Health Update (February 18)
|Congress and President Trump have averted another government shutdown. On Thursday, the House and Senate overwhelmingly approved a spending package that will fund the remaining nine government agencies through September 30, 2019. President Trump signed the bill, but said that he is “not thrilled” with the legislation. In a Rose Garden speech this morning, he announced that he will also sign a national emergency declaration to free up billions more to build 234 miles of wall at the southern border (expect this declaration to be met with legal challenges). The spending bill passed by Congress allocates $1.375 billion for fencing on the southern border, and also includes increased funding for border security agents, immigration judges, and technology to deploy at ports of entry. The bill also includes a 1.9% pay raise for federal employees and $17 billion for transportation infrastructure projects.
This week, House and Senate Democrats unveiled a plan to allow Americans over the age of 50 to buy into Medicare. Senators Tammy Baldwin (D-WI) and Debbie Stabenow (D-MI) and Representatives Brian Higgins (D-NY) and Joe Courtney (D-CT) are the sponsors of the “50 and Over” bill, which is designed to lower premiums for younger consumers on the Affordable Care Act (ACA) exchanges and current Medicare enrollees. According to the sponsors of the legislation, this proposal would pay for itself in premiums from new enrollees. Additionally, they argue that more of the money collected would pay for health care as opposed to overhead costs and profits in the private insurance market. For-profit hospital groups have already criticized the proposal, saying that earlier Medicare buy-in would increase pressure on doctors who already serve large Medicare populations.
While some supporters of Medicare for All are also supportive of incremental measures such as the Medicare at 50 proposal, some supporters of a single payer system argue that small reforms are not enough. Rep. Pramila Jayapal (D-WA) is set to introduce Medicare for All later this month with at least 100 original co-sponsors. While many House committees plan to hold hearings on the topic, Rep. Jayapal said that the Rules Committee will hold the first hearing, possibly during the last week of March. The House Budget Committee will also hold a hearing, and Ways and Means and Energy and Commerce leaders have suggested their committees might hold hearings as well.
U.S.-Mexico-Canada Agreement Drug Rules
As Congress continues to deliberate the new U.S.-Mexico-Canada Agreement (USMCA), Senate Finance Chairman Chuck Grassley (R-IA) has said that he will not revisit the pharmaceutical provisions in the agreement. The USMCA set a 10-year exclusivity period for the development of biologic drugs. Some members believe that long exclusivity periods for drugs are a significant contributing factor to high drug prices. Ways and Means Trade Subcommittee Chairman Earl Blumenauer (D-OR) said “I don’t think candidly that (USMCA) passes out of my Trade Subcommittee. Biologics are some of the most expensive drugs on the planet.”
Last week, the Food and Drug Administration sent a warning letter to McKesson Corporation for “significant violations to the Food, Drug, and Cosmetic Act,” which are “intended to help preserve the security of the supply chain for prescription drug products.” The letter details instances of lost or tampered opioid prescription bottles, and gives the company 15 days to complete a series of corrective actions to avoid legal action. The full letter can be read here.
Emergency Triage, Treat, and Transport Model
This week, the Centers for Medicare and Medicaid Services (CMS) released an Emergency Triage, Treat, and Transport (ET3) Model to allow ambulance care teams greater flexibility in addressing emergency needs of Medicare beneficiaries. The voluntary five-year payment model comes on the heels of a Health and Human Services white paper which estimates $560 million in annual savings by transporting low-acuity 911 calls to doctors’ offices rather than emergency rooms. A fact sheet from CMS can be viewed by clicking here.
ACA Stabilization Legislation
The Energy and Commerce Health Subcommittee met to examine the Trump administration’s impact on the implementation of the Affordable Care Act (ACA) and four bills that were introduced to reverse the Trump administration’s ACA reform efforts. HR 986, introduced by Representative Kuster (D-NH), would require the Trump Administration to rescind their October 2018 Section 1332 guidance. A bill from Representative Rochester (D-DE), HR 987, would restore the marketing and outreach budget cut by the Trump Administration. A third bill introduced by Representative Castor (D-FL) would revert the time allotted for limited duration insurance plans on the individual market back to three months. A fourth bill, HR 1143, would require short term limited duration insurance plans to explicitly expose what is and is not covered and any stipulations to coverage for individuals with pre-existing conditions. For full coverage of this hearing, please click here.
 Jacob Pramuk. “Congress passes bill to prevent another US government shutdown, sending it to Trump.” CNBC, 14 Feb 2019. https://www.cnbc.com/2019/02/14/congress-votes-to-pass-spending-bill-and-avoid-government-shutdown.html
 Alice Miranda Ollstein. “Push for Medicare buy-in picks up with ‘50 and over’ bill.” POLITICO, 13 Feb 2019. https://www.politico.com/story/2019/02/13/medicare-bill-health-care-1167664
 Mary Ellen McIntire. “House progressives work on ‘Medicare-for-all’ as debate heats up.” Roll Call, 14 Feb 2019. https://www.rollcall.com/news/congress/house-progressives-work-single-payer-bill-debate-heats
 Adam Behsudi. “USMCA pharma rules set up congressional clash.” POLITICO, 14 Feb 2019. https://www.politico.com/newsletters/morning-trade/2019/02/14/usmca-pharma-rules-set-up-congressional-clash-393774
 “Warning Letter.” Food and Drug Administration, 7 Feb 2019. https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm631088.htm