Federal Health Policy Updates for the
Week of September 27 - October 1, 2021
Believe in yourself
Unlike the federal debt
No limits for you
- Congress keeps the lights on through early December
- Democratic leadership works to find a way forward on dual infrastructure plans
- Dr. Viviana Martinez-Bianchi testifies at House hearing on COVID-19 community responses
- Biden administration releases part II interim final rule on surprise billing
- The latest from our desks
- Take our advocacy survey by October 8!
Federal Updates
You built a time machine out of a CR?
Congress has passed a continuing resolution (CR) to keep the federal government operating at largely FY 2021 funding levels through December 3, 2021. The legislation also addresses emergency spending for hurricane recovery and winding down the conflict in Afghanistan. We are starting off a new fiscal year by remaining stuck in the previous one for a little while longer. Maybe it’s because it’s now October, or maybe because this whole process has felt like a DeLorean ride through time and space, but you’ll have to forgive us for feeling somewhat like Marty McFly, the main protagonist of the now classic Back to the Future trilogy. It’s all heavy, and we’re going to need an extra jolt of power to get back to where we may want to be.
Without spoiling the plot(s) too much, Marty is generally successful in making it back to the present in each of the films, but the “future” to which he returns is almost always just a bit different than the one he originally left or even envisioned. That’s the trouble with being mired in the past for too long – more opportunities to lose sight of what’s ahead - and that’s why CRs are intended to be stopgaps and not longer-term solutions for the future of federal funding.
Between now and December 3rd, congressional leaders will attempt to work out a longer-term spending plan for FY 2022, but in the meantime, the increased investments in medical research, health care and social programs, and other key priorities proposed by House Democrats this summer will remain unrealized, stagnant. As the current CR does not address the looming debt limit crisis (Republican leaders blocked the dual CR-debt limit suspension plan we discussed last week), it is reasonable to expect that issue will also play a significant role in how funding negotiations between the House and Senate take shape.
Our office will continue to advocate for Duke Health federal funding priorities, including those supporting our workforce, patients, and communities – but don’t expect the trip to the real FY 2022 to be linear.
It’s reconciliation week until further notice
It’s the song that wouldn’t end, the repeating clock, Bill Murray’s Groundhog Day – and it’s seemingly here to stay for a while longer. The attempt at a dual track infrastructure/reconciliation process is now spilling into the third quarter of the year, and while the lengthy process wasn’t unexpected, many of the issues that have impeded progress and plagued Democratic leadership since the summer remain.
What’s clear today is that the House-crafted $3.5 trillion Build Back Better legislation as it stands right now has very little chance of securing a necessary unified Democratic vote in the Senate – even under the simple majority rules of reconciliation. Some cuts and revisions seem inevitable to move forward, with reports suggesting that a final package could be trimmed by over $1 trillion. The debate over what goes and what stays will draw the ire of both moderates and progressives, and congressional Democratic leaders have to find a balance that will secure enough votes. At stake is 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 resources for schools of nursing, among other priorities.
Separately, House Democratic leaders are also attempting to line up a vote on the $1.2 trillion bipartisan, “traditional” infrastructure package passed by the Senate in August. But, they face similar divisions among the moderate and progressive factions of their caucus. Some progressives won’t vote for the bill until there is a confirmed timeline and framework for the reconciliation strategy, while a number of moderates don’t want to lose any more momentum on the bipartisan legislation. A planned vote on Thursday evening was eventually delayed due to ongoing differences, and a very tight majority in the House doesn’t leave leadership with much room for error.
And let’s not forget about the debt limit. As we noted above, Democrats couldn’t pass a suspension with the CR and Republicans have blocked all other attempts short of reconciliation – which Democrats are refusing to consider. There’s just under three weeks until the government is no longer able to fulfill its obligations.
We’re following closely, continuing to weigh in as appropriate, and like many others, watching for something to break the loop.
House hearing on COVID-19 response in communities features Dr. Viviana Martinez-Bianchi
On Tuesday, the House Education and Labor Committee held a joint subcommittee hearing between the Civil Rights and Human Services Subcommittee and the Health, Employment, Labor, and Pensions Subcommittee entitled, “How to Save a Life: Successful Models for Protecting Communities from COVID-19.” Dr. Viviana Martinez-Bianchi, Director of Health Equity and Associate Professor in the Department of Family Medicine and Community Health in the Duke University School of Medicine and co-founder of the Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19), was among the featured witnesses.
Speaking on behalf of LATIN-19, Dr. Martinez-Bianchi discussed the disproportionate impact of COVID-19 on the Latinx community, and how LATIN-19 worked to address and reduce the negative impact of COVID-19 on the physical, mental, and social health of Latinx communities and amplify the voice of the community. She shared lessons learned including the importance of building trust in the community. Committee member Rep. Alma Adams (D-NC-12) asked Dr. Martinez-Bianchi about discrepancies accessing information about vaccines between men and women, and solutions to disseminate information more effectively. Dr. Martinez-Bianchi noted the importance of community engagement and listening to the questions from the community to know their concerns. She further explained that while many women had questions about the impact of the vaccine on fertility and pregnancy, there were good data to support long term health outcomes.
Administration releases part II interim final rule on surprise billing
On September 30, the Biden administration released a part II interim final rule (IFR) on regulations related to the No Surprises Act that was enacted as part of the Consolidated Appropriations and Omnibus Act in December 2020.
The new IFR follows a part I IFR released in July that focused on the broad parameters of the federal ban on surprise bills and a separate proposed rule released in mid-September on reporting requirements for air ambulances.
Covered items under the part II IFR include:
- Provisions related to the independent dispute resolution (IDR) process
- Good-faith estimates for the uninsured (or self-payers)
- Patient-provider dispute process for the uninsured (or self-payers)
- Expanded rights for external review
The administration has also launched a website to allow interested parties to become certified independent dispute resolution entities. This site will eventually include a portal for the federal provider-payer IDR process.
A comment period will run for 60 days from the date the IFR is officially published in the Federal Register (likely early today or early next week), and our office will work with health system leadership to coordinate any formal response.
From our desk(s): Duke Health GR this week
This week, we monitored the activities of two House and Senate Committees that turned their attention to school re-openings amid the public health emergency (PHE):
- On Wednesday, the Early Childhood, Elementary, and Secondary Education Subcommittee of the House Education and Labor Committee held a hearing entitled, “Back to School: Highlighting Best Practices for Safely Reopening Schools.” In his opening remarks, Committee Chairman Gregorio Kilili Camacho Sablan (Northern Mariana Islands) discussed research that shows that schools that started the academic year without mask requirements were over three times more likely to have a COVID-19 outbreak between August and September. Rep. Kathy Manning (D-NC-06) serves on the subcommittee, and we reconnected her team with materials and recommendations made by the ABC Collaborative.
- On Thursday, the Senate Health, Education, Labor and Pensions Committee held a full Committee hearing entitled, “School Reopening During COVID-19: Supporting Students, Educators, and Families.” Witnesses for the hearing included Secretary of Health and Human Services Xavier Becerra and Education Secretary Dr. Miguel Cardona. In his opening remarks, ranking member Richard Burr (R-NC) referenced a Duke-UNC study examining safety standards and practices of North Carolina school districts.
We were alerted to a newly launched effort by the Senate Finance Committee to develop bipartisan legislation to address barriers to mental health care that have only worsened during the current PHE. The announcement was accompanied by a bipartisan request for information from stakeholders on legislative proposals to improve access to health care services for individuals with mental health and substance use disorders. Our office is working to coordinate a response to the RFI from experts across Duke Health.
Our team urged members of the North Carolina congressional delegation to join a Dear Colleague Letter being circulated by Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) urging House leaders to extend the 3.75% increase to the Medicare conversion factor that Congress included in the Consolidated Appropriations Act of 2021 to provide continued stability to the physician and provider community as it works toward broader Medicare payment reform. As a result of our outreach, Reps. G.K. Butterfield (D-NC-01) and Deborah Ross (D-NC-02) have signed on.
We are monitoring legislation recently introduced by Senators Thom Tillis (R-NC), Susan Collins (R-ME), and Rand Paul (R-KY) to help reduce international employment visa backlogs, including those for health care workers. The Preserving Employment Visas Act (S.2828) would allow United States Citizenship and Immigration Services (USCIS) to recapture and preserve unused employment-based visas from FY20 and FY21 that would otherwise be lost and keep them available until completely used. We are also glad to report that following outreach from our office, Senator Tillis has become a cosponsor of the Conrad State 30 Physician Access and Reauthorization Act (S.1810), which would expand the Conrad State 30 program to allow more J-1 visa physicians remain in the U.S. following their residencies if they commit to practicing in medically underserved areas.
Further, we coordinated Duke Health joining a diverse stakeholder community letter led by the Defense Health Research Consortium urging Congress to pass a Defense appropriations bill that includes robust support for Department of Defense medical research programs.
Finally, we 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!
It's the final week!
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.