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Plan 10 steps ahead
But know limits of motion
It’s all one by one
Publication Notice: Congress will recess for the July 4th holiday, and our newsletter will also take a one-week hiatus. We’ll resume our regular publication schedule the week of July 8th.
The Rundown
- House runs the show before July 4th recess
- House Committees focus on VA healthcare networks and value-based care
- Supreme Court restores emergency abortion access in Idaho
- What’s up NC delegation
- The latest from our desks
- Join the Duke Health Advocacy Network!
Federal Updates
Full House
With the Senate beginning its recess a week early, the House found itself as the only congressional game in town – and if you’re alone at the table with a full deck, there are fewer disadvantages to showing your hand. Appropriators threw in their chips for FY 2025 spending recommendations, and hearing dockets examined priorities and potentially set up future runs of policy changes.
Any bluffs? Hard to say for sure right now, but we’re ready for the next hand.
All in.
Heard on the Hill
The House Energy and Commerce Committee was poised to take up eleven bills for consideration on Thursday, including comprehensive data privacy reform legislation and a bill that would extend current expanded telehealth coverage under Medicare, but the markup was abruptly canceled due to reported concerns about the future of the privacy effort.
Otherwise, it was a big committee week before the House takes flight for the July 4th holiday. Here’s a quick look at hearings we were following:
House VA Committee
The House Veterans’ Affairs (VA) Subcommittee on Health held a hearing on Tuesday to examine the Veterans’ Health Administration’s (VHA) healthcare network structure, known as the Veterans Integrated Services Network (VISN). Invited witnesses included representatives from the VHA, the Office of the Inspector General (OIG), a practitioner, and the former VA Under Secretary of Health Dr. Kenneth Kizer, who designed the VISN structure in the mid 1990s. Committee leadership and other members cited an OIG report suggesting that safety and accountability standards have not been universally applied across the VISN. Committee members further discussed the need for better reporting and uniformity among standards of care to limit potential regional differences in experiences and healthcare outcomes for Veterans.
House Ways and Means Committee
This week, the House Ways and Means Health Subcommittee held a hearing entitled, “Improving Value-Based Care for Patients and Providers.” The hearing examined the challenges and opportunities associated with delivering better health outcomes and Medicare savings through value-based care. Witnesses included Stephen Nuckolls, CEO of Coastal Carolina Health Care and founding member and board member for the National Association of ACOs (NAACOS), which represents more than 470 ACOs including Duke Connected Care. His testimony, which can be viewed at the link above, along with other witness testimony for the hearing discussed the experience of NAACOS members and offered recommendations to improve Medicare’s transition to alternative payment models (APMs).
The American Hospital Association provided comments ahead of the hearing, including principles Congress should consider when designing APMs to make participation more attractive for potential participants. Those comments can be viewed here.
House Subcommittee Advances Health Spending Bill
This week, the House Labor, Health and Human Services, Education, and Related Agencies (LHHS) Appropriations Subcommittee held a markup of its Fiscal Year (FY) 2025 spending bill. The bill, which includes funding for U.S. health and biomedical research agencies, contains several concerning provisions, including recommendations to reduce funding for important agencies and programs, such as healthcare workforce program at Health Resources and Services Administration, gun violence prevention research, and the Centers for Disease Control and Prevention, and to eliminate funding for the Agency for Healthcare Research and Quality.
The bill would provide a $280 million increase for the National Institutes of Health (NIH) above the FY 2024 enacted level, which represents essentially level funding with inflationary adjustments, but it also outlines significant policy change recommendations for restructuring and reorganizing NIH. Other policy riders that would impact funding for abortion access and research priorities are also included. While the tenor and tone of the bill was less than bipartisan, it does maintain critical investments in other Duke Health priorities.
While the funding cuts are drastic and some of the policy changes are concerning, it's important to remember that, at its core, this is an election year messaging bill. Additionally, we are only at step one of what will be a lengthy process that will require the Republican House and the Democratic Senate to come to an agreement, a reality acknowledged by House Appropriations Committee Chair Tom Cole (R-OK). Chair Cole noted that the final bill will not look like the current proposal and that work will have to be done to make the final product more bipartisan. He also offered praise for his colleague, Subcommittee Ranking Member Rep. Rosa DeLauro (D-CT), who expressed her frustration about what she viewed to be partisan policy riders and the decision to include NIH reforms in spending legislation.
The link to the markup and bill resources can be viewed here.
Our team weighed in with congressional leaders and will continue to educate and advocate on behalf of Duke Health priorities. This is just the beginning of the congressional FY 2025 appropriations cycle, and we will keep you informed at every step.
Supreme Court rules that Idaho hospitals must resume providing emergency abortion care
The US Supreme Court handed down a decision Thursday requiring Idaho hospitals to once again provide abortions in cases of medical emergency despite the state’s almost total ban on the procedure. The Biden administration had challenged Idaho’s refusal to provide abortions in life-saving circumstances as violating the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals that receive Medicare payments to provide stabilizing treatment when there’s an imminent threat to a patient’s life or health.
However, the Court did not resolve the case on the merits of that argument, instead holding in a 5-4 decision that it should not have taken up the case for final review in the first place, sending it back to the 9th Circuit Court of Appeals to review EMTALA’s applicability.
Since the decision in Dobbs two years ago overturning a federal right to seek and receive an abortion, the Supreme Court has largely avoided considering the merits of additional abortion-rights related challenges, including a ruling a few weeks ago that found that a group seeking to block access to the abortion drug mifepristone lacked legal standing to bring the case. This leaves the door open to future merit-based challenges on both issues, potentially as soon as next term.
The Court has yet to formally adjourn for its current term, with several high-profile decisions still pending.
What’s up NC Delegation
Senator Thom Tillis (R-NC) joined a bipartisan group of Senators in reintroducing the Improving Seniors’ Timely Access to Care Act, which seeks to streamline the prior authorization process under Medicare Advantage (MA). Specifically, the bill would:
- Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.
- Increase transparency around MA prior authorization requirements and its use.
- Clarify CMS’ authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.
- Expand beneficiary protections to improve enrollee experiences and outcomes.
- Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.
In other news, the House passed its version of annual national defense policy, the National Defense Authorization Act (NDAA), on June 14. Rep. Don Davis (D-NC-01), a member of the House Armed Services Committee, sponsored several health-related amendments that were adopted in the bill, including language seeking a report on innovative treatments for acute and chronic vascular trauma and additional language seeking a report on National Influenza Vaccine Modernization Strategy Implementation.
Earlier this week, Rep. Deborah Ross (D-NC-02) co-hosted a Reproductive Freedom Summit on the second anniversary of the Supreme Court’s Dobbs v. Jackson Women's Health Organization decision which overturned Roe v. Wade.
Rep. Kathy Manning (D-NC-06), in her role as Democratic Women’s Caucus Policy Co-Chair, led a letter to Meta, TikTok, X, and YouTube executives to express concern over the spread of misinformation and disinformation related to reproductive health and contraception on their platforms. The letter was endorsed by the American College of Obstetricians and Gynecologists (ACOG) and the National Women's Law Center.
From our desk(s): Duke Health GR this week
Our team participated in the American Hospital Association’s Government Relations Officers Network (GRON) meeting, where we heard from AHA leadership and key Hill staff on policy issues impacting hospitals. Following the GRON meeting, we joined the North Carolina Healthcare Association in a roundtable meeting with NC congressional staff to discuss priorities impacting NC hospitals.
Our team also joined our colleagues in Duke State Relations for our June virtual office hours through the Duke Health Advocacy Network Teams platform (more information on how you can join below). The discussion covered the latest from D.C. and included updates on policy priorities and issues of interest to our colleagues that impact their work and those served by the health system.
Join the Duke Health Advocacy Network!
Looking for more opportunities to connect with fellow advocates and professionals interested in public policy across the health system? Join the Duke Health Advocacy Teams Channel! We’re growing leaps and bounds and hope you’ll consider joining us!
Managed and moderated by Duke Health Government Relations and Duke State Relations, the purpose of the platform is for you to connect with your colleagues throughout the health system who are engaged and/or interested in public policy advocacy. We hope the channel will be used as a space for sharing ideas, collaboration, and engaging with the government relations teams on the issues most important to your work.
We encourage you to explore the channel, as we will post relevant news items, policy updates, questions, advocacy resources, and opportunities for engagement. As importantly, this is your space to do the same and to help grow the community.
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(Note: This is only open to Duke Health employees. By joining this teams channel, you acknowledge that the platform and your participation are intended for information sharing and connections/relationship building and is not an inducement by Duke Health Government Relations and Duke State Relations, or the channel’s participants, to act as an unauthorized advocacy and/or lobbying representative of Duke Health or Duke University).