Some things feel assured
Some rain, flowers in the Spring
And Senate delays
Federal Updates
Welcome to the big top: latest round of COVID relief enters final stages
“This is the circus. Everybody’s trying not to go home.” The previous line, taken from the character Russell Hammond in the film Almost Famous, aptly describes the current state of the Senate entering the final stages of consideration of the next round of COVID-19 relief, especially for Republican leaders who have largely had little power under reconciliation to influence the crafting of the legislation. It is not a perfect analogy. Russell was describing the mystique of touring with a mid-range rock band, after all, but with expected procedural delays (used by both parties at times when they are in the minority) and the joys of vote-a-rama still ahead, the Senate’s work will almost certainly carry on into the weekend. It’s going to be a show.
Senate edges closer to advancing revised COVID-19 relief bill
The Senate has voted to open debate on its modified version of the American Rescue Plan under the budget reconciliation process, setting the stage for the legislation to pass the chamber with only a simple majority (and likely the vote of Vice President Kamala Harris to break a tie). But, the path to 51 votes will not be without potential political minefields and procedural disruptions.
While the legislation largely reflects the version passed by the House, there have been some notable changes made this week as the result of rulings by the Senate parliamentarian on potential “Byrd rule” violations and an agreement reached by the White House and Senate Democrats. These include cutting out the proposed federal minimum wage increase to $15 per hour, adjusting the threshold for individual and family stimulus payments, removing for two years the income cap on subsidies for those purchasing insurance through federal or state exchanges, and providing 100% COBRA subsidies through the end of September for people who have lost their jobs to remain on their employer-sponsored healthcare plans. The legislation also includes $8.5 billion for rural healthcare providers to be issued through the provider relief fund.
More changes may still be on the way as the Senate moves toward its vote-a-rama process common to all budget resolution and reconciliation measures in the chamber. The vote-a-rama that accompanies the budget reconciliation process allows for any Senator to offer an amendment to the underlying legislation. Unlike a regular legislative process, the Senate can’t maneuver its way around votes on an amendment unless it is ruled out of order or withdrawn. While all will not ultimately receive a vote, many hundreds of amendments are expected to be filed, which could further delay a final vote. Efforts are underway to potentially increase the amount of funding for the provider relief fund, as well as to make further temporary enhancements to telehealth, but both campaigns face long odds.
Senate Majority Leader Chuck Schumer (D-NY) said that he expects the Senate will pass its COVID-19 relief measure this week, even if a final vote slips to Saturday. Once passed, the legislation will then go back to the House for reconsideration with the plan to have a final bill ready for President Biden’s signature by March 14.
Duke Health Government Relations continues to advocate for support for the research enterprise, provider relief, telehealth expansion, and other key Duke Health priorities.
Tie goes to the runner: Becerra nomination will be considered by full Senate
The nomination of Xavier Becerra to be the next Secretary of Health and Human Services now heads to the Senate floor after the Senate Finance Committee voted 14-14 along party lines to advance his confirmation process to a final vote.
Under the power sharing agreement reached by Senate Democratic and Republican leaders last month following Democrats officially taking over the majority, nominations and legislation are allowed to proceed from committee consideration with only a tie vote.
While Cabinet nominees need only a simple majority to be confirmed under Senate rules, Becerra’s final confirmation vote is expected to be tight. Thus far, no Republicans have signaled their public support, which means even one Democratic defection could doom his candidacy. It is unclear at this time whether Vice President Harris will be needed to break a potential 50-50 tie. Becerra’s confirmation vote has not yet been scheduled.
Meanwhile, a hearing announcement to begin the formal confirmation process for Centers for Medicare and Medicaid Services (CMS) Administrator nominee Chiquita Brooks-LaSure may come as soon as next week.
E&C Health Subcommittee begins examining telehealth beyond the PHE
There are plenty of reasons to be optimistic about the future of telehealth expansion beyond the COVID-19 public health emergency (PHE), but policymakers, as convinced as they are about telehealth’s long-term potential, are still going to need plenty of help…and data.
On Tuesday, the House Energy and Commerce Subcommittee on Health held a hearing entitled, “The Future of Telehealth: How COVID-19 is Changing the Delivery of Virtual Care.” Witnesses representing academic medicine, practitioners, insurers, and Medicare beneficiaries reported on the benefits and efficacy of telehealth expansion during the PHE. Many of the witnesses also expressed support for the Duke Health-endorsed TREAT Act (H.R. 708/S. 168), which would temporarily allow, subject to scope of practice and other requirements, a healthcare professional to provide in-person and telehealth services in any U.S. jurisdiction based on that individual's authorization to practice in any one state or territory during the COVID-19 PHE. While the topic of permanent national licensure is somewhat divisive in Congress, notably there was no outward opposition to the temporary aims of the TREAT Act.
Almost universally, committee members expressed interest in making many of the current temporary telehealth flexibilities permanent and signaled their support for at least temporary extensions of the flexibilities after the end of the PHE to give Congress and CMS more time to collect data on telehealth utilization, patient and provider experience, and outcomes.
At the same time, the hearing also highlighted serious concerns about healthcare disparities that have been exacerbated by the COVID-19 PHE, including technological and broadband gaps that have limited telehealth access to vulnerable populations. There also remain concerns about the efficacy of certain audio only visits and the potential for over-utilization of telehealth as a primary source of care.
Duke Health Government Relations will continue to follow up with congressional leaders as a resource on this issue and is working in partnership with Duke leadership and the Duke Telehealth Office to ensure that beneficial telehealth policies are strengthened and maintained.
From our desk(s): Duke Health GR this week
This week, in coordination with Duke telehealth experts, the Duke Health Government Relations office assisted staff of Rep. G.K. Butterfield (D-NC-01) in preparation for the Energy and Commerce Health Subcommittee hearing on telehealth and is following up with committee member offices on questions raised during the hearing. We are also reconnecting with staff of Senate telehealth champions from the 116th Congress to better understand their plans and priorities moving forward.
The team also submitted appropriations requests for several Duke Health priorities to congressional offices representing the Triangle area. Duke experts will join our office in upcoming Hill meetings to discuss the impact of these funding priorities on their clinical work and fields of research.
The Senate Health, Education, Labor and Pensions (HELP) Committee is scheduled to hold a hearing on March 9 entitled, “Examining Our COVID-19 Response: An Update from the Frontlines.” Duke University Health System Vice President of Patient Care & System Chief Nurse Executive Mary Ann Fuchs has been invited to testify.
Finally, we continue to connect our leadership, clinicians, and researchers with policymakers engaged in COVID-19 response efforts, protecting the research enterprise, and health equity.