Federal Health Policy Updates for the
Week of September 13 - September 17, 2021
More than a feeling
Such divides are deceiving
Stand firm? Walk away?
The Rundown
- Reconciliation process moves forward
- Maternal health prioritized in House reconciliation work
- Continuing resolution expected to begin FY 2022
- Additional surprise billing regulations released
- The latest from our desks
- Take our advocacy survey!
Federal Updates
The Rec Room: reconciliation’s big plans face hurdles
Various House committees have spent this week rounding out their specific legislative provisions to shape the $3.5 trillion Build Back Better human infrastructure reconciliation package. The committee work has provided the opportunity for congressional Democrats to add substance to the reconciliation spending framework – and the result has been a number of recommended investments in key health care priorities, which have been a focus of Duke Health and our office.
Legislative language marked up by the House Ways and Means Committee, which has jurisdiction over Medicare and oversight over many Affordable Care Act (ACA) provisions, would, among other provisions, permanently extend expanded ACA premium credits to support the purchase of health insurance and phase in the coverage of hearing, vision, and dental benefits for Medicare beneficiaries. The House Energy and Commerce (E&C) Committee’s work includes a permanent extension of the Children’s Health Insurance Program (CHIP), Medicaid gap fix and extended postpartum coverage, investments in nursing education and other workforce programs, inclusion of the Momnibus Act (more on this exciting development below), and recommendations for capital investments for aging hospitals and laboratories. The House Veterans’ Affairs (VA) Committee also proposed significant capital investments in VA health care infrastructure, and the House Judiciary Committee took the first steps on a proposal that would permanently implement pathways to citizenship for undocumented individuals.
Reconciliation is largely a partisan exercise by design, and most of the above reflect Democratic priorities – but there isn’t alignment across the board. Disagreements within the Democratic caucus in the House threaten to exclude key drug pricing reform language, such as price negotiation, in a final bill. On the Senate side, a small group of moderate Democrats are uncomfortable with the $3.5 trillion price tag. With slim majorities in both chambers, any defections could be catastrophic for the entire process – and sustained opposition in the Senate may result in a significantly scaled down package.
Drive the MOMNIBUS: maternal health included in reconciliation plans
As mentioned above, included in the E&C’s reported legislative language for the Build Back Better Act are policy provisions to improve maternal health outcomes, including Black maternal health. Specifically, the bill included parts of the “Black Maternal Health Momnibus Act”. The Momnibus was introduced in the House by Rep. Alma Adams (D-NC-12) and Rep. Lauren Underwood (D-IL-14) and would provide resources to improve maternal health and make progress toward closing racial and ethnic disparities in maternal outcomes. Provisions in the bill to improve maternal health include:
- $175 million in funding for local entities to address social determinants of maternal health like housing, nutrition, and environmental conditions – including a minimum of $75 million exclusively for community-based organizations working to promote maternal health equity.
- $275 million to grow and diversify the perinatal health workforce, including nurses, midwives, physicians, doulas, and maternal mental and behavioral health professionals – including $50 million specifically for doulas.
- $100 million for maternal mental health equity grant programs.
- $85 million to address the impacts of climate change-related maternal and infant health risks through health professional schools.
- $50 million to advance maternal health research at Minority-Serving Institutions like Historically Black Colleges and Universities, Tribal Colleges and Universities, Hispanic-Serving Institutions, and Asian American and Pacific Islander Serving Institutions.
- $50 million to promote representative community engagement in Maternal Mortality Review Committees.
- $160 million to strengthen federal maternal health programs like the CDC’s Surveillance for Emerging Threats to Mothers and Babies program, Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM), Pregnancy Risk Assessment Monitoring System (PRAMS), and the National Institute of Child Health and Human Development (NICHD).
- $60 million to expand access to digital tools and technologies that promote maternal health equity.
- Provides $25 million for bias trainings among health care professionals.
Duke Health quickly joined other organizations in expressing support and appreciation for these maternal health provisions and urging Congress to swiftly advance them to a final bill. With the reconciliation process at a critical juncture, our office will continue its strong advocacy efforts in support of the Momnibus, as well as other key provisions in the Build Back Better Act that would strengthen research capabilities, clinical capacity, and the health care workforce.
FY 2022 spending – doesn’t it make you CR(azy)?
It’s mid-September, and there are a few things that seem relatively clear about the future of FY 2022 federal spending: Congress will not complete the regular appropriations process before the current fiscal year ends on September 30; a continuing resolution (CR) will be needed to keep the federal government operating for some period beginning October 1 to avoid a government shutdown; and no one really wants a government shutdown.
Everything else? We’ll know when we know. In the meantime, congressional Democratic leaders are reportedly readying a CR to keep the government funded through at least December 10. The measure is expected to include roughly $24 billion in requested additional spending for disaster recovery emergency funding post Hurricane Ida and further winding down U.S. involvement in Afghanistan, among other priorities. Votes on the CR could come as soon as next week when both chambers officially gavel back into session.
The complicating factor remains what to do about increasing or further suspending the now-expired debt limit. Administration officials indicate that the United States risks default on its credit obligations between mid-October and early November without Congress taking action. Democrats are considering adding a debt limit increase to the CR. Republican leaders are telling Democrats to attach the increase to the reconciliation package because none of their members will support it.
Why should we care? These battles don’t really have winners, and the uncertainty left in their wake can have immediate and potentially long term repercussions for federal funding priorities important to Duke Health and academic medical and research institutions across the country.
Next round of surprise billing regulations released
On September 10, the Biden administration issued the next round of proposed rules related to the No Surprises Act ban on surprise medical billing included in the 2020 Consolidated Appropriations Act.
The announcement follows a part one interim final rule published in July that began to define certain parameters for how the federal government will regulate surprise medical bills. The newly released proposed rules establish a process for investigating complaints of violations of the No Surprises Act’s patient protections and taking enforcement action and outline new disclosure requirements for air ambulance providers and insurers covering air ambulance services. In addition, the rules include Department of Health and Human Services-specific proposals that would require insurers offering individual health insurance coverage or short-term, limited-duration insurance to disclose to enrollees and report any agent or broker compensation associated with that enrollment.
Comments on the proposed rules are due October 18, and the Duke Health Government Relations team is coordinating with hospital and Duke Life Flight leadership to coordinate any health system response.
From our desk(s): Duke Health GR this week
This week, our office coordinated a virtual meeting between Duke University Hospital President Thomas Owens, MD and Senator Thom Tillis (R-NC), as well as several members of the senator’s staff. The conversation focused heavily on the health system’s ongoing response to the COVID-19 public health emergency. Senator Tillis, whose daughter is a registered nurse, expressed his appreciation for the Duke Health team and systems across North Carolina in addition to exploring what more the federal government can do to mitigate health care professional shortages and support workforce well-being.
To build on the momentum of the Momnibus’s inclusion in the E&C Committee’s portion of the Build Back Better Act reconciliation package, our office supported Duke University School of Nursing Dean Vincent Guilamo-Ramos’s outreach supporting further advancement of these provisions to Reps. G.K. Butterfield (D-NC-01) and Richard Hudson (R-NC-08). Both serve on the E&C Committee, and Butterfield is a cosponsor of the Momnibus legislative package.
The team joined a number of the sessions for Research!America’s 2021 National Health Research Forum. The forum began with opening remarks from First Lady Dr. Jill Biden. Several members of the Duke Community were part of the sessions during the three-day event including Elizabeth Dodds Ashley, PharmD, MHS, FCCP, BCPS, Associate Professor of Medicine, Division of Infectious Diseases & International Health; Operations Director, DASON, Duke Center for Antimicrobial Stewardship and Infection Prevention; Susan Dentzer Chair, Research!America and Senior Policy Fellow for the Robert J. Margolis Center for Health Policy at Duke; Kafui Dzirasa, MD, PhD, Ranga Rama Krishnan Endowed Associate Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center; and Mark McClellan, MD, PhD Director, Robert J. Margolis Center for Health Policy, Duke University.
In addition, our office participated in the Association of American Medical Colleges Government Relations Representatives meeting to hear the latest updates from Congress and the Administration on policy impacting academic medical centers, updates from AAMC staff on initiatives, and from other colleagues.
We also continue to advocate for Duke Health federal funding and infrastructure priorities with members of the North Carolina congressional delegation and key committees as those processes continue into the fall.
TAKE OUR SURVEY!
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.