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Federal Health Policy Updates for the Week of May 24, 2021

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Reminder:
First announced in our May 21 newsletter, we want your poetry to replace our haikus for the month of June. Get creative and tell us a little more about your work.

Entering your submission is easy – just email it to dukegovrelations@dm.duke.edu – and we look forward to hearing from you!


Federal Updates
 
What deadline? Infrastructure talks might head to overtime
In Washington, D.C., what does the word “deadline” actually mean? Sometimes, it can be a hard and fast moment in time and space and other times it’s a mere suggestion by which some action might take place. Earlier this week, there was a set in stone deadline of Memorial Day for bipartisan infrastructure negotiations to wrap up. Today, it feels as if that deadline may have been written in sand, with the waves closing in.
 
We’ve had the White House’s opening offer with its combined $4 trillion two-part Build Back Better proposal, a $568 billion opening offer from Senate Republicans, another $1.7 trillion counter from the administration, and now, a counter-counter of $928 billion released by Senate Republicans on Thursday.

While the Biden administration continues to maintain that it is open to bipartisan negotiations, even indicating that the Memorial Day deadline may be softer than first announced, the latest Senate Republican offer only includes $257 billion in new spending. Additionally, there remains little to no agreement on how to pay for infrastructure legislation.

Talks continue heading into the holiday weekend, but there is a lingering question on just how long the Biden administration and congressional Democrats are willing to wait for an agreement before attempting to pass their own bill, likely through another round of budget reconciliation. House Speaker Nancy Pelosi (D-CA) originally said she wants an infrastructure package ready for a final vote in the House by the July 4 recess. That feels like a tall order at the moment – but what are deadlines, right?

Our office continues to monitor the release of proposals, legislation, and negotiations. Whatever the final product, we’ll work with our partners, associations, other stakeholders, and Duke leadership to advocate for robust infrastructure investment in academic medical and research institutions, hospitals, clinical and research laboratories, and technological investments supporting the delivery of and greater access to health care.
 
Watch (for) six (trillion): Full Biden budget expected today
The Biden administration released a “skinny” outline of its budget priorities in early April, and reports suggest that the full budget proposal being released today (after press time of this newsletter) has hit the gym. President Biden is expected to announce a FY 2022 budget of approximately $6 trillion, which will mark the highest level of sustained government spending since World War II.
 
The proposal, which is non-binding but provides guideposts for congressional committees on the administration’s priorities, contains major investments in infrastructure, education, and health care. It also assumes the passage of Biden’s American Jobs Plan and American Families Plan, which call for robust investments to rebuild aging infrastructure, bolster climate-friendly technologies like electric vehicles, and dramatically expand the social safety net.
 
The budget proposal is not expected to include details of other administration priorities, including an overhaul of unemployment insurance, broad scale student loan reform and forgiveness, or the creation of a public health care option.
 
Separately, Senate Health, Education, Labor and Pensions (HELP) Committee Chair Patty Murray (D-WA) and House Energy and Commerce Committee Chair Frank Pallone (D-NJ) have announced that they will begin work on legislation to create a public health care coverage option available to all Americans.
 
The proposal’s price tag will almost certainly be a nonstarter for congressional Republicans, but there may still be room for compromise on critical priorities, including infrastructure.
 
Our office will continue to monitor the FY 2022 budget and appropriations process closely and will report out in more detail in next week’s newsletter as information becomes available.
 
Progress can take a while: Brooks-LaSure confirmed to head CMS
What started as a relatively smooth confirmation process, but then became a mess, has finally reached a conclusion. This week, the Senate voted to confirm Chiquita Brooks-LaSure as the next Administrator of the Centers for Medicare and Medicaid Services (CMS). Brooks-LaSure is a former House Ways and Means Committee staffer and Obama administration HHS official. She becomes the first Black woman to lead CMS.
 
Her nomination had been held up for weeks following a protest by Senate Republicans over a Biden administration decision to revoke a special Medicaid waiver granted to the state of Texas near the end of the Trump administration. The protest resulted in her nomination vote being deadlocked in the Senate Finance Committee, which in turned forced Senate Democratic leadership to proceed with a special procedure known as a discharge petition to further advance to a vote on the Senate floor.
 
Brooks-LaSure’s confirmation comes at a critical time for CMS as it continues to analyze public health data, including for telehealth, from the COVID-19 public health emergency. CMS will also play a key role in drafting regulations for new surprise billing rules enacted at the end of last year, with the first proposed rules expected to be released by July 1.
 
House and Senate committees zero in on NIH budget
This week, the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, Education, and Related Agencies held hearings to examine President Biden’s $51 billion budget request, released as part of the April “skinny budget”, for the National Institutes of Health (NIH) for FY 2022.

The administration is pushing for a $9 billion increase above FY 2021 enacted levels for NIH. Key leadership from NIH, including NIH Director Francis Collins, MD, testified. Committee members were particularly interested in NIH’s ongoing research response to COVID-19, as well as other critical priorities, from cancer to neurological disease, to ensure that their focus is not lost amid necessary pandemic response.

Dr. Collins was also asked to comment on the administration’s call to establish the Advanced Research Projects Agency for Health (ARPA-H), which would account for roughly $6.5 billion of the budget’s overall NIH request. The introduction of ARPA-H, modeled after the Department of Defense’s Defense Advanced Research Projects Agency (DARPA), is intended to provide space in NIH to fund higher-risk and potentially higher reward research projects. Dr. Collins was careful to remark that the new agency is not intended to be duplicative of other translational research efforts within NIH, nor have any primary focus areas been predetermined and locked in by the administration. Additional details on the administration’s federal research priorities are expected to be released today in the full budget request.

HELP marks up health care workforce legislation
This week, the Senate HELP Committee met to mark up and advance several key pieces of health care and health care workforce-related legislation.
 
Among the bills that advanced out of the committee for possible consideration on the Senate floor is the Dr. Lorna Breen Healthcare Provider Protection Act (S.610). Named after Dr. Lorna Breen, a health care practitioner who committed suicide over a year ago while serving on the frontlines of the COVID-19 public health emergency, the bipartisan legislation aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals. Key provisions include offering more mental and behavioral health support services for health care workers and establishing suicide prevention training.
 
Mental health services for frontline workers has been a priority for HELP Committee leadership as it prepares health care workforce and pandemic preparedness legislation to be released in the coming months. Our office is continuing to work closely with HELP Committee staff in these efforts, connecting Duke Health experts to discuss policy developments and needs.
 
From our desk(s): Duke Health GR this week
The summer is going to be a sprint – but first, there was the last full week of May.

In conjunction with our colleagues in Duke State Relations, we held a public policy presentation and discussion with the Duke University School of Nursing Center for Nursing Research on key federal and state priorities. We met with staff for Senator Thom Tillis (R-NC) to introduce the work of Dr. Karin Reuter-Rice, a Duke Health clinical expert in the field of pediatric traumatic brain injury and research, and connected with Dr. Zach Rosenthal, director of the Duke Center for Misophonia and Emotion Regulation, to discuss emerging congressional interest on misophonia diagnosis, treatment, care, and research.

We were grateful for the opportunity to support the American Organization for Nursing Leadership Hill day, which included multiple leaders from across Duke Health sharing their experience on the frontlines. The participants met with Rep. David Price (D-NC-04) and the offices of Rep. David Rouzer (R-NC-07), Senator Richard Burr (R-NC), and Senator Thom Tillis (R-NC) about strengthening the nursing workforce, investing in nursing education infrastructure, supporting clinical well-being and resiliency, and expanding telehealth to increase access to care.

We coordinated a meeting for Jacquelyn McMillian-Bohler, PhD, CNM, CNE, Assistant Professor in the Division of Health for Women, Children and Families in the School of Nursing, and her colleagues from UNC-Chapel Hill and Vanderbilt University with the office of Rep. Alma Adams (D-NC-12) to discuss Black maternal health issues. They described their work in increasing birthing persons’ access to social, emotional, and educational support from trained Black doulas and certified nurse midwives. Rep. Adams co-chairs the Black Maternal Health Caucus with Rep. Lauren Underwood (D-IL), and they recently reintroduced the Black Maternal Health Momnibus Act that aims to address every dimension of the maternal mortality crisis in our country, including both clinical and nonclinical factors that are impacting maternal mortality and severe morbidity.

Additionally, our office joined a meeting of several Regional Biocontainment Labs (RBL) to share updates with staff for Senator Burr. Lab directors, including Greg Sempowski of the Duke RBL, noted the critical role of these labs in pandemic preparedness and outbreak response.

Want to Join Team Advocacy?
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By enrolling in the Phone2Action advocacy tool, individuals can join a powerful, collective voice on priority healthcare issues debated in Raleigh and Washington, D.C., including telehealth, workforce, drug pricing, and many more.

Learn more here. (NOTE: You must register and use a non-Duke email address to receive action alerts.)