the ongoing public health, economic, and social crises exacerbated by the COVID-19. While such actions are not uncommon for incoming presidents, the depth and breadth of the orders is notable and a departure from a more decentralized federal response more often utilized by the prior administration.
Among the day one orders include: instituting a 100 Day “Mask-wearing” challenge and requiring that masks be worn in federal buildings, on federal lands, and by federal contractors (with a separate order issued on January 21 to mandate masks while utilizing federally regulated modes of public transportation, including planes and trains); reversing the United States’ withdrawal from the World Health Organization (WHO) and designating National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD as the nation’s representative to WHO; creating a COVID-19 response coordinator; fortifying and continuing the current Deferred Action for Childhood Arrivals (DACA) program; reversing the immigration and travel ban for seven Muslim-majority countries; reversing the Trump administration’s review process for federal regulations; and standing down heightened immigration enforcement practices.
Other orders addressed extending the federal eviction moratorium and pause on federal student loan payments, preventing workplace discrimination on the basis of gender identity and sexual orientation, and commitments to climate and environmental policy.
President Biden is expected to take advantage of his Executive Authority as much as practical in his first few weeks of office, with the administration releasing a calendar of further orders on issues such as a COVID-19 action plan, climate change, immigration, and healthcare.
Duke Health Government Relations will monitor the release of these orders carefully, report on their significance to Duke Health, and weigh in with administration officials and the NC congressional delegation as appropriate.
Biden presses forward on COVID-19 strategy
On January 21, the Biden administration formally released its national COVID-19 strategic plan. The plan is centered around seven goals: restoring trust with the American people; mounting a safe and effective vaccination campaign; expanding masking, testing, data, and treatments; building the healthcare workforce; safely reopening schools, businesses, and travel while protecting workers; protecting those most at risk for serious illness, including people of color; and restoring U.S. leadership globally.
The plan includes a commitment to use the Defense Production Act (DPA) and other Executive powers to speed up the manufacturing of testing and vaccine supplies and other key resources. The DPA allows the president to compel and incentivize certain areas of industry and manufacturing to redirect their production to materials most needed during a security or public health crisis. Tim Manning, the administration’s COVID-19 supply coordinator, said that his team has identified 12 immediate supply shortfalls, including for N95 masks, isolation gowns, gloves, and swabs needed for tests. The DPA is also expected to be invoked to accelerate production of syringes and other raw materials used in vaccines. Administration officials have pledged to be deliberate and more aggressive in their utilization of the DPA than the prior administration.
It further calls for establishing an “effective, comprehensive” and “aggressive” vaccination campaign but did not offer timetables for when vaccines will be available to the general public.
The release aligns with several of the Executive Orders signed by Biden on January 21. The orders include: increasing federal reimbursement to states and tribes from 75 percent to 100 percent of the cost for National Guard personnel and emergency supplies (including the costs of supplies and setting up mass vaccination centers); creating a Pandemic Testing Board to increase testing capacity, expand the public health workforce, and support COVID-19 screening in schools and underserved communities; improving collection of COVID-19 data; establishing more federal guidance for school re-openings; establishing worker safety guidelines; and creating a COVID-19 Health Equity Task Force.
The strategic action plan is intended to work in concert with the administration’s COVID-19 relief legislative proposal that would provide $1.9 trillion in investments to strengthen the economy, protect individuals and small businesses, and provide response infrastructure support.
Duke Health Government Relations will closely monitor the implementation of the administration’s COVID-19 strategic plan, provide updates of relevance to Duke Health, and connect health system leadership and experts with federal officials as appropriate.
Biden administration aims to keep promises on immigration
To demonstrate the seriousness of the Biden administration’s pledge to reform the nation’s immigration system, the Biden team released a legislative proposal intending to do just that hours before the official swearing-in ceremony. The United States Citizenship Act of 2021 seeks to provide more expedited pathways to citizenship for undocumented individuals living in the United States, implement stronger worker protections, recapture and repurpose unused visas, improve visa processing and immigration court backlogs, address migration, and responsibly secure borders.
Among the notable highlights of the proposal is the section dedicated to immigration and economic growth. It includes a commitment to prioritize employment-based visa backlogs, and reducing processing wait times, which in particular could be helpful in addressing healthcare professional shortages across the country during and after the current public health emergency. It would also seek to make it easier for international graduates of United States-based universities with advanced STEM degrees to remain in the country and provide additional protections for dependents of H-1B visa holders. Additional provisions to adjust the issuance of green cards based on macroeconomic conditions and review compensation for highly-skilled workers also have the potential to attract and retain international talent but will have to be crafted carefully as to avoid unintended consequences.
It is unclear when Democratic leaders in Congress will begin its work on the proposal, although the House is expected to go first and may lead with committee-level hearings on the key issues outlined.
Duke Health Government Relations will continue to work with our leadership and colleagues on the campus-side government relations team in support of policies that protect and provide opportunities for our international students and workforce.
The next COVID-19 relief package is on deck
House Speaker Nancy Pelosi (D-CA) said this week that the House is planning to move immediately on the next round of COVID-19 relief and stimulus. House Democrats have rearranged their schedule over the next two weeks to allow relevant committees to consider the various provisions of an emerging COVID-19 relief package that is expected to feature many of the proposals favored by the Biden administration, including funding to support a national vaccination plan, testing, and resources for individuals, businesses, and state and local governments.
While a COVID package would likely pass the House, it will almost certainly face headwinds from Senate Republicans already balking at its potential size and scope. Though now technically in the minority due to Vice President Kamala Harris’ tie-breaking vote, Republican support will be needed under current rules to get beyond procedural hurdles.
Speaker Pelosi said that a package may be ready for consideration on the House floor as soon as the week of February 1.
As Congress and incoming the Biden administration begin debating additional COVID relief, Duke Health Government Relations will continue to advocate for support for the research enterprise, provider relief, telehealth expansion, and other key Duke Health priorities. Additionally, our office will look for opportunities for Duke Health experts to inform new policy directions.
Why do you have to make things so complicated? The Senate rules(!)(?)
No, we certainly have not forgotten about one of our more influential and cantankerous bodies of the federal government. While Senator Chuck Schumer (D-NY) became Majority Leader on Wednesday evening following the swearing in of President Biden, Vice President Harris, and three new Democratic Senators – Jon Ossoff (GA), Ralph Warnock (GA), and Harris’s replacement, Alex Padilla (CA) – much of the Democratic agenda will stall in the Senate without some Republican support under current rules.
Rules exceptions are in place for cabinet nominees, federal judges, and under a legislative process known as budget reconciliation that can only be used for specific purposes, but at the moment Democrats do not have the support necessary to end the procedural filibuster to avoid the need for 60 votes to end debate on most legislation.
Further complicating the current situation is that Majority Leader Schumer and now Minority Leader Mitch McConnell (R-KY) have yet to agree on a so-called “power sharing agreement.” The agreement will not prevent Democrats from setting the agenda but is expected to provide Republicans with equal representation on committees, an arrangement similar to one forged in 2001 when the Senate had a 50-50 split between members caucusing with Democrats and Republicans.
There is also the matter of the impeachment trial of former President Donald Trump. It is unclear at this point how Senate Democrats intend to proceed and whether Chief Justice John Roberts is required to preside. Minority Leader McConnell has proposed delaying impeachment until February to give Trump time to prepare.
What does it all mean? Democratic legislative plans will face similar challenges in the Senate as if they were still in the minority but now at least have the authority to call up bills for votes and force members to be on the record in support or opposition, which might be an incentive to attract bipartisan support.
Duke faculty meet with Rep. Price on ABC Science Collaborative
This week, Danny Benjamin, MD, PhD, and Kanecia Zimmerman, MD, faculty in the Duke Clinical Research Institute and Department of Pediatrics, shared their work as co-chairs of the ABC Science Collaborative with Rep. David Price (D-NC-04) and his staff. They described their partnership with school districts across the state to safely reopen K-12 schools.
The ABC Science Collaborative is funded in part by the National Institutes of Health. It pairs scientists and physicians with school and community leaders to help them understand the most current and relevant data about COVID-19 so they may make decisions that will keep teachers, staff, and children safe if and when they return to the classroom. Learn more at https://abcsciencecollaborative.org/.
Would you look at the time? Advocacy season for FY 2022 biomedical research funding is here
We are almost four months into fiscal year (FY) 2021, which means it is time to start thinking about research funding advocacy for FY 2022. The Ad Hoc Group for Medical Research has reached consensus on a funding recommendation of least $46.1 billion for the National Institutes of Health (NIH) for FY 2022. This funding level represents a $3.177 billion increase over the current FY 2021 funding level. The Ad Hoc Group for Medical Research includes patient groups, scientific societies, research and academic institutions, health professionals, educators, and industry.
Duke Health and Duke University have endorsed this recommendation, which would allow the NIH’s base budget to keep pace with the biomedical research and development price index (BRDPI) and allow meaningful growth of 5%. The recommendation also urges expeditious approval of emergency funding for NIH to mitigate the impact of the public health emergency on our nation’s research enterprise, a priority for Duke.