In the darkest days
Your strength pulled the shades – and now?
The light can’t retreat
Our thanks to everyone at Duke Health for your leadership, brilliance, compassion, calm, humor, and resolve during an exceptionally challenging year.
You’re our Why.
Federal Updates
Same old story… or is it?
What can we say about the position in which the 116th Congress finds itself in the waning days of 2020 that we haven’t already written numerous times already this year? Seriously. If this all feels like a retread, you’re not alone, as once again both optimism and frustration have permeated the Capitol. While this particular policymaking reality show is scheduled for a reboot in just a few weeks, the showrunners of its current iteration are hoping that any final twists and turns in the series finale lead to meaningful progress on key priorities.
Where there’s a deal, there’s a way: Congress closes in on FY 2021 spending package
House and Senate appropriations leadership reached a deal on top-line spending numbers for the 12 annual appropriations bills just before the Thanksgiving holiday. The agreement has paved the way for negotiators to begin the hard work of setting program-level funding for what is hoped to be a broad omnibus spending package that keeps the government funded for the remainder of the fiscal year.
That work also faces a fast-approaching deadline of December 11 when the current continuing resolution (CR) – which is funding the federal government at FY 2020 levels – expires. Lingering differences on some policy issues and the possibility that another round of COVID relief could be attached to the spending deal have slowed talks in recent days, meaning that another brief CR could be necessary to buy lawmakers more time to reach a final agreement.
Duke Health Government Relations will continue to advocate for FY 2021 priorities, including federal funding for biomedical research and healthcare workforce programs, until a final deal is reached.
Will three become one? Elusive COVID relief deal may finally be in sight
As pressure mounts to find a path forward on the next round of COVID-19 relief and stimulus, congressional leaders and the White House remain largely at an impasse.
Just this week, three proposals have emerged: an offering from House Democrats shared only with Republican leadership and the White House, a roughly $500 billion proposal from Senate Majority Leader Mitch McConnell (R-KY), which is very similar to the scaled back bill he introduced before the election, and a new $908 billion bridge proposal from a bipartisan, bicameral group containing elements of both Democratic and Republican favored provisions, including support for state and local governments, schools, testing, vaccines, small businesses, unemployment insurance, and a measure that would allow states to make their own determinations for liability protections.
House Speaker Nancy Pelosi (D-CA) and Senate Minority Leader Chuck Schumer (D-NY) have said publicly that the newly introduced bipartisan proposal should become the basis on any further negotiations. However, Leader McConnell is, for now, holding firm that any relief package in excess of $500 billion will be difficult for a majority of his caucus to support and has said that COVID relief must be attached to the planned FY 2021 omnibus spending package. Pelosi and McConnell held formal talks on Thursday, with Pelosi stating afterward she believes a deal can be reached within the next week. President Trump also indicated he will back a relief package if Congress reaches an agreement.
Something has to give, and while what happens next is an outstanding question, what’s missing from these discussions is equally important. From what is known publicly, none of the three relief proposals floated this week include any additional support for the research enterprise or efforts to expand telehealth beyond the public health emergency, and only one offers additional funds for the Provider Relief Fund. Additional support for these issues may be forced to wait until 2021 as the Biden administration is preparing to introduce its own massive stimulus response after January 20.
Duke Health Government Relations continues to advocate for $26 billion to support the research enterprise and greater certainty for the future of expanded telehealth policies in any COVID-19 relief and stimulus agreement.
Leaders hoping NDAA deal isn’t DOA
House and Senate negotiators have reached an agreement on a final version of the National Defense Authorization Act (NDAA). The NDAA is the primary defense policy authorization bill passed annually by Congress, which among other priorities includes the Department of Defense Medical Research Program. The announcement on Wednesday sets the stage for votes in the House and Senate in the coming days. While the bill is expected to clear Congress without many hurdles, it may face a veto threat from President Trump, who has insisted that a repeal of liability protections for social media companies be added to a final compromise. That request has been met with opposition from both Democratic and Republican leaders who instead say the issue should be addressed separately.
Looking ahead: Transition and the 117th Congress
Now that the Government Services Administration has officially signed off on the presidential transition, President-elect Joe Biden and Vice President-elect Kamala Harris are moving ahead quickly to fill key staff positions and announce nominations for Cabinet posts. Dr. Anthony Fauci, Director of the National Institute for Allergy and Infectious Diseases (NIAID), also met with the Biden transition team for the first time on Thursday and indicated that he plans to stay on in his capacity with the new administration.
House Democrats and Republicans this week filled some of the top Committee positions impacting healthcare policy and funding. Notably, Rep. Cathy McMorris Rodgers (R-WA) was selected to serve as Ranking Member on the House Energy and Commerce Committee. She will be the first woman to serve in this role from either side of the aisle. She was in tight competition with Rep. Michael Burgess (R-TX), a physician who currently serves as Ranking Member of the Health Subcommittee. Rep. Frank Pallone (D-NJ) was unanimously selected by the House Democratic Caucus to remain as Chair of the full Committee.
Rep. Rosa DeLauro (D-CT) was selected to serve as the next chair of the House Appropriations Committee. She is replacing her retiring friend and ally Rep. Nita Lowey (D-NY). Rep. DeLauro, a longstanding champion of biomedical research, is also expected to remain chair of the Labor, Health and Human Services, and Education Subcommittee, which has jurisdiction for funding critical pieces of the nation’s research infrastructure, including the National Institutes of Health.
BLOCKED: Federal court halts implementation of new H-1B visa rules
On Tuesday, a federal judge for the Northern District of California blocked any further implementation of controversial new rules affecting H-1B visa applications for highly-skilled workers. The ruling includes rolling back new prevailing wage determination requirements made effective October 8 that significantly raise minimum salary requirements for new and renewed H-1B highly skilled worker visa applicants. The court found that the Trump Administration’s argument that the rule changes – implemented without the standard notice and comment rulemaking process – were necessary to protect the American workforce during the public health emergency was not sufficient to bypass those standard requirements.
While the Trump Administration is expected to consider an appeal, the ruling is a victory for the business community, universities, and academic medical centers, particularly in terms of their continued ability to retain and recruit specialized international professionals, researchers, and academics. The ruling also decreases the likelihood that the Trump administration will have time to fully reinstate their preferred H-1B changes before President-elect Biden takes office.
Duke Health Government Relations is working with our leadership and colleagues on the campus-side government relations team in opposition to immigration policies that could negatively impact our international students and workforce. We will continue to communicate our concerns with the North Carolina congressional delegation and continue our advocacy with the next Congress and Biden Administration.
Ninth Circuit issues limited ruling to halt public charge rule changes
The Ninth Circuit Court of Appeals on Wednesday issued a ruling to stop further enforcement of the Trump administration’s “public charge rule” modifications, which would allow immigration officials to deny permanent residency to immigrants if they are found to have relied on government aid, such as nutrition assistance, Medicaid, and other public benefits, for certain periods of time. The appellate court decision is limited to the 18 states (and Washington, D.C.) that joined as parties in the original suit against the federal government. North Carolina was not included.
President-elect Biden has said he opposes the rule, but absent broader judicial activity, reversing it administratively will require an extensive rulemaking process. Duke Health Government Relations will continue advocating for all patients to have access to care.
CMS expands Hospitals Without Walls program to hospitals at home
The Centers for Medicare and Medicaid Services (CMS) announced last week that it is expanding its Hospitals Without Walls program started during the COVID-19 public health emergency to allow hospitals to treat patients at home instead of admitting them into acute inpatient care. The expanded flexibilities also allow Ambulatory Surgical Centers to continue to be certified as hospitals while requiring them only to have in place 24-hour nursing services when there is a patient receiving care onsite.
DUSON’s Dr. Mariam Kayle meets with congressional staff on the NC Sickle Cell Data Collection Program
This week, Duke University School of Nursing Assistant Professor Dr. Mariam Kayle met with congressional staff to inform them about efforts of the North Carolina (NC) Sickle Cell Data Collection Program. Currently, there is a lack of national surveillance data on the epidemiology, health care needs, and financial impact of sickle cell disease (SCD) in the United States.
The NC Sickle Cell Data Collection Program aims to implement a high-quality state-wide, population-based SCD surveillance program in NC to accurately describe the epidemiology of SCD, identify population healthcare needs, and disseminate findings to inform healthcare practices, research, and health policy for SCD in the State. During each meeting, Dr. Kayle provided an outline of the program, its aims, and the stakeholders involved, and discussed the importance of a state-wide SCD surveillance program to improve health outcomes for individuals across NC.