Federal Health Policy Updates for the
Week of September 20 - September 24, 2021
Fall, could it be you?
Cool air, bright leaves, shutdown threats
CR the good times
The Rundown
- Infrastructure, reconciliation caught in a spin cycle
- Continuing resolution aims to keep government funded through December 3rd
- More on other deadlines facing Congress and the Biden administration
- The latest from our desks
- Take our advocacy survey by October 8!
Federal Updates
Here we go again, again
What can we say about the infrastructure and reconciliation process that we haven’t already to lead off many of our newsletters over the past few months? Seriously, we’re asking – because while congressional efforts have been expectedly difficult, there have been more recent twists and turns on the dual legislative track than one might find driving the Blue Ridge Parkway (and with just as much potential for steep drop offs).
It really comes down to this, for the moment at least: the House has mostly completed its work putting the details together of a $3.5 trillion human infrastructure reconciliation package (you’ll find more details in last week’s newsletter). It’s worth noting that the amount of spending would be over a ten year period – and also that there are proposed revenue raisers to drive the total cost down. Therein lies part of the problem. All 50 Senate Democrats will need to be united on spending and revenue for this reconciliation process to have a chance, and that isn’t the case… yet. There are differences over revenue, the total amount of spending, and what to do about addressing drug pricing reform. Some of the names holding up the process in the Senate you’d likely find familiar, but there are just as many moderate Democrats in the House with concerns.
There’s also the added complication of an agreement that House Speaker Nancy Pelosi (D-CA) reached with her caucus to hold a vote on the separate Senate-passed traditional infrastructure bill by September 27. Of course, when that deal was made, Democratic leaders assumed the traditional infrastructure bill and what has become the Build Back Better Act would move in tandem.
What now? President Biden has been meeting with Speaker Pelosi and Senate Majority Leader Chuck Schumer (D-NY) to chart a path forward. With the scope of the package almost certain to be trimmed, Speaker Pelosi has said that the House won’t vote until there is a deal with the Senate.
Expect deadlines to shift – and while they won’t back down, there will be no easy way out.
Blindfolds at a staring contest: CR hangs in the balance
If you have children of your own, any direct experience with children, or know others who have children, then you are at least somewhat familiar with the myth of the nightly bedtime routine. The end goal is almost always met (at some point): the child goes to sleep. But, despite an often clear set of steps that typically lead to that result, the “routine” can break down at any moment, for seemingly any reason. We know you’re going to sleep, kid – why is the rest necessary?
And that’s it. That’s federal funding for FY 2022 and the status of a needed continuing resolution (CR) to keep the government funded beyond September 30.
The House has now passed a CR to keep the government funded through December 3rd and includes emergency supplemental funding for hurricane disaster recovery and winding down U.S. involvement in Afghanistan. Democratic leaders also attached a suspension of the now-expired federal debt limit through the end of 2022.
We’ve previously discussed the importance of the debt limit, as well as the consequences of Congress not acting by mid-October. We’ve also reported that Senate Republican leadership has been clear that it will not support a debt limit increase attached to a CR and have instead insisted Democrats use the reconciliation process. A CR won’t pass the Senate without at least ten Republican votes to get past procedural hurdles.
While the “routine” of the federal appropriations process has been anything but for a while, the timing of this particular deviation is perilous for any number of spending priorities and with more than just political fortunes at stake. They will get there – and hopefully before “lights out” has another meaning.
Other deadlines just outside the headlines
With most of the attention (understandably) focused on the September 30, the end of the current fiscal year, and anticipated mid-October deadline to raise or suspend the debt limit to avoid potentially catastrophic economic consequences, news on a number of other key federal priorities have flown under the radar. Below is just a brief list of other issues that will require the attention of Congress and/or the Biden administration:
September
- Surface Transportation Authorization – 9/30
- National Flood Insurance Program Authorization – 9/30
- COVID relief programs:
- TANF and Childcare Entitlements to States - 9/30
- Paid Sick and Family Medical Leave Tax Credits - 9/30
- Increased SNAP benefits - 9/30
October
- Surprise billing regulations (audit process rules) – 10/1
- COVID-19 Federal Public Health Emergency (PHE) – 10/19
December
- Surprise billing regulations (independent dispute resolution process) – 12/27
- National Defense Authorization Act (NDAA) – (includes authorization of medical research programs at the DoD) – 12/31
- Medicare sequester moratorium (2 percent cut) – 12/31
- Statutory PAYGO Sequester Relief (waiver required) – 12/31
Add to this list potential pandemic preparedness legislation being developed by Senate Health, Education, Labor and Pensions (HELP) Committee leadership, Chair Patty Murray (D-WA) and Ranking member Richard Burr (R-NC), an effort by Reps. Diana DeGette (D-CO) and Fred Upton (R-MI) to finalize follow up legislation to the 21st Century Cures Act, pending research innovations and economic competitive legislation, and possible legislation to extend many current Medicare waivers beyond the end of the PHE.
The to-do list keeps growing and with next year being an election year, there is not unlimited time. We will continue to monitor these issues closely over the next several weeks and months and advocate strongly in support of priorities supporting Duke Health and our communities.
From our desk(s): Duke Health GR this week
This week, our office monitored a Subcommittee on Oversight and Investigations for the Committee on Energy and Commerce hearing entitled “Putting Kids First: Addressing COVID-19’s Impacts on Children.” Noting that the number of children with COVID-19 is climbing and there are no vaccines yet for children under the age of 12, Energy and Commerce Chairman Frank Pallone (D-NJ) said that it is important to understand that children are experiencing this pandemic differently, and also that the mental health of our children in particular is of great concern. Among the witnesses for the hearing were Dr. Lee Savio Beers, President of the American Academy of Pediatrics.
Next week, we’ll turn our attention to two COVID-19 focused subcommittee hearings of the House. On September 28, there will be a joint hearing between the House Education and Labor Civil Rights and Human Services Subcommittee and Health, Employment, Labor, and Pensions Subcommittee entitled, “How to Save a Life: Successful Models for Protecting Communities from COVID-19.” On September 29, the Early Childhood, Elementary, and Secondary Education Subcommittee will hold a hearing entitled “Highlighting Best Practices for Safely Reopening Schools.” Rep. Kathy Manning (D-NC-06) is a member of this Subcommittee, and our office has reached out ahead of the hearing to offer Duke Health experts as a resource, including the ABC Science Collaborative.
We submitted responses to a request for information from the newly formed Congressional Social Determinants of Health (SDOH) Caucus. Our office complied feedback from across Duke Health to inform efforts to understand the challenges and opportunities related to social drivers of health.
We were pleased to help coordinate the participation of Dr. Viviana Martinez-Bianchi on a panel exploring “Latinos and COVID-19: Beyond the Vaccine Phase” at the Congressional Hispanic Caucus Institute’s 2021 Leadership Conference.
Team members met with congressional staff on legislation that would extend current flexibilities for remote patient monitoring reimbursement under Medicare; monitored the House’s work on its version of the NDAA; and joined a conversation with Rep. Richard Hudson (R-NC-08) to learn more about his priorities and outlook for the fall congressional session.
Later today, our team will join the kickoff meeting for the Advocacy in Clinical Research Track (ACLT) program in the Department of Medicine to provide an overview of our work and to begin an open dialogue with participating residents on the federal health care policy process.
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.