On The Hill

Though House Impeachment proceedings into President Trump dominated a rollercoaster week on Capitol Hill, there were numerous healthcare headlines as well. The House Energy & Commerce and Education & Labor Committees approved Speaker Nancy Pelosi’s (D-CA) drug pricing bill (H.R. 3), while the House Ways & Means Committee held a full committee hearing on the bill. In other major health headlines, the House Energy & Commerce Committee scheduled a hearing next week on the Trump administration’s attacks on healthcare, where CMS Administrator Seema Verma will testify. The Republican Study Committee (RSC) announced it will be releasing a health policy proposal next week, and Secretary of Health and Human Services (HHS) Alex Azar mentioned at the TIME 100 Health Summit that the Trump administration will not further attempt to replace the Affordable Care Act (ACA) unless Congress is on board.

 

Drug Pricing

 

House Ways & Means Hearing

The House Ways & Means Committee held a full committee hearing on Thursday (Oct. 17) on H.R. 3 entitled “Investing in the U.S. Health System by Lowering Drug Prices, Reducing Out-Of-Pocket Costs, and Improving Medicare Benefits.” Chairman Richard Neal (D-MA) and fellow Committee Democrats praised H.R. 3, the Lower Drug Costs Now Act, and championed it throughout the hearing as perhaps the most important legislation in this Congress to date. As they have been for weeks, Democratic members of the Ways & Means Committee touted the features of the bill that include lower drug prices, reduced premiums, and reduced out-of-pocket costs. Recently, the nonpartisan Congressional Business Office (CBO) estimated that the Medicare provisions of Title I will reduce Medicare spending by $345 billion over 10 years and this was brought up numerous times throughout the hearing by committee members from both sides of the aisle. Democrats touted the CBO score for its reduced spending, while Republicans highlighted the fact that it is not yet a full CBO score. Committee Republicans led by Ranking Member Kevin Brady (R-TX) argued that H.R. 3 attempts to nationalize the prescription drug industry through foreign price controls, retroactive tax penalties, arbitrary inflation caps, and federally mandated “negotiations,” which amount to nothing more than government extortion and price-setting. They also argued that these policies would lead to limits on access, making prescription drugs less available and that they will freeze innovation, reducing the investment in advanced treatments to cure serious illnesses. The Committee announced today (Oct. 18) that it will expect to markup H.R. 3 on Tuesday. To read an executive summary of this hearing, click here.

 

House E&C Markup

The House Energy & Commerce Committee held its markup on Thursday (Oct. 17) on H.R. 3. In the full committee markup of Pelosi’s drug pricing bill, Democrats held fast to their belief that allowing the Secretary of Health and Human Services (HHS) to negotiate drug prices with pharmaceutical companies will help lower health care costs for Americans. Democrats pointed out the recent CBO report that noted H.R. 3 will save up to $345B in Medicare spending. The legislation also caps out-of-pocket expenses for seniors at $2,000. Republicans reiterated their concerns that the bill amounts to government price controls, as each party is not given equal negotiating power. They were also concerned about the impacts of H.R. 3 on research and development of new cures and treatments and noted CBO’s finding that the legislation will result in fewer drugs coming to market. Additionally, Republicans expressed frustration at the process the Democrats took bringing the bill to the full committee markup, without having a subcommittee markup or a full committee hearing. They argued that the issue of drug pricing could have, and should have, been handled in a bipartisan manner. To read an executive summary of this markup, click here.

 

House Ed & Labor Markup

The House Education and Labor Committee also held a markup on Thursday (Oct.17) on H.R. 3. H.R. 3 passed on a 27-21 party line during this week’s markup in the House Education and Labor Committee. Committee Republicans argued that the legislation would limit patients’ options and curb drugmakers’ drive to develop new therapies. Committee Chairman Bobby Scott (D-VA) ruled that Rep. Phil Roe’s (R-TN) proposal to require pharmacy benefit managers (PBMs) pass all of drugmakers’ rebates through to group health plans was not germane. But several Committee Democrats said they were open to working with Roe on future legislation targeting PBMs and the role of rebates. ^[1] 

 

Grassley, Wyden op-ed

Senate Finance Committee Chairman Chuck Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) penned an joint op-ed, calling on Congress to act on lowering drug prices. A link to the full op-ed can be found here.

 

Affordable Care Act

HHS Secretary Azar announced during the TIME 100 Health Summit this week that the Trump Administration is focusing on protecting and improving job-based coverage, Medicare and Medicaid that covers the vast majority of Americans. Along with this, the administration has no plans to draft an Affordable Care Act (ACA) replacement until there’s a willing Congress or if the courts makes a final decision. HHS’ stance mirrors Senate Majority Leader Mitch McConnell’s (R-KY) position following Congress’ failure to repeal the law and supports earlier indications that the administration was backing away from a large-scale proposal, even as House Republicans plan to roll out a broad-based health reform proposal next week. “We have a vision of what kind of options can look like for an individual market, but what’s realistic is going to depend on who’s in Congress at the time, when does that occur, does that ever occur. Right now, what I’m doing is trying to run the Affordable Care Act as best as we can with the tools that we’ve got,” Azar said. ^[2] 

 

RSC Proposal

The Republican Study Committee (RSC) plans to release a lengthy, wide-ranging health policy proposal next Tuesday (Oct. 22) that House GOP members can point to as a health plan during the 2020 campaign. The plan is meant to provide a Republican alternative to Democrats’ call for single-payer on the campaign trail. Though the plan is broad, another Republican briefed on the proposal said that there’s a consensus that devolving power down through the states is the right way to go and that voters want to see more free-market proposals.^[3] 

CMS Strengthens Nursing Home Oversight

This week, the Centers for Medicare & Medicaid Services (CMS) announced a major step in the Agency’s efforts to ensure the safety and quality for nursing home patients and residents. As part of continuing efforts to keep nursing home residents safe and respond to concerns about inconsistent and untimely inspections, CMS is strengthening the system it uses to hold inspectors accountable, the State Performance Standards System (SPSS). Nursing homes are inspected by State Survey Agencies (SSAs), and their inspections protect patients and residents by ensuring nursing homes comply with federal safety guidelines. Under the changes announced in a memo to states today, CMS will, through the updated SPSS assessment tools, rigorously and rapidly analyze SSA performance to ensure inspections are timely and accurate. This includes new performance measures and stricter monitoring to ensure inspections are done in a fair, accurate, and timely manner. These new performance measures also have the goal of ensuring patient safety and ensuring that enforcement actions – like civil money penalties – are applied consistently. ^[4] 

 

References

^[1] Owermohle, Sarah. “House Education and Labor advances Pelosi’s drug pricing plan.” Politico Pro. 17 Oct. 2019. https://subscriber.politicopro.com/article/2019/10/house-education-and-labor-advances-pelosis-drug-pricing-plan-3973063

^[2] Lolven, Amy. “Azar Says HHS Will Confront ACA Replacement When Time Comes, Not Before.” Inside Health Policy. 17, Oct. 2019. https://insidehealthpolicy.com/daily-news/azar-says-hhs-will-confront-aca-replacement-when-time-comes-not

^[3] Cohen, Ariel. “Republican Study Committee 2020 Health Plan Coming Next Week.” Inside Health Policy. 15, Oct. 2019. https://insidehealthpolicy.com/daily-news/republican-study-committee-2020-health-plan-coming-next-week

^[4] “Trump Administration Strengthens Oversight of Nursing Home Inspections to Keep Patients and Residents Safe.’ CMS.gov. 17, Oct. 2019. https://www.cms.gov/newsroom/press-releases/trump-administration-strengthens-oversight-nursing-home-inspections-keep-patients-and-residents-safe?utm_source=TWITTER&utm_medium=social&utm_content=20191017_2745541772&utm_campaign=CMSPress&linkId=75484813

^[5] Cancryn, Adam. “Seema Verna to testify before House oversight panel.” Politico Pro. 16, Oct. 2019. https://subscriber.politicopro.com/article/2019/10/seema-verma-to-testify-before-house-oversight-panel-3973028