This week at the beach
Masks were off thanks to science
Faces are lovely
(Christin Daniels, Assistant Dean, Research Development, Duke University School of Nursing)
We need your help - just 1 opportunity left!
Our thanks to Christin for a much appreciated vacation haiku this week. As first announced in our May 21 newsletter, we want your poetry to replace our haikus for the month of June. Next week is it! Get creative and tell us a little more about your work.
Entering your submission is easy – just email it to dukegovrelations@dm.duke.edu – and we look forward to hearing from you!
Federal Updates
A “deeming” hot summer
Last week we raised an alarm of sorts on the near-term prospects for FY 2022 federal appropriations given all of the other priorities on the table this summer. You’ll have to forgive us a bit for signaling “Danger!” (special shout out to our fellow “olds” who immediately heard the Mystikal classic in their heads) when ambitious agendas and calendar space don’t quite sync up. We’ve seen a lot, and various priorities can get shuffled at any point in time.
Thanks to congressional procedure, House Democrats have not lost faith they can do it all. The House has passed what is known as a “deeming” budget resolution, which allows the House Budget Committee to set an overall topline discretionary spending target. In this case that amount totals $1.5 trillion, which closely mirrors President Biden’s regular appropriations requests, and it signals that the House Appropriations Committee can get to work on individual spending bills. Deeming resolutions are expedient and avoid some of the messiness than can bog down regular budget resolutions.
Just as importantly, this procedural move keeps the door open for the House Budget Committee to craft a separate budget resolution to be used for a reconciliation bill if necessary. House Appropriations Committee Chair Rosa DeLauro (D-CT) has now set a full committee and subcommittee markup schedule with the plan for the House versions of the 12 annual appropriations bills to pass by the end of July. The good news is that if all goes according to plan, there will be detailed legislative markers that reflect increased investment in federal medical research and other key priorities.
There’s always a “but”…
Senate Democrats face different challenges. It’s unlikely that the Senate will begin its appropriations work until July. Senate budget resolutions have different procedures (hello, Vote-a-rama), and even if an aggressive mark up schedule is undertaken, the tightest of majorities can slow the process. Throw in August recess, and it’s September before the House and Senate may even begin to discuss merging versions of their individual bills.
All of this is a recipe for a continuing resolution and the hard work of finalizing federal funding for FY 2022 being baked deep into the fall or winter. Things could always change, but recent budget cycles have demonstrated the increasing irregularity of regular order.
Our office is actively engaged in the budget and appropriations process and will continue to advocate for sustained and strengthened funding for Duke Health priorities.
Crystal ball s… peculation: where for art thou, infrastructure?
This week’s title is inspired by the senior Senator from Montana’s colorful response to questions earlier this week about the direction of infrastructure negotiations. Let’s just say that Senator Jon Tester (D-MT) does not fancy himself as a fortune teller. Where do things stand this week? Just imagine we painted a picture from a week ago and decided today to channel our inner Bob Ross and throw on a few clouds, some wildlife, and a little flair. It’s still not done (at least at the time of publication this morning), but there is “more.”
A bipartisan group of Senators, which has swelled to over 20 and includes North Carolina’s Senators Richard Burr (R) and Thom Tillis (R), have reportedly agreed to an infrastructure package framework totaling between $900 billion and $1.2 trillion. While there are not yet many details of the emerging proposal, it is expected to focus more on traditional infrastructure-related issues and less on the health care and family provisions outlined in the Biden administration’s American Families Plan. However, as a nod to the administration, the group is more willing to discuss adding revenue raisers, outside of some individual tax increases, as part of a final deal.
Pointing back to our Bob Ross example, a fifth of the Senate potentially agreeing doesn’t mean we’re close to a package ready for display. It’s progress – but the White House is still vetting the details and some Democrats in both the House and Senate have already expressed opposition if the deal leaves out major components of the American Families Plan.
As negotiations continue, Democratic leaders are signaling that they are preparing to go it alone if talks break down yet again. House Budget Committee Chair John Yarmuth (D-KY) has space to draft a budget resolution for reconciliation, Senate Majority Leader Chuck Schumer (D-NY) met with Senate Democrats this week to talk about a potential plan for reconciliation, and Senate Budget Chair Bernie Sanders (I-VT) has indicated that he is discussing a $6 trillion reconciliation resolution that encompasses the Biden administration’s infrastructure priorities, as well as Medicare expansion and drug pricing reforms.
What’s clear at this point is, well, not much – from whether the most recent compromise would have enough votes to pass to whether Democrats could shore up the full caucus in the Senate for another round of reconciliation.
We continue to monitor the release of proposals, legislation, and negotiations. We are 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 health care.
“Standing” tall: ACA survives its latest challenge
On Thursday, the Supreme Court issued a much anticipated ruling that leaves the Affordable Care Act intact. In a 7-2 decision, the Court avoided any discussion on the merits of the latest challenge to the ACA by finding that the plaintiffs did not have proper standing to bring the initial case. However, by ruling on procedure rather than the underlying legal question of whether the repeal of the individual mandate has removed justification for the law to be enforced, the door technically remains open to future challenges. The Court’s decision ensures continuation of coverage for nearly 31 million Americans.
Senate Finance Committee examines mental health policy
This week, the Senate Finance Committee, of which Sen. Richard Burr (R-NC) is a member, held a hearing entitled, “Mental Health Care in America: Addressing Root Causes and Identifying Policy Solutions.” Much like other congressional hearings held this year focused on mental health, members of the Committee and witnesses largely agreed that the ongoing COVID-19 pandemic has exacerbated issues surrounding mental health and highlighted the gaps in the nation’s existing mental health care system, including treatment of substance abuse and addiction.
Committee Chair Ron Wyden (D-OR) highlighted four areas of opportunity where he would like the Committee and Congress to focus its work, including expanding the mental health workforce, ensuring mental health treatments and services, including telehealth, are adequately covered by Medicare, addressing the racial inequities in mental health care, and building on areas of recent progress.
In December 2020 as part of the Consolidated Appropriations and Omnibus Act, Congress made permanent policies allowing Medicare coverage for mental health services via telehealth. Following the hearing, Senator Ben Cardin (D-MD), Senator Bill Cassidy (R-LA), Senator Tina Smith (D-MN), and Senator John Thune (R-SD) introduced the Telemental Health Care Access Act of 2021 (S. 2160). The legislation would further expand telemental health services under Medicare by permanently removing the face to face requirement for mental health services provided via telehealth. Cardin, Cassidy, and Thune all sit on the Finance Committee.
Duke Health Government Relations will continue to monitor the Committee’s work and advocate for additional mental health care resources and flexibilities, including additional telehealth expansion in this area.
From our desks(s): Duke Health GR this week
This week, our team monitored several hearings, including an Energy and Commerce Health Subcommittee legislative hearing that considered 12 bills aiming to strengthen the nation’s immunization infrastructure and public health systems. Among them, H.R. 951, the Maternal Vaccinations Act, would require the Centers for Disease Control and Prevention to carry out a national campaign to increase awareness of maternal vaccinations for pregnant and postpartum individuals and their children and to increase maternal vaccination rates with a focus on communities with historically high rates of unvaccinated individuals. This bill is also included in H.R. 959, the Black Maternal Health Momnibus Act of 2021.
We also monitored a Senate Judiciary Committee hearing on key immigration legislation and continue to be in touch, in coordination with our colleagues on the Duke University government relations team, on ongoing issues related to student and health care worker visas.
We connected with Duke Health experts on the FY 2022 hospital inpatient prospective payment system (IPPS) proposed rule and its provisions regarding patient access to organ transplantation. And members of our team attended a virtual roundtable featuring Rep. Virginia Foxx (R-NC-05) to learn more about her priorities as Ranking Member of the House Education and Labor Committee.
Additionally, the team submitted written testimony to the Senate Appropriations Labor-Health and Human Services-Education Subcommittee on Duke Health medical research and health care priorities, and we participated in an agenda planning meeting with the North Carolina Healthcare Association for an upcoming meeting with congressional staff on important issues impacting health systems across the state.
Save the Date and Register Now!
Town Hall: Leveraging Technology to Accelerate Innovation in Health Systems
On Tuesday, June 29 at 2:30pm, you are invited to join a virtual, public town hall conversation sponsored by Duke Health and UNC Health to discuss how federal policy, state policy, and public-private partnership opportunities can support advancing innovations in health to create pathways to opportunity and economic security. Topics will include addressing health equity, social determinants of health, and incentives for increased innovation.
The town hall will be led by the Future of Tech Commission, a private, independent and bipartisan working group developed in response to discussions with the White House and the Federal Communications Commission (FCC) to recommend a comprehensive tech policy agenda. The ideas and feedback generated from this event and diverse communities and groups across the country will be used to craft key tech policy measures, and set the stage to implement a robust tech agenda with bipartisan support.
Visit the event page to learn more and register!
Want to Join Team Advocacy?
Thanks to the PDC and our partners in the Duke State Relations office, Duke Health physicians and providers can engage with policymakers through the PDC Provider Advocacy Network.
By enrolling in the Phone2Action advocacy tool, individuals can join a powerful, collective voice on priority healthcare issues debated in Raleigh and Washington, D.C., including telehealth, workforce, drug pricing, and many more.
Learn more here. (NOTE: You must register and use a non-Duke email address to receive action alerts.)