Skip to main content

Federal Health Policy Updates for the Week of September 21, 2020

Duke Government Relations Logo

Quiet October?
You remember the year, right?
Play through the whistle
 
Federal Updates

Congress reaches agreement on a continuing resolution
Congress is expected to pass a continuing resolution (CR) to keep the government funded at current spending levels through December 11 and avoid a potential government shutdown before the November elections. The House adopted the measure this week while the Senate plans to hold its vote early next week. The CR agreement between House and Senate leaders was reached after both sides agreed to additional funding for nutrition assistance and aid to farmers. The CR also includes extensions of a number of expiring Medicare extenders, further delays cuts to Medicaid Disproportionate Share Hospital payments, extends the payment period and reduces the recoupment percentage for payments made under the Medicare Accelerated and Advance Payment Programs during the public health emergency, and extends the funding for multiyear research grants supported by the National Institutes of Health (NIH) that were interrupted in FY 2020 by COVID-19. Congress will likely address longer-term spending priorities during an expected lame duck, year-end session in late-November through the first few weeks of December.
 
October surprise comes early: Congress to split time between DC and home during the ramp up to the election
The passing of Justice Ruth Bader Ginsburg on September 18 has provided the Senate Republican majority with an opportunity to fill her seat on the Supreme Court ahead of the November election. Prior to this development, the Senate had planned to adjourn soon after the enactment of the CR. Now, with enough Republican votes reportedly secured to begin the confirmation process, the Senate is expected to largely remain in session for much of October, with members traveling to and from DC to fulfill campaign commitments. Senate Republicans can confirm a replacement with only a simple majority following rule changes made by Majority Leader Mitch McConnell (R-KY) in 2017. The Senate Judiciary Committee, of which Sen. Thom Tillis (R-NC) is a member, may begin confirmation hearings as soon as the week of October 12. The president is expected to announce his nominee this weekend.
 
House Speaker Nancy Pelosi (D-CA) previously indicated her plans to keep the House in session until a deal was reached on the next round of COVID-19 relief. It is unclear how Supreme Court confirmation proceedings in the Senate may impact those plans, but hopes for another COVID package before the elections have dimmed. Pelosi has reportedly instructed House Committee chairs to begin drafting a new COVID relief proposal with a price tag of around $2.2 trillion in an effort to restart negotiations with the White House. Senate Republican leaders have so far balked at supporting another COVID package over $1 trillion.

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 through CMS in any COVID-19 relief and stimulus agreement.
 
Congress takes step forward on mental health, including VA legislation
Following a final vote in the House on Wednesday, Congress passed the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (S.785). The legislation, introduced by Sen. Jon Tester (D-MT) and a diverse, bipartisan group of Senators in 2019, would update the Department of Veterans’ Affairs’ (VA) transition assistance, mental health care, and telehealth services. Among other provisions, the bill would:

  • Expand eligibility for VA hospital care and medical services to recently discharged or released Veterans during the one-year period following their discharge or release from active service;
  • Require the VA to make grants and take specific actions towards preventing Veteran suicide;
  • Require the VA to conduct various studies, implement temporary programs, and issue updated guidelines related to the causes, diagnoses, and treatment of Veterans' mental health issues;
  • Expand direct hiring authority for the VA’s mental health workforce to address serious staffing shortages and require the implementation of the VA Readjustment Counseling Service Scholarship Program; and
  • Require the VA to award grants for the expansion of telehealth capabilities and to provide mental health and other telehealth services to Veterans.

 
President Trump is expected to quickly sign the legislation into law.
 
In addition, this week the House passed several healthcare-related bills, including five bills focused on suicide prevention and awareness. 
 
House and Senate Committees hold hearings on COVID-19 health coverage and federal response
The House Energy and Commerce Subcommittee on Health held a hearing this week entitled “Health Care Lifeline: The Affordable Care Act and the COVID-19 Pandemic.” In his opening statement, Rep. Frank Pallone (D-NJ), Chairman of the E&C Committee said that “today’s hearing is an opportunity to better understand the ACA’s impact on the status of health coverage amidst COVID-19, and what needs to be done to expand and improve access to quality, affordable health care.” Pallone also acknowledged the high stakes for the ACA as the Supreme Court is scheduled to hear a new challenge to the law on November 10.
 
The Senate Health, Education, Labor and Pensions Committee also held a hearing this week related to the ongoing public health emergency, entitled “COVID-19: An Update on the Federal Response.” During this hearing, Committee members heard from leaders in the Administration including, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention, ADM Brett Giroir, MD, Assistant Secretary For Health at the Department of Health and Human Services, and Dr. Stephen Hahn, Commissioner of the Food and Drug Administration. The hearing grew contentious at times as lawmakers and the health experts discussed various policy decisions related to the federal response to COVID-19’s public health challenges.
 
Duke Health joins 340B Health Hill Day
On Wednesday, Duke Health participated in the 340B Health Hill Day to share updates and concerns with NC congressional offices about the 340B Drug Discount Program. Recently, several drug manufacturers have been taking actions that appear to fall outside the scope of the program, possibly jeopardizing patient access to drugs provided at a discount. Specifically, some manufacturers are refusing to offer drugs to safety-net providers at the discounted prices that federal law requires, while others are demanding claims data that go beyond the scope of the 340B statute. Duke Health Government Relations continues to urge our representatives to support giving the Health Resources and Services Administration (HRSA), which oversees the program, more authority to enforce the law.
 
Trump issues Executive Order on preexisting conditions, surprise billing, and other policy priorities
In an event in Charlotte on Thursday, President Trump announced a largely symbolic Executive Order on “An America First Health Plan” designed to highlight Administration policy on preexisting conditions, lowering health care costs and providing choice for Americans, and surprise billing.
 
The order includes language to make it “the policy of United States” that protections for preexisting conditions will be part of any health care policy or reform. The Affordable Care Act already provides that individuals with preexisting conditions may not be denied health insurance coverage. As noted in an article above, the Supreme Court is expected to hear a new challenge to the ACA in November that may invalidate the whole law or significant portions of it.
 
The order also states that the Administration will direct Health and Human Services Secretary Alex Azar to take administrative action to ban surprise medical bills for unforeseen out of pocket costs if Congress does not pass legislation on the issue by the end of the year. While a number of proposals have been introduced in Congress to address surprise medical billings, none have gained traction this year. It’s unclear whether this announcement will spark further progress toward a legislative solution in an expected lame duck session following the elections.
 
Other policy statements include Administration preferences to ensure price transparency for medical costs, lowering the cost of prescription drugs, and providing choice for where and how Americans choose their health insurance.
 
While lighter on firm policy details, the Executive Order may be viewed as a preview of how the Trump Administration would address health care reform in a second term.