Process and outcomes.
Count all the things to assess
Performance Measures
(Melissa Williams, Clinical Manager, CV Registries and Quality, Duke Heart Center)
We want to feature you:
Our thanks to Melissa for her excellent haiku! As 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
You say you want a resolution
Yes, we’re referencing The Beatles this week as a recent clarification from the Senate Parliamentarian (remember her?) on the budget reconciliation process likely has Senate Majority Leader Chuck Schumer (D-NY) longing for “Yesterday”. As we’ve discussed in past news letters – almost ad nauseum – and again below, the Democratic journey back to the budget reconciliation process for a comprehensive infrastructure package has been all but a fait accompli. Bipartisanship may still win the day as a chance to “Come Together”, but it’s difficult to move forward when there is a lack of understanding on the fundamentals.
Democrats rejoiced earlier this year when the Senate Parliamentarian seemed to indicate that they could potentially reuse the procedural process for the COVID-19 relief bill for other priorities, but the parliamentarian has clarified that another bite at that apple will require a whole new budget resolution to provide the necessary reconciliation instructions, one that must cover FY 2022. This is a hiccup – and one that congressional Democrats are seemingly prepared to tackle – but the implications for so many other priorities may be profound, almost certainly delaying the federal appropriations process and likely necessitating at least a short term continuing resolution to keep the government funded beyond September 30.
Democrats can hardly afford to wait while some Republicans may be content to run down the clock as long as possible. The further we get into the fall and the closer to the next session, the more difficult passing a broad package becomes.
What’s next? Likely a "Hard Day's Night" as no one is content to just “Let it Be”.
If a budget drops on a Friday afternoon…
While presidential budgets are generally anticipated as an opening statement of an administration’s priorities, there were few surprises in President Biden’s $6 trillion FY 2022 budget plan released May 28. Among the reasons is that President Biden has been publicly shopping many of the proposals and policy statements in the budget document since the passage of the American Rescue Plan COVID-19 relief package in March.
The proposal, which is non-binding but provides guideposts for congressional committees, contains major investments in infrastructure, education, and health care and assumes the passage of Biden’s American Jobs Plan and American Families Plan.
The newly released details include programmatic investments in maternal health, community-based violence intervention, support for states and territories to improve health equity and data collection for racial and ethnic populations, and continued support for research at the Departments of Defense and Veterans’ Affairs.
While the full budget does not include specific policy details for a number of other administration policy objectives, including broad scale student loan reform and forgiveness and the creation of a public health care option, it does state support for congressional efforts to lower drug prices. Recommendations include allowing Medicare to negotiate payment for certain high-cost drugs and requiring manufacturers to pay rebates when drug prices rise faster than inflation. This is notable because these recommendations are among the provisions included in the House Democratic leadership’s signature drug pricing reform legislation, the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3), which was passed by the House in the 116th Congress but has struggled to get the support of the full Democratic House majority in the 117th.
The proposal’s price tag has been characterized as a nonstarter for congressional Republicans, and the FY 2022 budget and appropriations process and timeline may be complicated in general due to ongoing conversations on infrastructure and the possibility that Democrats may seek to use the budget reconciliation process to move a package forward.
A brief summary of Biden’s budget is available on our website and includes a link to a resource released by the Department of Health and Human Services on the budget’s healthcare research and investment priorities.
Our office will continue to monitor the FY 2022 budget and appropriations process closely and advocate on behalf on Duke Health research funding and policy priorities.
Biden’s cabinet is complete; Eric Lander confirmed to head OSTP
On May 28, the Senate voted to confirm Biden Cabinet nominee Eric Lander to lead the Office of Science and Technology Policy (OSTP). President Biden made the head of OSTP a Cabinet-level position shortly after taking office as a signal of his commitment to integrating science into the administration’s decision-making. Dr. Lander, a top geneticist and director of the Broad Institute of MIT and Harvard, is the last of the president’s Cabinet nominees to be confirmed.
Get off this and get on with it: congressional Democrats are losing patience on infrastructure
It’s infrastructure week… again.
With the original Memorial Day deadline for bipartisan infrastructure negotiations to reach a conclusion (and a deal) now in the rearview mirror, where are we now? Are the negotiations stuck somewhere along I-95 in post-holiday summer traffic with nothing but brake lights in sight? Is there an off-ramp to reconciliation just around the corner? Will the congestion suddenly break up ahead, allowing for a smooth ride toward a deal? It’s unclear, but there is no doubt that the passengers are getting restless.
Earlier this week, President Biden met again with Senator Shelley Moore Capito (R-WV), who has been leading infrastructure negotiations for a group of Senate Republicans. As has been the case for the past few weeks, both sides expressed cautious optimism about the state of the negotiations, with Senate Republicans potentially sending over another counteroffer to the White House. Yet, there is no indication that the gap has been closed on the overall price tag. Additionally, there has been no reported progress on disagreements on how to pay for an infrastructure package.
Another open question is to what extent health care infrastructure priorities are being discussed in current negotiations. House Democrats, in particular, are positioning their own legislative markers, including the LIFT America Act (H.R. 1848), which among its provisions would direct investments in hospital infrastructure and clinical laboratories.
President Biden’s insistence to pursue a bipartisan package is wearing on the patience of congressional Democrats who seem all but ready to go it alone and pursue reconciliation - if they can firm up the full support of the Democratic caucus.
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.
From our desk(s): Duke Health GR this week
This week our team coordinated a meeting for Dr. Geri Dawson, director of the Duke Center for Autism and Brian Development, to connect with staff for Senator Richard Burr (R-NC) and discuss the center’s experiences with digital medicine, diagnostics, and innovations in telehealth during the COVID-19 public health emergency. We also facilitated a separate meeting with Burr staff for Duke University Hospital President Tom Owens, MD, to inform their work on pandemic preparedness and workforce legislation on the Senate Health, Education, Labor, and Pensions (HELP) Committee.
We connected with the office of Senator Joe Manchin (D-WV) on emerging federal telehealth expansion legislation, and a member of the team was invited to join a listening session organized by the Association of Air Medical Services (AAMS) with CMS’s Center for Insurance Information and Consumer Oversight to discuss developing federal regulations on surprise medical billing. Additionally, we also reached out to staff of the NC congressional delegation to encourage support for the Healthcare Workforce Resilience Act (H.R. 2255/S.1024), which would redirect up to 40,000 unused visas to be prioritized for international healthcare workers (25,000 for nurses and 15,000 for physicians).
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.)