Health Update (November 18)
While the focus in Washington was primarily on the public impeachment hearings of President Trump, the relevant health care committees continued their business as usual with two hearings and a mark-up. The Trump administration released new transparency rules aimed at making it easier for consumers to learn how much hospitals charge health insurers. There have also been rumors of an agreement between Congress and the administration on spending levels for several FY 2020 bills to avoid a government shutdown. Youth vaping also took center stage this week, as the Senate HELP Committee held a hearing and the House Energy & Commerce Health Subcommittee held a markup on H.R. 2339, the “Reversing the Youth Tobacco Epidemic Act of 2019,” along with two bipartisan bills on maternal health. Additionally, the House Ways & Means Committee held a hearing on aging and long-term care, where there was strong bipartisan agreement.
Hearings and Markups
House E&C Markup
The House Committee on Energy & Commerce Subcommittee on Health held a markup on Wednesday (Nov. 13) on bills H.R. 2339, the “Reversing the Youth Tobacco Epidemic Act of 2019”; H.R. 4995, the “Maternal Health Quality Improvement Act of 2019”; H.R. 4996, the “Helping Medicaid Offer Maternity Services (MOMS) Act of 2019”; and H.R. 2387, the “Stop the Overuse of Petitions and Get Affordable Medicines to Enter Soon (STOP GAMES) Act of 2019.” The subcommittee advanced a measure that would ban flavored tobacco products, push the purchasing age up to 21 nationwide and ban online sales. Full Committee Chairman Frank Pallone (D-NJ) and Rep. Donna Shalala (D-FL)’s measure, H.R. 2339, passed by voice vote. Some Democrats on the panel argued that a menthol ban would disproportionately impact African-Americans who primarily buy the products, while Rep. Kathy Castor (D-FL) pushed for premium cigars to be exempted from FDA regulation except for buying-age requirements. The subcommittee adopted an amendment from Rep. G.K. Butterfield (D-NC) that would instruct CDC to focus on smoking cessation among under-served communities and particularly racial minorities. Lawmakers also adopted language from Ranking Member Michael Burgess (R-TX) to require the FDA submit annual reports on how it spends user fees collected from industry. Republicans argued that the underlying bill went too far and would not solve the current health crises. Lawmakers on the panel also advanced a pair of bills, H.R. 4995 and H.R. 4996, aimed at lowering maternal mortality rates. One measure would fund research on best practices for healthcare professionals, expand telehealth grants and offer training for providers on how to recognize and address biases in caring for mothers of color. The other would incentivize states to extend Medicaid or CHIP coverage for new mothers for up to a year postpartum. An executive summary of this markup can be found here.
House Ways & Means Hearing on Aging
The House Committee on Ways and Means held a hearing on Thursday (Nov. 14) entitled, “Caring for Aging Americans.” The committee members touted aging as one of the more bipartisan issues that can be addressed in the coming months. Chairman Richard Neal (D-MA) mentioned how deeply personal the issue is to all Americans and also highlighted the high expenses families face when finding the proper care for elders – often exceeding $100,000 per year. Notable testimony and member statements featured tragic stories of nursing home abuses and the lack of funding for caregivers, especially those helping patients with Alzheimer’s and Dementia. Both Democrats and Republicans continually asked witnesses as to what the best legislative actions are to improve the quality of care in nursing homes, care in rural areas, and to better train and fund caregivers. Dr. Lynn said that, often, long-term care should be included in Medicare and that caregivers are some of the most vital people in communities and must be better funded and trained in the near future. Mr. Mollot addressed numerous long-term care questions throughout the hearing and noted that CMS needs to do a better job of implementing its rules and oversight in communities across the country. An executive summary of this hearing can be found here.
Senate HELP Hearing
The Senate HELP Committee held a hearing on Wednesday (Nov. 13) entitled, “Examining the Response to Lung Illnesses and Rising Youth Electronic Cigarette Use.” Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) expressed serious concern over the sharp increase in the number of kids and teenagers using e-cigarette and vaping products. Both called upon government agencies to address the issue; Murray harshly criticized the Trump administration for lax enforcement and delayed oversight of products. Witnesses Mitch Zeller and Anne Schuchat described their respective agencies’ responses to both the rise in youth e-cigarette use and the recent outbreak of serious lung illnesses associated with vaping. In the question period, lawmakers expressed exasperation over how quickly the crisis expanded and urgently sought updates on how the FDA and CDC plan to proceed. Alexander, Murray, and Tim Kaine (D-VA) had tough questions for Mr. Zeller about FDA practices. When lawmakers asked him for specifics about the administration’s announced flavor ban policy, Zeller refused to discuss what he called “the deliberative policy process” and suggested that the committee direct any questions about current policy to the White House. An executive summary of this hearing can be found here.
White House Transparency Rules
On Friday (Nov. 15), The Trump administration announced new rules aimed at making it easier for consumers to learn how much hospitals charge health insurers — part of a broader transparency push that’s prompted threats of industry lawsuits. One proposed rule targets health plans in both the Affordable Care Act (ACA) exchanges and employer-sponsored insurance market, the latter of which covers 155 million Americans and is where costs have been growing the most. Plans would have to disclose the rates they have negotiated with providers in their networks, as well as the amounts they will allow for out-of-network care. Insurers would also have to tell patients in real-time, through an online tool, what they’ll owe out-of-pocket for all covered health care services. The requirement could make it easier for people to compare the costs for specific doctors or hospitals before they receive care. The administration also finalized a separate rule for hospitals, first proposed in July. Effective Jan. 2021, facilities would have to disclose currently confidential rates they’ve negotiated with insurers; what the hospital is willing to accept in cash from a patient and the minimum and maximum negotiated charges. The requirement would apply for all items and services and be available online in a single data file. Hospitals will have to post that information online for 300 common services such as X-rays and lab tests in an easily understandable format. CMS will specify 70 of these services, and hospitals can choose the rest. Hospitals that don’t comply could face fines of up to $300 per day. 
Latest on CR
Congressional leaders are close to securing a deal with the White House on spending levels for a dozen fiscal 2020 bills that will fund the day-to-day operations of the federal government. An agreement could be reached as soon as Friday or Monday. Once those subcommittee allocations, known as 302(b)s, are set, the House and Senate Appropriations subcommittees will work out the details of their individual bills, including how much to provide for President Donald Trump’s border wall.  It is expected that there will be an extension of the extenders package until Dec. 20, but no new policy offsets are expected.
 Luthi, Susannah. “White House rolls out sweeping transparency rules for hospitals, insurers.: Politico Pro. 15 Nov. 2019. https://subscriber.politicopro.com/article/2019/11/white-house-rolls-out-sweeping-transparency-rules-for-hospitals-insurers-3974064
 Emma, Caitlyn. “Congress nears deal with White House to set spending levels for appropriations.” Politico Pro. 14 Nov. 2019. https://subscriber.politicopro.com/article/2019/11/congress-nears-deal-with-white-house-to-set-spending-levels-for-appropriations-3974051