They looked inward – but
May be time for compromise
No one has the votes
The Rundown
- The House continues its search for a new Speaker
- Hearings focus on AI, emerging technologies, Medicare Advantage, and biosafety
- Senate HELP Committee holds confirmation hearing for NIH director nominee
- The latest from our desks
- Join the Duke Health Advocacy Network!
Federal Updates
House attempts (interim) step forward...and trips
Today marks Day 18 that the House has been without a Speaker and it remains to be seen what path exists for House Republicans to move forward. Following the selection and withdrawal of Majority Leader Steve Scalise (R-LA) as the Republican nominee for speaker, House Republicans nominated Rep. Jim Jordan (R-OH) for the post on Friday last week. By Tuesday evening, Jordan had lost the first vote on the floor, followed by a second loss on the floor Wednesday afternoon.
Recognizing the difficulty of getting any Republican speaker nominee over the 217-vote threshold, House Republican leadership on early Thursday expressed interest in a plan to elect Speaker Pro Tem Patrick McHenry (R-NC-10) in a temporary capacity until January to at least get some critical business moving again in the House, including foreign aid and FY 2024 funding, but by the afternoon, the idea had been largely scuttled due to opposition within the Republican conference.
What now? Rep. Jordan may get a third vote on the House floor. Another candidate may emerge. More calls for a consensus pick might come to fruition. We hedge for a reason. We hedge because the news seems to change on the next possible step every few hours. We wonder now as we write how often we will update this section before tomorrow morning.
At this point, the only certainty is that we have 28 days until the current continuing resolution (CR) expires and the government is faced with another potential government shutdown.
The House needs leadership – or there will be no last-minute deal to keep the lights on next time.
Heard on the Hill
Amid all of the dysfunction surrounding the House of Representatives, several committees in both the House and the Senate held hearings this week focused on healthcare issues of interest to Duke Health. Here’s a quick snapshot of a few that our team has been following:
House Energy and Commerce Subcommittee on Health
The House Energy and Commerce (E&C) Subcommittee on Health held a hearing entitled, “What’s the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors.” The hearing examined legislation to lower the cost of prescription drugs, reform physician payment policies, and increase beneficiary access to care for seniors. Specifically, the Committee examined legislative policies to further the goals of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the Sustainable Growth Rate (SGR) formula that had been used to determine Medicare payments to physicians but had consistently led to the threat of severe payment cuts. Another issue of interest to Duke Health is that the Committee discussed the Value in Health Care Act, a bipartisan bill that would make several important reforms to ensure alternative payment models (APMs) continue to produce high quality care for the Medicare program and its beneficiaries, including extending MACRA’s 5 percent advanced APM incentives that are scheduled to expire at the end of the year. Duke Health supports passage of this bill.
House Energy and Commerce Subcommittee on Data, Innovation, and Commerce
On Wednesday, the House E&C Subcommittee on Data, Innovation, and Commerce held a hearing entitled, “Safeguarding Data and Innovation: Setting the Foundation for the Use of Artificial Intelligence.” Witnesses included representatives from industry, entertainment, tech associations, and the former commissioner of the Federal Trade Commission. While the focus of the conversation was rooted in AI, much of the discussion was centered on the need for Congress to pass a national data privacy standard to address the inherent risks of new AI technologies.
Last Congress, the E&C Committee approved comprehensive data privacy reform legislation, which included provisions to regulate third party vendors with access to sensitive health and personal information, but the bill did not receive a vote on the House floor. The committee is attempting to revive those efforts as part of rumored plans to release an updated version of the American Data Privacy and Protection Act. In her opening statement, full E&C Committee Chair Cathy McMorris Rodgers (R-WA) noted that a national data privacy standard is “foundational” to additional AI regulation and “must be the first step towards a safe and prosperous AI future.”
Wednesday’s hearing was the first in a series on AI planned by E&C, which is expected to explore AI’s application across sectors, including healthcare, telecommunications, and energy.
House Space, Science, and Technology Committee
The House Space, Science, and Technology Subcommittees on Oversight and Investigations and Research and Investigations held a hearing entitled, “Balancing Knowledge and Governance: Foundations for Risk Management in Artificial Intelligence.” Witnesses included representatives from the federal government, academia, and industry associations. The overarching conversation was focused on breaking down the role of the federal government in AI regulation, as well as appropriately gauging potential threats and opportunities of emerging technologies. Subcommittee on Oversight and Investigations ranking member Valerie Foushee (D-NC-04) struck a measured tone in her opening remarks and questions, cautioning fellow committee members and panelists to think carefully about perceived risks so that any developed national standard have practical application.
Before the hearing, our team worked with Rep. Foushee’s staff in preparation, providing resources from Duke AI Health and connecting our experts to answer questions to help set the tone for the congresswoman’s approach to the conversation.
Senate Finance Committee Focuses on Medicare Advantage
This week, Senate Finance Committee held a hearing entitled, “Medicare Advantage Annual Enrollment: Cracking Down on Deceptive Practices and Improving Senior Experiences,” which examined the “middlemen,” marketing practices, and transparency in Medicare Advantage.
In other Medicare Advantage news, Senate Finance Committee Chair Ron Wyden (D-OR) and Committee members Michael Bennet (D-CO) and Thom Tillis (R-NC) introduced the “The Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act,” focused on addressing “ghost networks” in Medicare Advantage plans. The bill would “strengthen requirements for Medicare Advantage plans to maintain accurate and updated provider directories; ensure patients do not pay out-of-network costs for appointments with providers that were incorrectly listed in their plan’s provider directory as in-network; and direct CMS to publish guidance for plans to maintain accurate provider directories.”
In his statement for the bill, Senator Tillis said, “Far too often, North Carolinians, especially seniors enrolled in Medicare Advantage and those in need of mental health services, find themselves unable to access the care they need due to inaccurate provider directories… This legislation ensures that consumers can access updated provider information enabling them to make informed decisions about their healthcare.”
Select Subcommittee Examines Biosafety and Biosecurity
Also this week, the Select Subcommittee on the Coronavirus Pandemic held a hearing entitled, “Strengthening Biosafety and Biosecurity Standards: Protecting Against Future Pandemics.”
At the hearing, Rep. Deborah Ross (D-NC-02) asked the witnesses about how a comprehensive investment in the Biomedical Advanced Research and Development Authority (BARDA) safeguards America’s public health and security and what role the agency plays in fortifying our leadership on pandemic preparedness within the international community.
Our office contacted Rep. Ross’s office to offer Duke Health’s expertise in preparing for the hearing.
Senate HELP Committee Holds Hearing on NIH Director Nomination
On Wednesday, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on the nomination of Dr. Monica Bertagnolli to be director of the National Institutes of Health (NIH). Dr. Bertagnolli currently serves as the Director of the National Cancer Institute.
Senator John Barrasso (R-WY), a physician, introduced Dr. Bertagnolli, and expressed his support for her nomination.
As expected, questions and comments from HELP Committee Chairman, Bernie Sanders (I-VT), focused on his concern with healthcare costs, especially for prescription drugs. He had been holding up the nomination hearing until he received the Administration’s plan on lowering drug prices. Chairman Sanders asked Dr. Bertagnolli if she would commit to reinstating and expanding the Reasonable Pricing Clause, but she did not directly respond. Instead, Dr. Bertagnolli said she would work to ensure that the benefits of NIH research are affordable and available without giving specifics about that plan. She reiterated this point again when HELP Committee Ranking Member Bill Cassidy (R-LA) also asked her if she would apply Reasonable Pricing to contracts but presented an opposite point of view from Chairman Sanders. Ranking Member Cassidy noted the past failure of the Reasonable Pricing Clause and the past decision by NIH to rescind the policy. Ranking Member Cassidy also asked about March in Rights.
Neither Sanders nor Cassidy gave a clear indication about whether they would support Dr. Bertagnolli’s nomination. Ranking Member Cassidy acknowledged her scientific qualifications but focused his comments on her overall ability to lead the NIH moving forward, noting the “eroded trust between the NIH and the public and the task she will have in reestablishing that trust.”
Questions at the hearing covered a range of biomedical research topics including cancer research, Alzheimer’s research, long-COVID, mental health, and rural health. Several Republican members also asked about gender affirming care. Dr. Bertagnolli was also questioned about fetal tissue research and Gain of Function.
The HELP Committee plans to vote to advance her nomination at an executive session on October 25th.
From our desk(s): Duke Health GR this week
Our office hosted several Congressional district staff from across the state to learn more about the impact of extreme heat and heat-related illness on the health system, the associations between a changing physical environment and physical and social health among different populations, and an overview of Duke Health’s HR, facilities and construction, supplies procurement, and water approaches that aim to reduce our environmental impact.
Our office participated in a quarterly stakeholder call with the Centers for Medicare and Medicaid Services (CMS) to hear updates from Chiquita Brooks-LaSure and other CMS leaders on updates from the different centers.
Members of our team joined national partners from the Coalition for Healthcare AI (CHAI) to meet with the staff of Senator Martin Heinrich (D-NM), co-chair of the Senate AI Caucus, staff of Senate Majority Leader Chuck Schumer (D-NY), majority staff for the Senate Finance and HELP Committees, and staff for House, Space, Science and Technology Subcommittee on Oversight and Investigations Chair Jay Obernolte (R-CA) to talk about the meaningful contributions of CHAI members, including Duke Health, to create national standards for healthcare AI development and regulation.
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