McDermott+Consulting Check-Up: March 31, 2023
THIS WEEK’S DOSE
In a bit of a surprise move this week, the Senate voted to end the COVID-19 national emergency, while all other action related to healthcare was at the committee level. FY 2024 budget hearings continued, and other health-related hearings included a House Energy and Commerce Committee hearing focused on transparency and competition, and a Senate Finance Committee hearing on pharmacy benefit managers (PBMs).
Senate Votes to End COVID-19 National Emergency. On March 29, the Senate voted 68–23 to end the national emergency. The House approved the joint resolution (H.J.Res. 7) earlier this year. At the time of House passage, President Biden indicated opposition, given that his Administration is already on a path to end both the public health emergency (PHE) and the national emergency on May 11, and suggested that Congress should not disrupt that orderly path.
This week, however, the Administration switched gears and signaled to Senate Majority Leader Chuck Schumer (D-NY) that the president would sign such a policy if the Senate passed it. This means that while the PHE will end on May 11, the national emergency will end earlier, after the president signs that resolution. The impact of ending the national emergency is not as significant as ending the PHE with respect to the health policies and flexibilities that will be undone. But it is still confusing, and may cause some disruptions in delivery of healthcare in the coming weeks. Our team continues to monitor and will provide relevant updates.
House Energy and Commerce Committee Holds Hearing on Healthcare Costs. On March 28, the Energy and Commerce Health Subcommittee held a hearing titled “Lowering Unaffordable Costs: Examining Transparency and Competition in Health Care.” The hearing was marked by a display of bipartisanship that has become increasingly uncommon on Capitol Hill, including a witness list mutually agreed upon by both parties.
While Democrats highlighted their efforts to make healthcare more affordable in the Affordable Care Act (ACA) and the Inflation Reduction Act, few overtly partisan themes arose during the hearing. Members on both sides of the aisle appeared to coalesce around the need for hospitals to improve their efforts to make pricing information available, and around efforts to strengthen hospital transparency requirements, including stronger enforcement and standard formatting.
Subcommittee Chair Brett Guthrie (R-KY) hinted that legislation may be forthcoming on strengthening hospital transparency, and the tone of the hearing suggested there could be bipartisan agreement on such an effort.
Other themes touched on during the hearing included transparency in the 340B program, physician practice and hospital consolidation, site-neutral policies and transparency related to PBM practices.
FY 2024 Budget Hearings Continue. With budget season in full swing, Biden Administration officials continued to make the rounds on Capitol Hill this week to defend the president’s FY 2024 budget request.
On March 28, US Department of Health and Human Services (HHS) Secretary Xavier Becerra testified at a House Ways and Means Committee hearing. Secretary Becerra provided details on HHS’s funding priorities, including increasing access to equitable healthcare, tackling the mental and behavioral health crisis, lowering the cost of prescription drugs and strengthening the Medicare program.
The Secretary fielded questions from committee members that touched on several issues, including concern over implementation of the No Surprises Act, HHS oversight of nursing homes and hospice agencies, Medicare and Medicaid payment cuts, and the overdose and mental health crises. There was bipartisan support for the Administration’s focus on expanding 9-8-8 hotline capacity and suicide prevention efforts.
Democratic members highlighted the Administration’s successes in expanding ACA subsidies, capping insulin prices and enabling Medicare prescription drug price negotiations. Republicans focused on the impact of the Administration’s proposed changes to Medicare Advantage payments, which they characterizes as cuts, government drug price controls stifling innovation, and a lack of HHS program oversight.
Secretary Becerra also testified before the House Energy and Commerce Committee during a March 29 hearing. The hearing included similar partisan divides and focused on issues such as price transparency, pandemic preparedness and response, and recently approved Alzheimer’s drugs that are not currently being considered for coverage by the Medicare and Medicaid programs.
The Senate Finance Committee held a hearing titled “Pharmacy Benefit Managers and the Prescription Drug Supply Chain: Impact on Patients and Taxpayers.” The hearing followed recent action by the Senate Commerce Committee to advance the Pharmacy Benefit Manager Transparency Act (S. 127), which aims to increase transparency and prevent unfair PBM practices, including spread pricing (i.e., when a PBM charges an insurance plan more than it reimburses a pharmacy for a drug).
The House Appropriations Committee held an oversight hearing on rural issues. The hearing discussed how those in rural areas face access-to-care challenges and have disproportionately worse health outcomes than those residing in urban areas. The issue of rural hospital closures was also raised, with discussion on how closures have been exacerbated by workforce shortages, high volumes of Medicaid and Medicare patients with lower reimbursement rates, and general lack of funding and resources.
The Senate Finance Health Subcommittee held a hearing on disparities in oral healthcare. The hearing focused on how oral health is integral to overall health and wellbeing, and discussed efforts to address disparities and improve oral health outcomes.
A US District Court Judge in Texas issued a decision striking down the ACA requirement that health insurance plans cover US Preventive Services Task Force “A” and “B” preventive services without cost-sharing for consumers. In Braidwood Management v. Becerra, Texas businesses asserted that the ACA requirements for the Task Force to recommend covered preventive services is unconstitutional, and that the requirement to cover preexposure prophylaxis for HIV prevention violates their religious rights. The judge sided with the plaintiffs and stuck down the ACA requirement, a decision that could put at risk free coverage of a range of preventive care services. Following the ruling, House Energy and Commerce Committee Ranking Member Frank Pallone (D-NJ) issued a statement blasting the decision.
Reps. Larry Bucshon (R-IN) and Diana DeGette (D-CO) reintroduced the Verifying Accurate, Leading-edge IVCT Development (VALID) Act (H.R. 2369), to modernize the review process for diagnostic testing, clarify the regulatory authority between the US Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS), and limit duplication between the two agencies by ensuring uniform standards are in place that support innovation.
HHS announced that the FDA approved the first nonprescription, over-the-counter naloxone nasal spray. As a medication that can reverse opioid-related overdoses, naloxone has been an important tool in battling the opioid epidemic and preventing fatal overdoses.
CMS announced a new study published in JAMA Psychiatry demonstrating that the expanded availability of opioid-use-disorder-related telehealth services and medications during the COVID-19 pandemic was associated with a lowered likelihood of fatal drug overdose among Medicare beneficiaries.
NEXT WEEK’S DIAGNOSIS
Congress is in recess until April 17. Our weekly Check-Up will be on hiatus during the recess and will return on Friday, April 21.