Health Update (July 1)
Senate HELP Committee Markup
The Senate HELP Committee held a Wednesday (June 26) markup hearing to examine three bills: S. 1199, S. 1173, and S. 1895, with near-unanimous consent on the bills and amendments. S. 1895, the Lower Health Care Costs Act, was the only bill debated, and passed as amended with 20 ayes and 3 nays (Warren, Sanders, and Paul). In their opening statements, Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) praised the bipartisan effort that went into the Lower Health Care Costs Act. While members raised some concerns as part of the markup, the Committee largely avoided any protracted policy debates. Chairman Alexander touted that the bill ends surprise billing, creates more transparency pertaining to drug pricing, and increases prescription drug competition. Regarding drug prices, the committee unanimously adopted an amendment offered by Chairman Alexander to fold the CREATES Act into the LHCC Act, which would prevent branded drugmakers from withholding samples from potential competitors. The committee also adopted the FAIR Drug Pricing Act by a vote of 16-7, which would require drugmakers to disclose and justify their planned price hikes. To read an executive summary of this markup, click here.
Trump Executive Order on Surprise Medical Bills
President Trump also engaged on the topic of surprise medical bills by signing an executive order earlier this week aimed at helping patients understand their medical costs upfront that could force providers and insurers to open their books on secretive price negotiations. The text of the Executive Order can be found here. The intention is to give patients more information and is part of broader efforts to make healthcare more transparent, although critics have warned certain measures could have the opposite effect. The order calls for Health and Human Services (HHS) to issue a rule(s) requiring hospitals to disclose prices in an easy-to-read format reflecting what patients and insurers actually pay. The department will also require providers and insurers to disclose information about patients’ out-of-pocket costs before they receive care. The order calls for a roadmap for consolidating quality metrics across all federal healthcare programs, expanding access to health care claims data de-identified to preserve privacy and directs the Treasury Department to expand the availability of health savings accounts to pay for more health care services. 
Earlier this week, a federal appeals court questioned whether Democratic states and the House of Representatives have the right to appeal a court ruling that declared all of the Affordable Care Act (ACA) unconstitutional. In a surprise move that legal experts said added an unexpected threat to the ACA, the Fifth U.S. Circuit Court of Appeals asked who — if anyone — has standing to appeal the December lower court ruling after the Trump administration recently sided with red states who brought the lawsuit. The Fifth Circuit, which is scheduled to hear oral arguments on the lawsuit in two weeks, questioned whether the Democrats had standing to defend the law after the Trump administration made a significant shift in legal strategy. The Trump administration initially only supported part of the lawsuit brought by more than a dozen GOP-led states, requesting that the courts strike just the law’s insurance protections, including those for people with preexisting conditions. But in an expansion of the legal fight in March, the Justice Department backed the lower court ruling against the entire ACA. 
The White House budget office is now reviewing a HHS proposal to peg payments for certain Medicare drugs to prices paid overseas, which is a central part of the administration’s plan to lower drug prices. President Trump first announced in October 2018 a plan to tie Medicare payments for some physician-administered drugs in Part B to a basket of lower international prices, potentially slashing Medicare reimbursements for those products by 30 percent. The idea has been met with resistance from the pharmaceutical industry and some Republican lawmakers, who say it would amount to importing foreign price controls. Senate Finance Committee Chairman Chuck Grassley (R-IA) publicly opposed the plan this week, saying he didn’t believe the approach would “benefit of the adoption of and research for modern drugs.” 
Ways and Means Markup
On Wednesday, the House Ways and Means held a markup hearing to examine four pieces of legislation ranging from chronic care management to addressing the opioid crisis. All legislation considered at this markup passed out of the committee. The bills, listed below, included: H.R. 3417, the BETTER Act, had unanimous support and many members spoke of its importance for improving Medicare. H.R. 3429, the HEARTS and Rural Relief Act, was also unanimously approved by the committee, and members emphasized the importance of the bill for veterans, rural hospitals, and disabled Americans. H.R. 3436, the Improving Chronic Care Management Act, was split. Democrats supported the legislation, and support eliminating the copay in Chronic Care Management Services. Republicans did not support this legislation because it eliminates cost-sharing. H.R. 3414, The Opioid Workforce Act of 2019, also had a split vote, with contentious debate on the legislation regarding rural care. Democrats felt the bill was adequate and faced the more immediate problem around opioids. Republicans argued that the bill lacked attention to rural areas and that rural areas are facing the brunt of the opioid crisis. Republicans also said there needed to be a better evaluation of our investment in this training. Amendments were proposed by Rep. Ron Estes (R-KS) and Rep. Jason Smith (R-MO). H.R. 3439, the PATIENTS Act of 2019, was the final bill considered and passed with a split vote. Democrats supported the bill and wanted to reauthorize funding for the Patient-Centered Outcomes Research Institute. Republicans agreed that PCORI produces great research but were concerned about the funding source that was established in the ACA. Amendments were proposed by Rep. Brad Wenstrup (R-OH) and Rep. George Holding (R-NC). Rep Wenstrup’s amendment would have reauthorized funding for PCORI but would have shifted its funding from mandatory to discretionary, with re authorization subject to annual discretionary appropriations. Rep. Holding’s amendment would have permanently repealed the health insurance tax. Both amendments failed. To read an executive summary of the hearing, click here.
Senate Judiciary Markup
The Senate Judiciary Committee held a markup on Thursday (June 27) that discussed four bills aimed at lowering drug prices, three of which – S. 1227, S. 1224, S. 1416 – passed easily with bipartisan support and little discussion. The final bill, S. 440, which aims to prohibit the patent holder from claiming sovereign immunity from administrative review, was met with opposition from committee Democrats. They fear the language is too broad and would severely limit the sovereignty of Native American Tribes. The bill passed on party lines. To read an executive summary on the hearing, click here.
Both the House and Senate have adjourned for the Fourth of July recess. The Senate will reconvene on Monday July 8, with the House having first votes on Tuesday, July 9.
 Roubein, Rachel. “Trump aims at health cost transparency with executive order.” Politico Pro. 24 June 2019. https://subscriber.politicopro.com/article/2019/06/trump-aims-at-health-cost-transparency-with-executive-order-1549570
 Demko, Paul. “Appellate court raises new threat to Obamacare.” Politico Pro. 26 June 2019. https://subscriber.politicopro.com/article/2019/06/appellate-court-raises-new-threat-to-obamacare-3496516
 Owermohle, Sarah. “OMB Reviewing Trump rule tying drug payments to foreign prices.” Politico Pro. 21 June 2019. https://subscriber.politicopro.com/article/2019/06/omb-reviewing-trump-rule-tying-drug-payments-to-foreign-prices-3465041