United States: Capitol Hill Healthcare Update - June 10, 2019

Below is this week's "Capitol Hill Healthcare Update," which is posted on Mondays when Congress is in session.


Senate Finance Committee Chairman Chuck Grassley, R-Iowa, had hoped his panel could vote on legislation this month to tackle prescription drug prices and lower seniors' out-of-pocket costs for medicine, but committee action on his still-under-development bill is likely to slip to July.

Separately, Grassley told reporters last week that his legislation would require prescription drug manufacturers to pay a greater percentage of seniors' drug costs under Medicare Part D. He also said his bill would allow generic manufacturers to gain access to drugs protected by the FDA's risk evaluation and mitigation strategy safety program.

The chairman also spoke favorably of merging his legislation with elements of a proposal backed by Senate HELP Committee Chairman Lamar Alexander, R-Tenn., that aims to reduce overall healthcare costs. Alexander's bill includes narrow drug pricing initiatives; Grassley's bill is expected to be more sweeping.

Other senators also plan to introduce drug pricing bills they hope will become candidates for Grassley's package. For example, Sen. Bill Cassidy, R-La., is developing legislation that would promote insurance coverage of biosimilars, reform pharmacy fees and allow the FDA to block procedural efforts to delay development of generic drugs. Sen. Mark Warner, D-Va., is updating previously introduced legislation to spur value-based payment arrangements by hospitals and clinics for expensive inpatient and physician-administered drugs

Meanwhile, House Democrats continue to wrestle with their plans to reduce prescription drug costs. Some lawmakers – including Rep. Lloyd Doggett, D-Texas, the chairman of the Ways and Means Health Subcommittee – want to go big: Medicare should negotiate prices and invalidate patents for manufacturers that fail to reach an agreement with the government.

But House Speaker Nancy Pelosi, D-Calif., appears to be preparing for a legislative package that falls short of that – setting up a potential flashpoint within her caucus.


The House Ways and Means Committee will hold a hearing Wednesday on Democrats' single-payer "Medicare for All" initiative as well as proposals that would allow Americans younger than 65 years old to buy into Medicare coverage.

Republicans have criticized the effort by saying Democrats' plans for single-payer coverage would end employer-sponsored insurance as well as Medicare Advantage, would increase taxes, and would reduce payments to physicians, hospitals and other providers.

The House Energy and Commerce Health Subcommittee will hold a hearing Wednesday on surprise medical bills. Lawmakers in both parties and both chambers are developing legislation to address scenarios in which patients receive surprise medical bills, often for out-of-network services.

A Senate Judiciary subcommittee plans a hearing Wednesday on vertical consolidation within the healthcare industry.

A House Veterans' Affairs subcommittee will hold a hearing Wednesday on the use of electronic health records at the departments of Defense and the Veterans Affairs.

The House Small Business Committee will hold a hearing Wednesday on how rising student loan debt is impacting small medical practices, including sole practitioners.


Several medical device industry executives will be on Capitol Hill this week to lobby for the repeal of the Affordable Care Act's 2.3% excise tax on the sales of everything from surgical gowns and gloves to drug-coated balloons.

The fly-in is being coordinated by the device industry trade group AdvaMed.

Meanwhile, the Senate Finance Committee last month established task forces to examine sector-specific temporary tax provisions that have expired or are soon scheduled to expire. The task force examining health-sector taxes – led by Sens. Pat Toomey, R-Penn., and Bob Casey, D-Penn. – will be looking to develop a permanent solution to the medical device tax.

The device tax has been suspended since 2016 but is scheduled to go back into effect Jan. 1 unless Congress acts to block it. Bipartisan legislation has been introduced in the House and Senate to repeal the tax.

The Senate task force is accepting written statements from manufacturers and other stakeholders this month. A behind-closed-doors listening session with senators on health taxes – including the medical device tax – is scheduled for next week.


The House is scheduled to vote this week on a $1 trillion package of appropriations bills that includes an $8.8 billion boost for the Department of Health and Human Services (HHS).

Overall, HHS would see $99.4 billion in fiscal 2020 under the plan developed by House Democrats. The administrative budget for the Centers for Medicare and Medicaid Services would increase by $399 million; the National Institutes of Health's budget would increase by $6.9 billion to $41 billion; and the Centers for Disease Control and Prevention's budget would increase by $1.7 billion to $8.2 billion.

More than 60 amendments are possible just for the HHS portion of the bill, so final numbers and program details could change. The overall bill reflects House Democrats' policy and budget priorities and still must be approved by the Senate, where Republicans have different policy and spending objectives.

Fiscal 2020 begins Oct. 1.


New Jersey's two Democratic senators last week demanded answers from American Medical Collection Agency, the billing collections vendor at the center of a data breach that compromised the personal, financial and medical information of 20 million LabCorp, Quest Diagnostics and Opko Health patients.

Sens. Bob Menendez, D-N.J., and Cory Booker, D-N.J., want to know how the breach went unnoticed for nearly a year. Menendez is a member of the Finance Committee, which has jurisdiction over Medicare and Medicaid.

Separately, Sen. Mark Warner, D-Va., earlier this year sought information from trade groups representing hospitals, physicians, health IT and medical device manufacturers on policies to improve healthcare cybersecurity.

Warner said sharing of patients' health data and tech solutions such as telemedicine represent a boon to patients, particularly in rural and underserved areas. But the technology also creates risk, he said.

Warner is a member of the Finance Committee and is the top Democrat on the Intelligence Committee.


Two House lawmakers introduced legislation last week that would create a multistate research project in conjunction with the Centers for Disease Control and Prevention (CDC) to reduce the incidence of gestational diabetes and improve outcomes for both mothers and their babies.

The bill by Reps. Eliot Engel, D-N.Y., and Michael Burgess, R-Texas, would also authorize federal grants for surveillance and public health research on gestational and type 2 diabetes. Burgess, the top Republican on the Energy and Commerce Health Subcommittee, is a former obstetrician and gynecologist.

Nearly 10% of all pregnancies in the United States are affected by gestational diabetes, according to the CDC.


Bipartisan legislation introduced in the House last week aims to streamline and standardize prior authorization requirements in Medicare Advantage programs.

In addition to creating transparency in insurers' prior authorization decisions, the bill would require that health plans make prior authorization available in "real time" for routinely approved services. The legislation also includes a surgical exception that allows a surgeon to rely on the initial authorization if additional services are needed while the patient is undergoing surgery.

The bill was introduced by Reps. Suzan DelBene, D-Wash., and Mike Kelly, R-Penn.

This isn't the first bipartisan bill that targets what insurers say are important cost-containment tools.

Separate bipartisan legislation introduced in the House earlier this spring would require employer-sponsored health plans that utilize step therapy protocols to create exceptions for patients when medically necessary.


Bipartisan legislation introduced in the Senate last week aims to streamline consumers' access to mental health and substance abuse treatment by requiring insurers to give the same access to care for a patient with a mental health diagnosis as they do for a patient with a broken leg.

The bill was introduced by Sens. Bill Cassidy, R-La., and Chris Murphy, D-Conn. Cassidy, a former gastroenterologist, serves on the Finance Committee, which has jurisdiction over Medicare and Medicaid. Murphy serves on the HELP Committee, which oversees some healthcare programs.

Mental health and addiction parity laws have been on the books for more than a decade, and are designed to make insurance coverage for mental health and substance use disorder treatment no more restrictive than for other medical conditions. But patient advocates say health plans and insurers are not meeting the law's requirements that govern how they design and apply managed care practices for mental health and substance use services.

Rep. Katie Porter, D-Calif., is introducing the House version of the senators' bill.

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