What distinguishes
A tipped from a balanced scale?
The weight of the world
Publication Note: Congress is will take a brief break next week for the Thanksgiving holiday and so will our newsletter. We will resume our regular publication schedule the week of November 28.
For the latest news in the meantime, please follow us on Twitter @DukeGovRel or join the Duke Health Advocacy Network Teams channel (more information below).
The Rundown
- Are we there yet? Post-post-election update on the 118th Congress
- The lame duck session is here and federal funding, Medicare reimbursement, telehealth, FDA policies, and more are all on the table
- Senate moves forward with legislation to codify constitutional marriage protections
- The latest from our desks
- Join Duke Health Advocacy Network
Federal Updates
Are we there yet?
It’s been 10 days since the federal midterm elections, and we’re finally seeing the 118th Congress rounding into shape.
House
Republicans are officially projected to take the House majority, and while the final margin is not yet set, it will likely be close to a mirror image of the slim 3 to 4 seat majority currently held by House Democrats. House Minority Leader Kevin McCarthy (R-CA) secured the party nomination to be the next Speaker of the House, but he still has some work to do to fully unite the Republican caucus behind his candidacy ahead of the official vote in January. Rep. Steve Scalise (R-LA) is on track to be the next House Majority Leader. House Republican leaders are also working through votes to formally adopt conference and chamber rules for the next two years, which could bring changes to legislative processes, including the newly reinstated community funded project appropriations requests.
House Democrats will not hold their formal leadership elections until after Thanksgiving, but big changes are on the horizon. House Speaker Nancy Pelosi (D-CA) announced this week that she intends to remain in the House but that she will not seek election as Democratic Minority Leader in the 118th Congress. This clears the way for current Democratic Caucus Chair Hakeem Jeffries (D-NY) to seek the Minority Leader post. Reports suggest that current House Majority Leader Steny Hoyer (D-MD) will remain in Congress but will also decline to pursue a leadership position.
Senate
After maintaining the Senate seats in Nevada and Arizona, Democrats will hold the majority in the Senate but could increase their total to 51, no longer requiring a Vice Presidential tie-breaking vote, if Senator Ralph Warnock (D-GA) wins reelection in the December 6th run-off in Georgia. Leadership in the Senate will largely remain the same in the 118th Congress with Senator Chuck Schumer (D-NY) and Senator Mitch McConnell (R-KY) returning to their posts as Senate Majority Leader and Senate Minority Leader, respectively.
What now?
The 118th Congress will be defined by divided party leadership in the upper and lower chambers. It means that some policy goals will be frustrated by gridlock and that bipartisanship will not be a luxury for legislative success. This is where leadership will matter, particularly in the House, and both parties will be tested early by their Members to hold together a legislative agenda. We’re also closely monitoring how committee leadership and membership is coming together for next year, especially with shifting House priorities and the NC congressional delegation featuring five new members in the House and a new junior Senator.
Practically, however, we won’t have to wait until next year to see how new dynamics in Congress will influence priorities and legislative trajectory. The ripples of this initial “wave” of change are already impacting the potential scope of the lame-duck session.
Schedule and policy update
Lame duck is here and living up to its moniker. There has been a lot of speculation about how the next four to six weeks will play out and what will and won’t be included as part of year-end legislative deals. The final weeks of 2022 will help determine at least the immediate trajectory of so many of the priorities for which our team has advocated and those that are important to the mission of Duke Health, our patients, and our communities.
Also, no news is likely good news for at least one more extension of the COVID-19 public health emergency (PHE) and Congress is attempting to continue its streak of 60-plus years in delivering a major defense policy bill on time.
FY 2023 federal funding
Among the items considered to be must-pass legislation includes a FY 2023 spending bill to keep the federal government open and working past December 16, when the current continuing resolution expires. A couple of weeks ago, there was some confidence that a final FY 2023 spending agreement encompassing all 12 annual appropriations bills could be reached, but the election outcomes and relative lateness of when majorities have been solidified is beginning to challenge that faith. Recent conversations have raised the possibility of an omnibus bill that only includes another short-term CR into sometime early next year for a divided Congress to haggle over final spending numbers. The likely path forward should be more apparent shortly after the Thanksgiving recess, but a little more uncertainty seems to be on the table.
As Congress negotiates a spending package, the White House has also requested additional emergency funding for COVID-19, the war in the Ukraine, and recent natural disasters in the U.S. Even with slim Democratic majorities through the end of the year, additional robust funding for these priorities as a package will be a tough sell.
Debt limit
Yeah, it’s back. While Congress does not need to take action to raise the federal debt limit right now, there are some concerns among current Democratic leadership and the White House how the issue may be negotiated next year. Democratic leaders are hoping to work out a deal to attach a debt limit increase to a spending bill, but there doesn’t seem to be much bipartisan momentum at the moment. It’s been suggested that Democrats would consider pursuing the budget reconciliation process to pass an increase without Republican support, but there may not be enough time on the calendar – and doing so could imperil other agenda items that could not pass under reconciliation rules.
Medicare reimbursement
Due in no small part to the advocacy of healthcare professionals, hospitals, health systems, and stakeholders across the country, including our team and Duke Health leadership, Congress is seriously considering proposals to prevent or mitigate current and looming cuts to Medicare reimbursement payments. This includes preventing the 4% Statutory Pay-As-You-Go (PAYGO) sequester impacting hospitals and stopping cuts to providers resulting from the Medicare physician fee schedule. We are also working to extend the 5 percent Alternative Payment Model incentive payments under the Medicare Access and CHIP Reauthorization Act (MACRA) in an end-of-the-year bill, which will impact Duke Connected Care.
Extenders (including telehealth), FDA riders, and everything after
A one or two-year extension of current public health emergency-related Medicare telehealth flexibilities is under consideration, as are many of the FDA policy riders not included as part of the FDA user fees reauthorization legislation passed by Congress in September. Efforts are also underway on the Black Maternal Health Momnibus, the Senate Health Education Labor and Pension Committee’s PREVENT Pandemics Act, the VALID Act for laboratory developed tests, and provisions strengthening coverage, care, and access for mental and behavioral health services.
PHE
The prospect for a COVID-19 public health emergency (PHE) renewal in January is all but a done deal. The administration’s self-imposed 60 day-notice deadline came and went over the weekend without any declaration or hint that federal officials would begin to officially wind down the PHE, meaning that another 90-day extension is expected in early 2023. This would leave the PHE in place until at least early April.
NDAA
Despite some hiccups, there are signs that the pathway to an agreement on the 2023 National Defense Authorization Act (NDAA) will be relatively smooth. We’ll see – but negotiations are underway behind the scenes, even as the Senate prepares to take up its version of the NDAA after the Thanksgiving holiday. Why does it matter to Duke Health? The NDAA formally authorizes broad programmatic and spending initiatives at the Department of Defense (DOD), including the Defense Health Program, which supports and funds DOD medical research, as well as the Defense-supported medical workforce. It also occupies a fair amount of floor time, so the sooner it’s passed, the more time there will be for other priorities.
Duke Health GR and lame duck
The year-end session is a little like our own pentathlon – a lot of events – a lot of “points” up for grabs – and the name of the game is to finish strong. We’ve spent much of 2022 laying the groundwork in support of these and other policy priorities, training, if you will, and the finish line is closer than it actually seems. We’ll continue to post updates here, on social media, and in our advocacy network teams channel (more on how to access that below). It’s go time.
Senate advances legislation codifying constitutional marriage protections
This week, the Senate cleared a key procedural hurdle to advance the Respect for Marriage Act, which would formally codify the current constitutional rights to same-sex and interracial marriages into federal law. The final vote was 62-37, with 12 Republicans joining all 50 Democrats. Both Senator Thom Tillis (R-NC), one of the lead Senate negotiators on the bill, and Senator Richard Burr (R-NC) voted in favor of moving forward with the debate. The Senate is expected to hold a final vote, which will only require a simple majority, shortly after the Thanksgiving recess.
The House previously passed this bill on a bipartisan basis in July, but it will have to vote again following Senate passage due to adjustments to the religious freedom provisions. The House is expected to quickly take up the legislation following final Senate approval.
From our desk(s): Duke Health GR this week
This week, a member of our team participated in the Friends of Cancer Research Annual Meeting, which featured strategic conversations on healthcare priorities during the lame duck session and the incoming 118th Congress.
Our team reached out to the offices of the NC congressional delegation in support of the VA Infrastructure Powers Exceptional Research (VIPER) Act (H.R. 5721), which includes a legislative fix to address recent VA guidance on conflict of interest policy applied to VA researcher outside compensation impacting non-public VA-affiliated institutions. The bill passed the House this week and is in position to be included as part of year-end legislation. We have been working closely with the office of Senate Veterans’ Affairs Committee member Senator Tillis on this issue and will continue to advocate for the bill’s passage this year.
We participated in stakeholder meetings with the American Telemedicine Association and the Alliance for Connected Care to discuss state and federal licensure for telehealth and telehealth services expansion beyond the current COVID-19 PHE. We are currently advocating for at least a two-year extension of current PHE-related Medicare telehealth flexibilities to be included in a year-end legislative package and support emerging efforts for permanent telehealth expansion in the 118th Congress. We also continue to advocate for at least a two-year extension of the current Acute Care Hospital at Home waiver program.
Our office also coordinated support for the health system to join radiation oncology stakeholder organizations in calling on Congress to pass legislation before year-end to prevent significant Medicare payment cuts to radiation therapy services.
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