Federal Health Policy Updates for the
Week of October 4 - October 8, 2021
Like students cramming
We’ve kicked the panic attack
Down to December
The Rundown
- NIH Director to step down by the end of the year
- Debt limit deal complicates year end schedule
- Democratic leadership is negotiating path forward on reconciliation/infrastructure
- The latest from our desks
- Last day to take our advocacy survey!
Federal Updates
Swan song: Collins to step down as NIH director by year’s end
On Tuesday, National Institutes of Health (NIH) Director Francis Collins announced he would step down by the end of the year. In an announcement on social media, Dr. Collins wrote, “it's been a privilege & honor to serve as #NIH Director for over 12 years. However, I believe no person should hold this position for too long. So with deep gratitude to this great agency & the people who carry out its mission, I've decided to step down.”
Dr. Collins began his tenure as Director in August of 2009, and his 12 years marks the longest for an appointed NIH Director. According to NIH, Dr. Collins will continue to lead his research laboratory at the National Human Genome Research Institute, which is pursuing genomics, epigenomics and single cell biology to understand the causes and means of prevention for type 2 diabetes. His lab also seeks to develop new genetic therapies for the most dramatic form of premature aging, Hutchinson-Gilford Progeria Syndrome.
The position of NIH Director requires Senate approval. President Biden’s nominee for the next Director must first be approved by the Senate Health, Education, Labor and Pensions Committee, of which Senator Richard Burr (R-NC) serves as Ranking Member, before a vote of the full Senate. The White House hopes to have a nominee in place ahead of Dr. Collins’s planned departure, but there is reportedly discussion of candidates to serve as an acting director, including Principal Deputy Director Dr. Lawrence Tabak.
On a final note (pun intended), Dr. Collins is also a musician, who at times has been accompanied by his guitar when discussing research, federal appropriations, vaccines, health and safety, and while just poking some fun at himself. We leave you with a performance from 2020.
Crisis averted until it’s a crisis again: Debt limit deal reached through early December
There is some good news, and a sign of bipartisan recognition that the West Side Story-like showdown between Democratic and Republican leaders on the federal debt limit has no winners (or choreographed dance numbers)…at least for the next six weeks.
Senate leaders have reached a deal for a temporary extension of the federal debt limit until early December. The agreement came together after Senate Minority Leader Mitch McConnell (R-KY) offered to Senate Majority Leader Chuck Schumer (D-NY) the idea of a short-term debt limit extension that was largely welcomed by Senate Democrats. The expectation is that the House will vote quickly to pass the extension once cleared by the Senate.
However, the differences in principle that were in place before the compromise remain. McConnell as not wavered in his insistence that Democrats use the reconciliation process to make any long term changes to the debt limit unilaterally. The brief extension would give them more time to consider that option. Schumer and Senate Democrats are adamant that raising the debt limit through reconciliation is off the table. So, what now?
The added complication is that the debt limit has once again become entangled with federal spending by virtue of the calendar. The current continuing resolution keeping the federal government operating expires December 3rd. Over the next month and half, Congress will have to reach an agreement on both FY 2022 spending and the debt limit – or we’ll be right back to where we were in late September… again.
Trick or treat: reconciliation/infrastructure next steps may be decided by Halloween
With decisions on FY 2022 federal spending and the federal debt limit pushed to December, congressional Democratic leaders are working to reach an intra-party, inter-chamber agreement on a scaled back version of the Build Back Better human infrastructure package that will also allow the House to take up and approve a bipartisan “traditional” infrastructure package passed by the Senate in August. There is also a new internal deadline by which to have at least a framework for a new reconciliation package ready for consideration (no, thankfully it is not also December) – October 31.
If that isn’t scary enough, reports suggest that the original $3.5 trillion Build Back Better packaged crafted through the budget reconciliation process in the House will need to be trimmed back to $1.8 to $2.3 trillion to win the approval of Senate moderates and ensure the unified Democratic vote necessary to pass the bill without Republican support. At stake in the ongoing negotiations are the size and scope of potentially major investments in maternal health, capital funding for hospitals and laboratories, health care access, childcare, education, Medicare expansion, new GME slots, drug pricing reform, and new resources for schools of medicine and nursing, among other priorities.
During these negotiations, our office is continuing its advocacy efforts in support of a number of Duke Health priorities, including provisions from the Black Maternal Health “Momnibus” Act of 2021, which were recommended by the House Energy and Commerce Committee. This week, Rep. Lauren Underwood (D-IL-14), who serves as co-chair of the Black Maternal Health Caucus along with Rep. Alma Adams (D-NC-12), penned an op-ed, "We Must Advance Maternal Health Equity in the Build Back Better Act", to broaden public support for the Momnibus. She wrote, “in the coming days and weeks, as debates about the Build Back Better Act continue, it is imperative that we prioritize these maternal health investments that mothers, babies, and families are counting on. There have been too many alarming statistics, too many devastating stories of loss, to wait another second. Together, we can save moms’ lives, end racial and ethnic maternal health disparities, and ensure that in the United States of America, every family can thrive.”
From our desk(s): Duke Health GR this week
This week, our office monitored a hearing of the Senate Commerce, Science, and Transportation Subcommittee on Communications, Media, and Broadband entitled, “State of Telehealth: Removing Barriers and Improving Patient Outcomes.” It focused on the importance of access to telehealth services, utilization and changes during the COVID-19 public health emergency, the critical role of access to broadband in the public health response, and also included a discussion on the need for licensure flexibilities to help address future emergencies. Ahead of the hearing, our team reconnected with staff of subcommittee member and co-chair of the Senate Telehealth Working Group Sen. Brian Schatz (D-HI) to share Duke Health’s perspective and reaffirm our support of making current expanded telehealth flexibilities permanent.
In addition, our team continues to work with Duke Health leadership in evaluating the part II interim final rule surprise billing regulations and has contacted members of the North Carolina congressional delegation to express initial concerns on provisions related to the new federal independent dispute resolution (IDR) process. These concerns are also shared by a growing number of congressional leaders, including the underlying legislation’s principle authors. We are meeting with colleagues across provider and professional associations on additional advocacy strategy and will coordinate any formal response from Duke Health through the comment period open until early December.
One member of the team participated as a panelist in policy conversations as part of a class for doctoral nursing students, Transforming the Nation’s Health, in the Duke University School of Nursing, while another participated in a monthly policy committee meeting for the Trauma Center Association of America (TCAA) to discuss strategies for federal support for trauma centers and trauma grant programs.
Finally, we reached out to the office of Senator Thom Tillis (R-NC) about concerns in the House FY 2022 funding bill regarding research using animal models so that similar language is not included in final spending legislation as negotiations continue. We also reiterated support for the Momnibus to the HELP Committee.
TAKE OUR SURVEY!
LAST DAY!
In an effort to enhance and take account of Duke Health’s advocacy footprint across our entities, Duke Health Government Relations and Duke State Relations invite you to participate in an Advocacy Census Survey.
The survey will capture information on the various state and federal advocacy organizations that Duke faculty, researchers, clinicians, students and staff are involved in, with a goal of understanding the breadth of Duke’s engagement in policy and educational activities.
Duke Health team members will have until October 8, 2021 to complete the Advocacy Census Survey. Please contact govrelations@dm.duke.edu if you have any questions.