THIS WEEK’S DOSE
On June 3, President Biden signed the debt limit legislation into law, averting default and allowing Congress to return to regularly scheduled business. However, that return was short-lived in the House when a small group of Republican members from the far right defeated a rule on the House floor on June 6 in protest of the debt limit package. Republican leaders were forced to cancel votes for the rest of the week as they work to resolve the conflict so the House can conduct legislative business. Committee action did proceed in the House this week with healthcare-related bills advancing in the Committees on Education and the Workforce and Ways and Means. The Energy and Commerce Committee also held hearings regarding oversight of the Centers for Disease Control and Prevention (CDC) and the opioid crisis. In the Senate, the Finance Committee held a hearing on healthcare consolidation, and the Health, Education, Labor and Pensions (HELP) Committee held a hearing on youth mental health.
House Ways and Means Committee Advances Several Healthcare Bills. On June 7, the House Ways and Means Committee held a markup of Social Security and tax bills that included several bills in the healthcare arena. All bills were advanced by the committee and are expected to be brought to the House floor in the coming months. Details on the health-related bills, including vote outcomes, are as follows:
- H.R. 3797, the Paperwork Burden Reduction Act, would amend the Internal Revenue Code of 1986 to allow for electronic or upon-request furnishing of certain health insurance coverage statements to individuals. This bill advanced by a unanimous vote of 38–0.
- H.R. 3801, the Employer Reporting Improvement Act, would streamline and improve the employer reporting process related to health insurance coverage and protect dependent privacy. This bill advanced by a unanimous vote of 37–0.
- H.R. 1843, the Telehealth Expansion Act, would permanently extend a provision allowing for pre-deductible coverage for telehealth services for those with HSA-eligible HDHPs (the provision was most recently extended through 2024 as part of the year-end omnibus package). This bill advanced by a bipartisan vote of 30–12.
- H.R. 3800, the Chronic Disease Flexible Coverage Act, would codify existing Internal Revenue Service (IRS) guidance permitting pre-deductible coverage of care for chronic conditions for those with HSA-eligible HDHPs. This bill advanced by a bipartisan vote of 34–6.
- H.R. 3798, the Small Business Flexibility Act, would require the IRS to inform employers of flexible health insurance benefits and would require outreach to small businesses, with an emphasis on making known the possibility that small businesses might establish certain health reimbursement arrangements, as well as the small business owners’ potential eligibility for the small employer health insurance credit. This bill advanced by a bipartisan vote of 36–3.
- H.R. 3799, the Custom Health Option and Individual Care Expense Arrangement Act, would codify the requirements of individual coverage health reimbursement accounts, which are accounts to which employers can contribute funds that employees can then spend on coverage in the individual marketplace if it covers the same essential health benefits as the employer’s group health plan. This bill advanced along party lines, by a vote 25–18.
House Energy and Commerce Committee Examines CDC Oversight and Opioid Crisis. On June 7, the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing to discuss the CDC’s Moving Forward Initiative and its use of data to make decisions during the COVID-19 pandemic. The hearing addressed concerns about missteps the agency took during the pandemic and discussed solutions to prepare for the next pandemic and restore public trust. During the hearing, witnesses and committee members expressed a need for updated data and systems, and both sides of the aisle expressed frustration about the politicization of COVID-19 and public health. Republican members also raised concerns related to school closures and the influence of teachers’ unions in CDC’s guidance.
The House Energy and Commerce Committee also held a field hearing on June 9 to discuss the opioid crisis and to examine the SUPPORT Act five years after enactment. Committee members discussed reauthorizing key portions of the SUPPORT Act.
House Education and the Workforce Committee Advances Health Insurance Bills. On June 6, the House Education and the Workforce Committee met to discuss and markup four pieces of legislation, two of which were related to health insurance. H.R. 2813 would preempt state law and allow small and midsize businesses to purchase stop loss insurance. H.R. 2868, the Association Health Plans Act, would allow small business and independent contractors to join association health plans as an alternative to the Affordable Care Act marketplace. Both bills advanced along party lines. It was announced that the markup would include consideration of H.R. 824, the Telehealth Benefit Expansion for Workers Act, but that bill was dropped from consideration after the Energy and Commerce Committee claimed jurisdiction on the legislation.
Senate Finance Committee Discusses Healthcare Consolidation. On June 8, the Senate Finance Committee held a hearing on consolidation and corporate ownership in healthcare, including an examination of impacts on access, quality and costs. The discussion focused on factors that lead to higher costs, lower quality and worse outcomes for patients. The hearing featured testimony from various experts, including healthcare providers, patients and industry representatives. Witnesses discussed the impact of healthcare consolidation on their work and on their patients, and offered recommendations for addressing some of the challenges posed by consolidation.
Witnesses and committee members discussed ways to reduce healthcare spending, including reforms to Medicare and Medicaid payment systems such as site neutral payment policies and value-based payment models. Witnesses also discussed how healthcare data transparency can help patients shop for better prices and make more informed decisions.
Senate HELP Committee Holds Hearing on Youth Mental Health. On June 8, the Senate HELP Committee met to discuss causes and solutions for the youth mental health crisis. The committee heard testimony from the US surgeon general and the Office of Special Education and Rehabilitative Services at the US Department of Education, as well as a panel of stakeholder witnesses. Witnesses and committee members discussed the impact of social media on the youth mental health crisis, and there was bipartisan support for addressing this subject. The hearing also examined solutions currently being implemented to increase access to mental health resources in schools, including examples from the front lines and success stories from schools.
FY 2024 Appropriations Process Update. Following a pause to accommodate debt limit negotiations, the House and Senate are both restarting the FY 2024 appropriations process—a necessary step if there is any possibility of completing all 12 annual appropriations bills, or some portion of them, prior to the end of the fiscal year on September 30. We are awaiting formal scheduling announcements but anticipate that the House Appropriations Committee will resume markups next week, with the Senate Appropriations Committee potentially following suit and resuming action the following week. Appropriations bills are expected to take up significant floor time this summer in both chambers.
Making Care Primary Model Provides Investments for Primary Care. On June 8, the Center for Medicare and Medicaid Innovation announced a new primary care model, the Making Care Primary Model, which will be tested in eight states. The model aims to provide participants with additional revenue to build infrastructure to participate in value-based models, make primary care services more accessible, and better coordinate care with specialists.
CMS expects this work to lead to downstream savings over time through better preventive care and reductions in potentially avoidable costs, such as repeat hospitalizations. The Making Care Primary Model will run for 10 and a half years, from July 1, 2024, to December 31, 2034. The eight participant states are Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina and Washington. The application for the model opens in late summer 2023, and the model will launch on July 1, 2024.
CMS has indicated that the agency is working with state Medicaid agencies in the eight states to engage in full care transformation across public programs, with plans to engage private payers in the coming months. The model includes a progressive three-track approach based on participants’ experience level with value-based care and alternative payment models.
CMS Holds Health Equity Conference. CMS hosted its inaugural Health Equity Conference on June 7 and 8. The theme of the conference was “Framing the Future of Equitable Health Care” and, as the name suggests, it was an opportunity for CMS leadership to share foundational information and discuss plans for the future. Leaders throughout CMS provided updates on health equity research, discussed promising practices and innovative solutions, and highlighted the value of collaboration across the agency and with the broader community. To that end, the conference also provided a platform for community partners to discuss multiple programs that incorporate equity-focused initiatives.
CMS Releases New List of Drugs Subject to Inflationary Rebate. On June 9, 2023, the CMS released information on Part B drugs subject to the inflationary rebate under the Inflation Reduction Act (IRA). There are 43 prescription drugs for which Part B beneficiary coinsurances may be lower, which is up from 23 in the previous quarter. The rebates will be in effect between July 1 – September 30, 2023. CMS indicated that some Medicare beneficiaries who take these drugs may save between $1 and $449 per average dose starting July 1, depending on their individual coverage. Under the IRA, people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation. CMS’ normal procedure is to release the ASP public files several weeks before the quarter of which they will go into effect so the public can review and notify CMS of any potential discrepancies. The files may need to be corrected or updated based on feedback received after the files are published. CMS full list is available here. A fact sheet is available here.
Update on Braidwood Case Regarding ACA Coverage of Preventive Medicines. On June 6, the US Court of Appeals for the Fifth Circuit heard oral arguments on whether to continue the stay of a district court’s ruling on Braidwood Management Inc. v. Becerra. The Fifth Circuit’s May issuance of an administrative stay in the case temporarily stopped a ruling by a Texas district court judge to strike down the Affordable Care Act (ACA) requirement that health insurance plans cover US Preventive Services Task Force “A” and “B” preventive services without cost-sharing for consumers. Following this week’s hearing, the Fifth Circuit asked the parties in the case to file a report by June 9 on a possible agreement regarding the stay, as the Fifth Circuit continues to consider the case.
Supreme Court Rules on Medicaid Beneficiaries Right to Sue. On June 8, 2023, the Supreme Court ruled 7-2 in favor or preserving Medicaid nursing home residents right to seek relief in federal court when state officials do not meet a certain quality of care. The case raised the issue of whether Medicaid beneficiaries can seek relief in federal court when they believe their rights are being violated by state officials, or whether enforcement of state compliance with federal Medicaid rules should be left solely to the federal Centers for Medicare and Medicaid Services (CMS). While the case is about Medicaid, there could have been implications for other federal programs beyond Medicaid where states play a role in administering or implementing them.
- On June 6, the US Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration, published the National Model Standards for Peer Support Certification for substance use, mental health and family peer workers. The agency noted that these standards were created to accelerate universal adoption, recognition and integration of the peer workforce across all elements of the healthcare system. Read the HHS press release here.
- The US Government Accountability Office released a report to help guide HHS efforts to address risk and improve preparedness. The report hopes to improve leadership and coordination of future public health emergencies.
- Chairman of the Senate Finance Committee Ron Wyden (D-OR) and Ranking Member of the House Energy and Commerce Committee Frank Pallone (D-NJ) sent a letter to Secretary of HHS Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure raising concerns about the Medicaid eligibility redeterminations process. The letter cites reports of beneficiaries facing disenrollment for procedural reasons not related to eligibility. Wyden and Pallone request information from CMS around state compliance with redetermination requirements, release of required data from states on initial redeterminations, and details on any corrective actions plans CMS has imposed on states.
NEXT WEEK’S DIAGNOSIS
The House and Senate are both scheduled to be in session next week, although House action is dependent upon reaching at least a temporary agreement with the Republican members currently preventing votes in the House from occurring. The House Energy and Commerce Health Subcommittee will hold a legislative hearing on June 13 to discuss solutions for preparedness and response to public health security threats and hazards, as well as a legislative hearing on June 14 to examine access to patient care and support for rare disease research. The Senate HELP Committee will hold an executive session to consider several healthcare bills. Appropriations markups are expected to resume in the House.