Negotiations
Deals can’t and won’t stick without
Consideration
The Rundown
- Debt limit negotiations continue as time runs short
- Energy & Commerce Committee holds markup session on healthcare bills
- Momnibus reintroduced in the House and Senate
- President Biden announces 13 new actions to reduce gun violence
- House advances fentanyl focused legislation
- The latest from our desks
- Join the Duke Health Advocacy Network!
Federal Updates
Debt Negotiations Are Down to the Wire
In mid-January, the federal government officially reached the debt limit, which is representative of the government’s borrowing authority and ability to pay back debt that has been incurred. The Department of Treasury has since undertaken “extraordinary measures” to continue meeting the nation’s financial obligations, but those efforts will cease to be effective as early as June 1. If you are keeping track, that is less than one week from today.
We’ve been updating you on the back-and-forth, will-they-won't-they negotiations for the past few weeks, and this week’s update is more of the same. As of the time of publication, the status of negotiations over the debt limit is extremely fluid. Over the past week, members of the House Republicans’ negotiating team have acknowledged that talks have seesawed between productive and on the brink of a breakdown. Yesterday, House Republican leadership expressed confidence that a deal to raise the debt limit and pare back federal spending will come together sometime in the next few days. With no deal imminent, Speaker Kevin McCarthy (R-CA) has agreed to send lawmakers home for the long Memorial Day weekend, suggesting that negotiations will drag into next week.
As with anything in DC, oftentimes a deal comes together right when it seems like negotiations have completely fallen apart.
If negotiators are unable to come to a deal and the debt limit is reached, it is unclear how the Treasury Department would proceed to finance government operations. According to the American Hospital Association (AHA), under a default scenario, hospitals and healthcare providers might not receive full or timely payments from the federal government. There is no way to determine which government obligations may be at risk, but the following is a list of June transactions identified by independent analysts at the Bipartisan Policy Center that could affect the healthcare field, including hundreds of billions of dollars in Medicare, Medicaid, and Affordable Care Act (ACA) payments. Payments potentially missed or delayed in June include:
- Medicare payments that could be disrupted in June include $47 billion on June 1; $2 billion on June 5, 13, 16 and 27; and $49 billion on June 30.
- Medicaid payments that could be disrupted in June include $2 billion on June 2; $6 billion on June 6; $3 billion on June 7; $6 billion on June 8; $5 billion on June 9 and June 22; and $4 billion on June 29.
- ACA payments that could be disrupted include $8 billion on June 22.
With these negotiations continuing to dominate headlines and activity on the Hill, House Appropriations Chairwoman Kay Granger (R-TX) announced that she would be postponing several FY 2024 full committee appropriations markups this week. House Appropriations Subcommittees have already advanced FY 2024 spending bills for Agriculture (which also includes funding for the FDA), Homeland Security, Legislative Branch, and Military Construction-Veterans' Affairs. Each appropriations bill contains some funding reductions influenced by the debt limit legislation, with the proposed FDA discretionary spending for FY 2024 essentially flat.
Energy & Commerce Committee: On Your Mark(up), Get Set, Go –or Don’t!
On Wednesday, the House Energy and Commerce Committee continued to advance several healthcare policies during its full Committee markup. The markup included H.R. 3561, which was advanced out of the Health Subcommittee and we reported on last week. It contains several concerning site-neutral policies regarding off-campus hospital outpatient departments (HOPDs) that would result in a reduction of billions of dollars for hospitals across the country. Ahead of the markup, our office reached out to express concern and shared the potential impact on Duke Health. The American Hospital Association (AHA) also stated that “the proposed reductions fail to account for the fundamental differences between HOPDs and other ambulatory care sites, would exacerbate Medicare’s chronic failure to cover the cost of care and threaten beneficiary access to quality care.”
On an encouraging note, this bill also included a delay in cuts to the Medicaid Disproportionate Share Hospital (DSH) program. A full list of provisions in H.R. 3561 can be viewed here. Medicare site-neutral payment policy also falls under the jurisdiction of the House Ways and Means Committee, so we anticipate further conversation on this topic as this Committee examines the issue.
Our office also shared concerns ahead of the markup about proposals that would unnecessarily burden hospitals, including redundant and additional 340B reporting requirements on covered entities, including Duke Health hospitals participating in the program. These 340B policies also were approved out of the Committee. Organizations including the AHA, the American Society of Health-System Pharmacists (ASHP), America’s Essential Hospitals (AEH), the Association of American Medical Colleges (AAMC), the Catholic Health Association of the United States, and the Children’s Hospital Association sent a letter to the Committee leadership expressing strong concerns about the measures impacting the 340B program.
Some of the approved bills have been referred to multiple committees and would still have to be considered by the full House and later the Senate, where a 60-vote threshold is needed before becoming law. Our office will continue to work with Congress on these issues.
Happy (Belated) Mother’s Day: Momnibus Reintroduced
Last week, Senator Cory Booker (D-NJ) and Representatives Lauren Underwood (D-IL-14) and Alma Adams (D-NC-12) reintroduced the Black Maternal Health Momnibus Act, which is supported by the Black Maternal Health Caucus. The bill is similar to the Momnibus Act introduced last Congress and includes 13 bills to address the high rates of maternal mortality and disparities in outcomes. According to the press release, the bill makes “historic investments that comprehensively address every driver of maternal mortality, morbidity, and disparities in the United States.”
Accompanying the bill’s introduction, Rep. Adams said that “maternal mortality and morbidity rates in the United States are unacceptable, and far higher than in other wealthy countries...The Black Maternal Health Momnibus Act of 2023 addresses this urgent crisis that affects thousands of American parents every year.” Rep. Adams further stressed that “as many as 80% of maternal deaths are preventable with proper care and treatment… The Momnibus makes over $1 billion in historic investments in the health and care of moms… It is nothing short of a game-changer for Black mothers as well as every parent bringing a child into the world.”
Reps. Don Davis (D-NC-01), Deborah Ross (D-NC-02), Valarie Foushee (D-NC-04), Kathy Manning (D-NC-06), and Jeff Jackson (D-NC-14) are all original cosponsors of the bill.
Duke Health and our office have been strong advocates for this bill and will continue to urge passage this Congress.
President Biden Announces 13 New Actions to Reduce Gun Violence
On May 14, President Biden announced 13 new actions his administration is taking to implement the Bipartisan Safer Communities Act (BSCA) and maximize the benefits of the law in order to reduce gun violence and save lives. The BSCA, passed during the 117th Congress, is the most significant gun safety reform legislation in decades. According to the Biden administration, actions include new steps to keep guns out of dangerous hands, ensure BSCA’s mental health funding helps those dealing with the grief and trauma resulting from gun violence, make schools safer, and expand community violence interventions.
Our office continues to follow implementation of the BSCA and advocate for provisions to reduce gun violence including support for federal funding for gun violence prevention research.
House Advances Fentanyl Focused Legislation
This week the House began consideration of the “HALT Fentanyl Act.” Included among the provisions in this bill are placing fentanyl-related substances as a class into schedule I of the Controlled Substances Act (CSA). The bill would also make several changes to registration requirements related to research including:
- permitting a single registration for related research sites in certain circumstances,
- waiving the requirement for a new inspection in certain situations, and
- allowing a registered researcher to perform certain manufacturing activities with small quantities of a substance without obtaining a manufacturing registration. (Source)
The White House issued a Statement of Policy maintaining that permanently scheduling all fentanyl-related substances (FRS) not otherwise scheduled into Schedule I of the CSA as a class and expediting research into fentanyl-related substances has long been supported by the Administration. The full statement can be viewed here. A group of about 150 organizations sent a letter opposing the legislation, noting that “This bill permanently schedules FRS on schedule I of the SA) based on a flawed class definition, imposes mandatory minimums, and fails to provide an offramp for removing inert or harmless substances from the drug schedule.” At the Subcommittee markup in March, House Energy and Commerce Committee Ranking Member Anna Eshoo (D-CA) said “most Democrats support permanently scheduling illicit fentanyl-related substances. We just need to make sure the policy on mandatory minimums is revised to avoid continuing the ineffective and harmful policies of the past. Mandatory minimums should take into account whether the cases involve overdoses or serious bodily harm.”
Earlier this week, the House passed the Preventing the Financing of Illegal Synthetic Drugs Act by a vote of 402-2. This bill would require the Government Accountability Office to carry out a study on illicit financing in connection with the trafficking of synthetic drugs, including fentanyl and methamphetamine, fentanyl- and methamphetamine-related substances, Captagon, and fentanyl and methamphetamine precursors, and to report to Congress. It now awaits action by the Senate.
From our desk(s): Duke Health GR this week
This week, our office hosted staff from the office of Senator Thom Tillis (R-NC) to share background on the partnership between the School of Medicine and the Durham VA Medical Center. Our team also participated in the White House Health Community Engagement Call, where we heard updates on issues including mental health and negotiations on the debt ceiling.
Since our last newsletter, our office also reached out to Senators Tillis and Ted Budd (R-NC) on a letter being circulated by Senators Bob Menendez (D-NJ) and Kevin Cramer (R-ND) urging CMS to reevaluate the agency’s FY 2024 inpatient prospective payment system (IPPS) proposed rule and consider using its special exceptions and adjustments authority to revise the IPPS final rule and increase the payment update, ensuring that hospitals have the resources they need to deliver high quality care.
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