With deadlines creeping
Cooler temps and cooler heads
Must be reconciled
The Rundown
- Senate Democrats release FY 2022 appropriations bills
- Democrats inch toward infrastructure framework
- Public health emergency extended through mid-January
- House Energy and Commerce highlights public health legislation
- The latest from our desks
Federal Updates
Senate Democrats put down markers for FY 2022 spending
This week, Senate Appropriations Committee Chair Patrick Leahy (D-VT) released the committee’s final nine FY 2022 appropriations bills, including the spending legislation that provides funding for the National Institutes of Health (NIH) and other key biomedical research and healthcare priorities.
The House was able to pass a majority of its appropriations bills before the August recess, but FY 2022 began with a continuing resolution (CR) on October 1 in part because of drafting delays in the Senate. However, the process was always going to be more difficult for the upper chamber because of an evenly split Appropriations Committee and little margin for differences on key priorities. While many, if not all, of these bills are unlikely to go through a typical committee approval process, they are critical markers for negotiations between the House and Senate on a final FY 2022 spending agreement.
Several of Duke Health’s priorities would see growth in the FY 2022 Labor-Health and Human Services-Education appropriations bill. Highlights include:
- $47.9 billion for NIH, including $45.5 billion for the NIH’s base and $2.4 billion for the newly proposed Advanced Research Project Agency for Health (ARPA-H).
- $50 million to be evenly divided among the nation’s 12 Regional Biocontainment Labs, including Duke.
- Increased funding for the Clinical and Translational Science Awards (CTSA) Program.
- $9.7 billion for the Centers for Disease Control and Prevention (CDC), an increase of $1.9 billion above the FY 2021 enacted level.
- $50 million split evenly between CDC and NIH for gun violence prevention research,
- $380 million for the Agency for Healthcare Research and Quality (AHRQ), an increase of $42 million above the FY 2021 enacted level.
- $5 million for the MISSION Zero Military-Civilian Partnership for Trauma Readiness Program (the first time the program has received a regular appropriations request in the Senate).
- $603.7 million for Title VII health professions programs at HRSA, an increase of $114 million above the FY 2021 level.
- $280.9 million for Title VIII Nursing Workforce Development programs, an increase of $16.5 million above the FY 2021 level.
Additionally, the Senate FY 2022 Defense appropriations bill would provide robust and continued funding for Defense medical research programs; the FY 2022 Military Construction and Veterans’ Affairs appropriations bill recommends $882 million for the VA Medical and Prosthetic Research Program (an over $60 million increase from current levels); and the FY 2022 Homeland Security appropriations bill includes language that would allow for the recapture of unused visas over the past two years to be reused and re-prioritized for families and workforce needs, including those in the healthcare and research fields.
Our office has worked across the health system, and with other academic health systems, to identify and advocate for funding priorities to support Duke Health’s workforce, education, research, and patient care priorities. With the current CR set to expire December 3rd, among the biggest, immediate challenges is continuing to advocate for a full FY 2022 spending agreement and not another CR, which would only offer more uncertainty on long-term funding for so many agencies, programs, and policies important to Duke Health.
Magic numbers key to infrastructure advancement
In the sports world, there is a concept known as the “magic number,” which is typically the number of games a team needs to win or maintain a lead over its opponents in the standings to further advance its season – and these “magic numbers” are often dynamic depending on various circumstances. In Congress, the “magic numbers” needed for Democratic leaders to advance a revised framework of the Build Back Better Act, or “human” infrastructure package, are more static: 218 votes in the House, and with reconciliation, 50 votes in the Senate (with the Vice President holding the tie-breaker if needed).
Congressional Democrats and the White House have had these “magic numbers” top of mind while huddling over the past couple of weeks to reach an agreement on a roughly $2 trillion framework. A deal on a legislative outline is reportedly very close, and many social safety net and healthcare access priorities remain in the mix, although details are not yet finalized. There are still significant sticking points on revenue and policies related to climate change, meaning it is equally as likely Democrats will need to continue negotiations beyond a self-imposed October 31 deadline. There is also the outstanding question whether a further extension of the federal debt limit, which expires December 3rd, will be included as Senate Republicans have indicated they will not support any extension as long as the reconciliation bill remains in play.
A new framework is also the key to unlocking the path forward for a final House vote on the bipartisan, “traditional” infrastructure package passed by the Senate in August. Without it, House Democratic leaders can’t be assured they’ll have the 218 necessary to send the legislation designed to improve roads, bridges, and airports, among other things, to the president’s desk.
We continue to monitor the situation closely and advocate for priorities important to Duke Health and the communities served by our institution.
Federal public health emergency extended through mid-January
The Biden administration has officially extended the federal COVID-19 public health emergency through mid-January 2022. The PHE extension means that many of the waivers and flexibilities implemented to help the national healthcare infrastructure respond to COVID-19, including telehealth expansion under Medicare and hospital at home, will remain in place for at least another 90 days. There are currently efforts in Congress to ensure that current telehealth flexibilities are extended for at least a year after the end of the PHE to allow the Centers for Medicare and Medicaid Services (CMS) and Congress to collect and analyze efficacy and utilization data.
Our office is actively engaged in advocacy efforts to ensure many of these Medicare telehealth flexibilities are made permanent, including audio-only coverage for clinically appropriate services, as well as PHE authorized enhancements for the Medicare hospital at home program.
Energy and Commerce highlights public health legislation
On Wednesday, the House Energy and Commerce Health Subcommittee held a hearing entitled, “Enhancing Public Health Legislation to Protect Children and Families.” The hearing examined several pieces of public health legislation, some of which Duke Health Government Relations has been actively monitoring. The “Improving The Health of Children Act,” which was introduced by Committee members Reps. G.K. Butterfield (D-NC-01) and Richard Hudson (R-NC-08), would reauthorize the National Center on Birth Defects and Developmental Disabilities. The hearing also examined the “Increasing Access to Quality Cardiac Rehabilitation Care Act” to authorize physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac rehabilitation care starting in January 2022, and order patients to cardiac and pulmonary rehabilitation under Medicare. The Subcommittee further expressed strong bipartisan support for legislation introduced by Rep. Neal Dunn, M.D. (R-FL) to reauthorize CDC’s Prostate Cancer Research and Treatment program.
Next week the Subcommittee will hold a hearing to examine several pieces of workforce, patient care, and caregiver legislation.
Committee activity on these bills is not only intended to raise awareness of key public health issues, but also to apply pressure on negotiators to pull together broader healthcare funding and research investments in a revised Build Back Better Act.
From our desk(s): Duke Health GR this week
This week, our team coordinated a meeting for Duke Health experts to connect with staff of House Energy and Commerce Committee ranking member Cathy McMorris Rodgers (R-WA) to discuss the new NIH-supported Duke-UNC Alzheimer’s Disease Research Center, as well as research advances demonstrating linkages between Down Syndrome and Alzheimer’s. The meeting was spurred in part by comments from the Congresswoman at a July 29th hearing on neurodegenerative diseases, where she strongly cautioned NIH against complacency and a perceived lack of progress on uncovering new treatments for neurological diseases, such as Alzheimer’s.
We continue to communicate with the North Carolina congressional delegation about the health system’s concerns about the recently released surprise medical billing interim final rule part II. Our team is encouraging them to join a letter circulating in the House that requests the Biden administration revisit the rule and make changes to the federal independent dispute resolution process to more closely align with legislative intent of the No Surprises Act and avoid de facto rate-setting. Our office is coordinating with Duke Health leadership on formal comments on IFR II due on December 7.
We are monitoring legislation introduced in the Senate that would make changes to the False Claims Act (FCA) and potentially make it more challenging for defendants, including hospitals and health systems, to defend against alleged FCA violations. Due to strong opposition to the bill in its current form by members of the Senate Judiciary Committee, including Senator Thom Tillis (R-NC), the legislation was pulled from committee consideration this week and is reportedly being modified to help attract support. We are in close contact with Senator Tillis’s staff and will continue to watch any developments closely.
Our office also participated in a Research!America discussion with Grace Graham, Chief Counsel of the House Energy and Commerce Health Subcommittee minority staff, to hear about her priorities for the Committee.
On a final note, our office routinely engage with departments and cohorts throughout the health system to discuss policy priorities and advocacy opportunities. If you are interested in connecting with our federal team, please let us know at govrelations@dm.duke.edu. |
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