There’s rules to these things
Never take the first offer
And make the last shot
The Rundown
- President Biden releases FY 2024 budget proposal
- Committee updates: House Energy & Commerce, House VA, and House Select Subcommittee on the Coronavirus Pandemic hold a markup and hearings this week
- Biden administration moves forward with effort to rescind Conscience Rule changes
- HHS releases healthcare cybersecurity guidance
- The latest from our desks
- Join the Duke Health Advocacy Network!
Federal Updates
And we’re off: President Biden begins unveiling details of his FY 2024 budget request
It wasn’t a complete deluge of new information – more like a steady, scattered shower, as the Biden administration began releasing details of its FY 2024 budget request to Congress on Thursday. Additional details will be released over the next week, but the initial release offers just enough insight into how the White House is prioritizing key federal spending and policy initiatives and President Biden’s opening offer in anticipated debt limit negotiations with House.
While the president’s budget request is non-binding – and likely a non-starter in many areas for the House Republican majority – it is not unimportant. In fact, in terms of the overall FY 2024 budget and appropriations process, it’s go time.
President Biden’s FY 2024 budget proposes to balance targeted and increased investments in discretionary spending with over $3 trillion in deficit reducing proposals achieved through tax increases and ending certain subsidies for oil and gas, real estate, and cryptocurrencies. The budget also proposes to raise the Medicare hospital insurance tax by 1.2 percent on high income earners to extend the Medicare trust fund by 25 years and would address Medicaid Managed Care overpayments to lower healthcare spending.
Among the notable recommended discretionary spending investments include:
- $48.6 billion in discretionary and mandatory resources for the National Institutes of Health (NIH), an increase of $920 million above the FY 2023 level.
- $447.5 million for the Agency for Healthcare Research and Quality (AHRQ), an increase of $74 million, or 19.8 percent, above the FY 2023 level.
- $11.581 billion for the Centers for Disease Control and Prevention (CDC), an increase of $2.397 billion above the FY 2023 level.
- $150 million for the National Child Traumatic Stress Network, which is coordinated by the Duke-UCLA National Center for Child Traumatic Stress, an increase of $56 million above the FY 2023 level.
- $938 million for the Department of Veterans’ Affairs Medical and Prosthetic Research program, an increase of $22 million above the FY 2023 level.
- Increased investments in the Defense Health Program supporting medical research.
- Investments in telehealth access and broadband expansion.
- Continued investments in mental health and healthcare workforce support.
- Support for maternal health priorities to reduce mortality and expand care in rural areas.
- Increased investment for the Cancer Moonshot.
Our team will continue to evaluate, analyze, and share with Duke Health leadership additional details from the administration’s budget priorities as they are released over the next week and publish any further updates in next week’s newsletter.
Want to dig in a little more? Here are a couple of resources on the administration’s FY 2024 budget:
Heard on the Hill: Committee activity recap
It was another busy week for committees on Capitol Hill in the run up to a brief spring recess in a few weeks. Here’s a quick snapshot of some committee activity with healthcare operations and policy implications.
House Energy and Commerce Subcommittee on Health – Legislative Markup
This week the House Energy and Commerce Health Subcommittee held a markup of five bills, including:
- H.R. 501, the Block, Report, And Suspend Suspicious Shipments Act;
- H.R. 498, the 9-8-8 Lifeline Cybersecurity Responsibility Act;
- H.R. 485, the Protecting Health Care for All Patients Act of 2023;
- H.R. 467, the “HALT Fentanyl Act; and
- H.R. 801, the “Securing the Border for Public Health Act of 2023.
Of the legislation considered by the subcommittee, H.R. 501, which would clarify the due diligence processes for filling orders of controlled substances, and H.R. 498, which would require the Substance Abuse and Mental Health Services Administration (SAMHSA) to undertake efforts to protect the 9-8-8 Suicide & Crisis Lifeline from cybersecurity threats, had the most bipartisan support. Members of both parties suggested changes and reconsiderations of various provisions in the remaining three bills before they are brought before the full committee for approval.
Descriptions of each of the bill can be found in the Committee’s memo here.
House Veterans’ Affairs (VA) Committee – VA Subcommittee on Oversight and Investigations
The House Veterans’ Affairs Committee continued its series of oversight hearings this week with a Subcommittee on Oversight and Investigation on “Accountability at VA: Leadership Decisions Impacting its Employees and Veterans.” The sole witness represented the VA’s Human Resources and Administration leadership and spoke to internal efforts within the agency to increase transparency and accountability of employees across various service lines, including those in the Veterans’ Health Administration.
The committee is likely to turn its attention to President Biden’s FY 2024 budget request for the Department of Veterans’ Affairs in the coming weeks before resuming additional oversight hearings on VA operations.
House Select Subcommittee on the Coronavirus Pandemic – COVID-19 Origins
The House Select Subcommittee on the Coronavirus Pandemic held its first hearing on the origins of COVID-19 this week. In his opening remarks, Subcommittee Chairman Brad Wenstrup, DPM (R-OH) noted that while the subcommittee is tasked with examining the broader federal response and impact of the COVID-19 pandemic, it is important to first ask a “fundamental” question on where the virus first originated, adding that the answer to that question is important to predicting and preparing for future pandemics and strengthening the public health and national security. In contrast, Ranking Member Raul Ruiz, MD (D-CA) spoke to the continued work of the research and intelligence communities to evaluate the virus and understand its origins, also cautioning that results so far have been inconclusive and efforts to further investigate should not be impeded by politics or partisanship.
Former CDC Director Robert Redfield, based on his own analysis of the data, reiterated his support for the theory that the COVID-19 infections more likely were the result of an accidental lab leak than the result of a natural spillover event. Dr. Redfield further commented that the pandemic is a case study on the potential dangers of gain of function research, calling for a moratorium on all gain-of function research until consensus is reached as a community about the value of gain-of-function research.
Rep. Deborah Ross (D-NC-02), who serves on the Select Subcommittee, empathized that she and her Democratic colleagues strongly support expert community efforts to determine the origins of the novel coronavirus, because doing so is critical to preparing and preventing for future pandemics.
Biden administration moves closer to formal rescission of Trump administration proposed federal “Conscience Rule” changes
This week the public comment period closed on a proposed rule from the Biden administration to partially rescind changes put forward in 2019 to the federal “Conscience Rule” that would have allowed healthcare professionals in federally-supported programs to deny care for certain services such as gender-affirming care or abortions, based on the practitioner’s religious beliefs.
Practically speaking, the 2019 modifications proposed by the Trump administration were never allowed to take effect as they were vacated by federal courts just weeks before implementation. However, the Biden administration has decided to take the extra step of formally removing the Trump-era rule changes through rulemaking as to avoid potential legal challenges alleging violations of administrative procedure that might otherwise leave room for the rules to be revived.
After a public comment review, the Biden administration is likely to issue its final rule later this year.
HHS issues updated healthcare cybersecurity guidance
On March 8, the Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response released updated guidance for healthcare organizations to strengthen their cybersecurity efforts.
The guide includes best practices and a “common language” for addressing cybersecurity issues to help organizations better determine their preparedness and can help organizations gauge their preparedness. It is intended as the formal implementation of the voluntary 2018 cybersecurity standards developed by the Commerce Department’s National Institute of Standards and Technology.
The guidance was created in partnership with the Health Sector Coordinating Council Cybersecurity Working Group, which includes representatives of healthcare companies, hospitals, and industry trade groups. Duke Health is an organizational member of the Health Sector Coordinating Council.
Separately, healthcare-related cybersecurity legislation is being developed in the Senate by Cybersecurity Caucus co-chair Senator Mark Warner (D-VA) with an initial draft anticipated to be released this spring. Senator Thom Tillis (R-NC) serves as the lead Republican co-chair of the Cybersecurity Caucus.
From our desk(s): Duke Health GR this week
This week, our team coordinated a meeting for Duke Health experts to meet with staff of House Ways and Means Subcommittee on Health member Greg Murphy, MD (R-NC-03) to discuss Medicare Advantage (MA) challenges and the impact on patient care and access, including those associated with increased lengths of stay as a result of MA policies.
We continued a series of meetings with a colleague from the Duke University Office of Government Relations and staff of the NC congressional delegation to discuss university and health system-wide immigration policies and priorities, including visa and green card processing and professional and educational international recruitment.
Our team coordinated with Duke Health experts to prepare a health system response to a request for information issued by Reps. Richard Hudson (R-NC-09) and Anna Eshoo (D-CA) to inform legislative efforts in preparation for congressional reauthorization of the Pandemic All-Hazards and Preparedness Act (PAHPA).
Our office also provided a government relations update to the Advanced Practice Committee for Legislative Affairs; Nurse Executive Council; and Dr. Don Bradley’s Duke Health Markets and Policy class.
Members of our team also participated in national policy coalition and strategy calls related to digital health and data privacy, telehealth, federal support of trauma centers, pediatric mental health, nursing, and medical research.
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