Can they get it done?
The second month is for deals
If the stars align
The Rundown
- Negotiations continue on government funding, foreign aid, and immigration/border security
- Committees prioritize healthcare and higher education savings
- Safety from Violence for Healthcare Employees (SAVE) Act advocacy ramps up
- What’s up NC delegation
- Regulatory policy update
- The latest from our desks
- Join the Duke Health Advocacy Network!
Federal Updates
Time (mis)management: congressional priorities stack up
Can Congress, especially the Senate, multitask? They haven’t left themselves much choice, as five high-profile, competing priorities are about to start taking up valuable real estate on the congressional calendar.
Late last week, the lead appropriators in the House and Senate reached a deal on the funding allocations for the 12 spending bills for Fiscal Year 2024. While the agreed upon numbers are not publicly available yet, the agreement allows lawmakers to get into the funding points of each individual bill. Appropriators have less than a month to write and pass all 12 spending bills that adhere to the topline spending deal negotiated between Senate Majority Leader Chuck Schumer (D-NY) and House Speaker Mike Johnson (R-LA). If this is not accomplished by March 1, Congress will need to approve yet another CR to avoid a partial government shutdown.
While appropriators work behind the scenes, much of Congress’ attention remains focused on the Biden Administration’s $105 billion supplemental funding request related to aid for Israel and Ukraine, federal disaster relief, and immigration/border security policy and funding. Apparently, bill text stemming from the Senate immigration/border security negotiations is soon to be released, but it remains to be seen how this package moves forward in either chamber.
While the Senate works on immigration and border security, the House has been busy with a bipartisan tax package and impeachment proceedings for Homeland Security Secretary Alejandro Mayorkas. On Wednesday, the House passed a tax package to expand the child tax credit and revive business tax breaks, sending the bill to the Senate for consideration. A vote of the full House to impeach Mayorkas could happen soon. If the articles of impeachment pass the House, that will then force the Senate to spend time on a trial, which is unlikely to result in a conviction and removal from office.
Also competing for time before early March, the Federal Aviation Authority’s (FAA) authority expires on March 8. The Senate Commerce Committee has not started marking up its version of the reauthorization bill, but eventually the bill will need to be considered on the floor.
Flexibility will be required as February continues. We’re in the game and watching the line while continuing to advocate for Duke Health priorities with the NC congressional delegation.
Committees focus on healthcare and higher education financing
On Wednesday, the House Energy and Commerce Committee Subcommittee on Health held a hearing entitled "Health Care Spending In The United States: Unsustainable For Patients, Employers, And Taxpayers.” Both full committee Chair Cathy McMorris Rodgers (R-WA) and Subcommittee Chairman Brett Guthrie (R-KY) discussed the Lower Costs, More Transparency Act bill that passed the House in December. Among its provisions, the bill included cuts to payments for services provided in hospital outpatient departments, which our office continues to actively oppose.
Members also discussed projections in growth in healthcare spending and offered examples of where costs could be impacted. Witnesses represented a range of perspectives and organizations, including the Congressional Budget Office (CBO). Hospitals and providers were not represented at this hearing, but Subcommittee Chair Brett Guthrie (R-KY) noted that this discussion would continue over the next couple of months.
On Wednesday, the House Committee on Education and the Workforce held a markup of the College Cost Reduction Act, which would make several changes to federal higher education programs including proposed elimination of the PLUS Loans program. While some aspects of the bill make positive changes to higher education programs, there is concern about how the elimination of the PLUS Loan programs will impact Duke students, including in the Duke University School of Medicine and Duke University School of Nursing. Our office is coordinating with our Duke University government relations colleagues on advocacy on this issue. Our office has also contacted our NC members on the Committee to share the impacts on our health professions.
In addition, ahead of the mark up, several of our member organizations joined broader efforts to weigh in on the bill and share concerns, including elimination of the PLUS Loans program.
Advocacy on the Safety from Violence for Healthcare Employees (SAVE) Act ramps up
This week, the American Hospital Association (AHA) held a briefing on the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768). Among its provisions, the bill would make it a federal crime to assault a healthcare worker in the hospital, providing similar protections to those of airline workers. The briefing follows a letter that was sent by several stakeholders including AHA and the Association of American Medical Colleges (AAMC) to the bill’s sponsors in the House and Senate expressing support for the legislation.
The SAVE Act is a vital advocacy priority for our office. Currently Reps. Deborah Ross (R-NC-02), Don Davis (D-NC-01), Kathy Manning (D-NC-06), and David Rouzer (R-NC-07) co-sponsor the bill. Our office continues to work to build support for this bill.
What’s up NC delegation
Late last week, Rep. Alma Adams (D-NC-12) gave her annual State of the District address highlighting policy achievements and work on behalf of the district. Rep. Chuck Edwards hosted a community summit last Friday to discuss homelessness in his district. Several members of the North Carolina Delegation, from both sides of the aisle sent a letter to the NC Department of Insurance Commissioner expressing “great concern over the potential for increased rates on homeowners’ insurance.”
It rules: Regulatory and executive policy roundup
Here’s the latest on what’s coming and what’s pending.
Sickle cell and Cell and Gene Therapy
This week the Biden administration announced that sickle cell disease (SCD) will be the first focus of the Cell and Gene Therapy (CGT) Access Model that was announced last year. “The Cell and Gene Therapy (CGT) Access Model seeks to test whether a CMS-led approach to negotiating and administering outcomes-based agreements (OBAs) for cell and gene therapies, in the context of a comprehensive strategy for addressing a range of barriers to equitable access to cell and gene therapies, will improve access and health outcomes for people with Medicaid, and reduce health care costs.” The factsheet on the CGT can be viewed here. Duke Health is one of the few centers in North Carolina to offer the new FDA-approved gene therapy for SCD, and our office is monitoring federal developments closely.
Medicare Advantage RFI
This week, the Centers for Medicare & Medicaid (CMS) released a request for information to collect public input on Medicare Advantage (MA) data to inform data capabilities and guide future rulemaking efforts. Specifically, CMS noted they have a special interest in comments related to the following: beneficiary access to care including provider directories and networks; prior authorization and utilization management, including denials and algorithms used; cost and utilization of different supplemental benefits; MA marketing and consumer decision making; care quality and outcomes, including value-based arrangements and health equity; healthy competition in the market, including the impact of mergers and acquisitions, high levels of enrollment concentration, and the effects of vertical integration; data topics related to Medicare Advantage prescription drug plans (MAPDs); and special populations such as individuals dually eligible for Medicare and Medicaid.
Comments are due on May 29, 2024, and we will engage Duke Health leadership on any potential system-wide comments.
Coming soon: nondiscrimination rules and proposed HIPAA updates
The Biden administration’s long-awaited final rule updating the Affordable Care Act’s Section 1557 nondiscrimination in protections in healthcare is expected to soon clear review at the Office of Management and Budget. The rule is being updated in part to codify the Supreme Court’s decision in Bostock v. Clayton County, which extends nondiscrimination protections to include sexual orientation and gender identity. The rule may also include updates to standards related to artificial intelligence and potential algorithmic and systems bias. Our team is monitoring the imminent release closely.
The Biden administration has also recently submitted to OMB proposed rule changes to strengthen privacy protections under HIPAA for pregnant people who choose to terminate a pregnancy. It is unclear at this time when the proposed rule may be ready for public release.
From our desk(s): Duke Health GR this week
This week, our team had an opportunity to visit with the leadership of Watts College of Nursing and tour its facility. We look forward to continuing to work with the team there to advance nursing education opportunities for students and graduates.
This week our office participated in the American Hospital Association Virtual Advocacy Update to hear update and plans for 2024 advocacy and issues. We are also meeting with staff of Rep. Don Davis (D-NC-01) and Rep. Chuck Edwards (R-NC-11) to discuss Duke Health priorities and provide updates to staff.
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