Federal Health Policy Updates for the Week of June 15, 2020


The Headlines



  1. The latest from Congress, the Administration, and the Supreme Court on issues from COVID-19 and appropriations to non-discrimination and diversity.
  2. Help us tell the story of COVID-19's impact on your research or patient care!
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The Details
1. Federal health updates from Capitol Hill, the Administration, and the Supreme Court
While resuming a more regular schedule, new precautions are being put into place to protect Members and staff. The Office of the Attending Physician, which serves Congress and the U.S. Supreme Court, has warned that pre-COVID-19 normal operations will not be back in place for quite some time.

For more information on key issues we're tracking, visit our updated Federal Issues page (now with more navigation).
COVID-19: Connecting Duke Health and Congress
This week, Dr. Cameron Wolfe, Associate Professor of Medicine, and another infectious disease expert from Wake Forest Baptist Medical Center met virtually with health policy staff from the offices of Senators Richard Burr and Thom Tillis to discuss the recent rise in COVID-19 cases in NC. Dr. Wolfe noted the factors and health disparities contributing to the significant number of members from the Latinx community being disproportionately represented in new cases in Durham. He further shared with staff that while increased testing may account for some of the increased cases identified, overall we are seeing a more disturbing trend that is rooted in people not exercising proper social distancing and other safety protocols, including wearing masks in public spaces. Dr. Wolfe said increased testing alone is insufficient and that much more expansive contact tracing capabilities would be necessary to mitigate the impact of COVID-19 in NC.

The Supreme Court on June 18 rejected the Trump Administration’s attempt to end the Deferred Action for Childhood Arrivals (DACA) program. Chief Justice John Roberts led a 5-4 decision that found the Administration’s process to wind down the Obama-era program for Dreamers in 2017 lacked a sound legal basis. The decision does not prevent future moves to end DACA, but it seems unlikely that another framework will be attempted before the November elections. This major victory for approximately 650,000 immigrants also includes an American Association of Medical Colleges’ estimate of 200 medical students and residents responding to the COVID-19 public health emergency amid physician shortages.

Non-discrimination issues: HHS and the Supreme Court
On June 12, the Department of Health and Human Services (HHS) finalized proposed revisions to a 2016 rule implementing nondiscrimination protections for patients under Section 1557 of the Affordable Care Act. The final rule removes the 2016 definition of "discrimination based on sex," which includes discrimination on the basis of gender identity. In a statement, HHS said the government's interpretation of sex discrimination will be based on "the plain meaning of the word 'sex' as male or female and as determined by biology." The decision faced immediate backlash from groups across the country, including the American Hospital Association (AHA), which urged HHS to reconsider eliminating the nondiscrimination protections. AHA noted that “narrowing the current regulation's protections against discrimination based on sex, including gender identity, sexual orientation and sex stereotypes, could have an adverse impact on access to care and the health of individuals."

Duke Health leadership, led by Chancellor of Health Affairs and President and CEO of the Duke University Health System Eugene Washington, MD, issued a statement of support to the Duke Health LGBTQ+ community this week, making clear that discriminatory environments and practices have no place at Duke.

While the Trump Administration rolled back protections for the LGBTQ+ community, the Supreme Court on June 15 expanded safeguards for LGBTQ+ workers. In a 6-3 decision in Bostock v. Clayton County, the majority opinion of the Court said that Title VII of the Civil Rights Act of 1964, which prohibits employers from discrimination based on a person's sex, also extends to a person’s sexual orientation and transgender identity.

The House Energy and Commerce Health Subcommittee held a hearing this week entitled “Safeguarding American Innovation Act.” In his opening statement, the full Committee Chairman Frank Pallone (D-NJ) said, “I am hopeful this hearing will be a step forward in better understanding and addressing these heartbreaking inequities with both COVID-19 and our overall health care system.” During the opening remarks of the hearing, a newly formed Energy and Commerce Racial Disparities Working group was announced and will be co-led by Reps. Yvette Clark (D-NY) and Robin Kelly (D-IL).

Reps. G.K Butterfield (D-NC-1) and Richard Hudson (R-NC-8), North Carolina’s Members on the Committee, were in attendance at the hearing and spoke to the impact in inequities.

On June 23, the House Energy and Commerce Committee will hold a hearing, “Oversight of the Trump Administration's Response to the COVID-19 Pandemic." The hearing will include leaders in the Administration’s COVID-19 response including: Dr. Anthony Fauci, Director of the National Institute for Allergy and Infectious Diseases at the National Institutes of Health; ADM Brett P. Giroir, Assistant Secretary for Health at HHS; Dr. Stephen Hahn, Commissioner for the Food and Drug Administration; and Dr. Robert Redfield, Director for the Centers for Disease Control and Prevention.

The Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing on June 17 on “Telehealth: Lessons from COVID-19.” Chairman Lamar Alexander (R-TN) noted that the Committee was beginning its work to better understand how the recent telehealth waivers and enhancements due to the public health emergency have impacted provider delivery and patient care and which provisions may be most ripe to be made permanent going forward. Among the changes discussed for permanence were the elimination of the site origination requirements, as well as the thirty-one specific reimbursement-related changes for Medicare and Medicaid. Senator Richard Burr (R-NC), a member of the Committee, focused much of his brief remarks on the need for advancements in broadband technology to help ensure broader telehealth access, commenting that private industry innovations may help provide the quickest solutions to technology gaps.

As federal policymakers grapple with which temporary telehealth waivers issued by HHS and the Centers for Medicare and Medicaid Services should be made permanent for Medicare and Medicaid beneficiaries, regional private insurers are also taking steps to extend their coverage for telehealth. This week, Blue Cross and Blue Shield of NC announced it will extend its expanded telehealth policies through the end of 2020 as the state continues its efforts to mitigate the impact of COVID-19 while providing access to care.

Duke Health Government Relations, in partnership with the Duke Telehealth Office, continues to engage with the HELP Committee, the NC congressional delegation, and other policymakers to share data and patient and provider experiences that support efforts to permanently expand covered telehealth services.

The Senate Appropriations Committee is scheduled to begin marking up its versions of the twelve annual appropriations bills for FY 2021 next week. However, disagreements over whether additional COVID-19 relief and policing reforms language should be included may ultimately delay the Committee’s work. The House Appropriations Committee previously announced that it plans to begin markups of its FY 2021 bills the week of July 6.

Duke Health Government Relations continues to advocate for robust and increased funding for health care priorities and medical research funding, as well as appropriate flexibilities to strengthen the COVID-19 public health response, as part of the FY 2021 appropriations process.
Additional COVID-19 Stimulus and Recovery
The slow march to more formal negotiations on a “Phase IV” COVID-19 recovery and stimulus package continues. With congressional attention turned to more immediate, pressing matters of national importance, including calls for policing reforms, discussions on how to proceed with the next, and likely final, round of broad COVID legislation have gone quiet. Senate Majority Leader Mitch McConnell (R-KY) maintains that the earliest the Senate will take up “Phase IV” legislation would be the week of July 20. House Democrats are continuing to position key components of their “Phase IV” bill, the HEROES Act (H.R. 6800), for future negotiations.
Duke Health Government Relations is advocating for at least $26 billion to be included in a “Phase IV” package to protect the research enterprise, including $10 billion for the National Institutes of Health and $3 billion for the DoD Medical Research Program, as well as additional relief for providers.
2. Are you interested in sharing an example of the impact of COVID-19 on your research or patient care?
Duke Health Government Relations is supporting efforts from the Association of American Medical Colleges to collect and share examples about COVID-19’s impact on young/early stage investigators, the research process, and the potential impact on patients over the long term (including the development of new diagnostics, treatments, and cures and the halting of clinical trials). Duke Health Government Relations would also like to share these stories with policymakers to provide real-world examples to illustrate why additional relief is needed during this unprecedented pandemic.
If you would like to share a story, please contact julie.rose@duke.edu.

Visit our website to read how the pandemic is impacting a Duke researchers.