United States: Capitol Hill Healthcare Update - April 1, 2019

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

REPUBLICANS BALK AT TRUMP'S CALL FOR NEW HEALTHCARE BILL

President Donald Trump last week said Republicans would introduce legislation to replace the Affordable Care Act (ACA) after he called on federal courts to strike down the law, but GOP lawmakers on Capitol Hill don't want to renew a policy fight many believe cost them control of the House in 2018.

Congressional Republicans were dumbfounded when the Trump doubled down on his administration's decision to ask a federal court in New Orleans to overturn the ACA by saying Congress could swiftly pass a new healthcare law. "The Republican Party will become 'The Party of Healthcare!' Trump tweeted last week.

Republicans famously couldn't pass ACA replacement legislation in 2017, when the party controlled both chambers in Congress. In fact, despite campaigning against the ACA for nearly a decade, the GOP has never been able to reach consensus on replacement legislation.

Individual GOP lawmakers – such as Sens. Bill Cassidy, R-La., and John Barrasso, R-Wyo. – are working on component pieces of healthcare legislation. But the party is light years away from agreement on the law's most thorny issues, such as how to keep insurance premiums low but still cover pre-existing conditions.

Senate Majority Leader Mitch McConnell, R-Ky., said he "looks forward to what the president is proposing and what he can work out with [House Speaker Nancy Pelosi, D-Calif.]." McConnell doesn't want the Senate to lead on what likely would be a political fool's errand.

Senate Finance Committee Chairman Chuck Grassley, R-Iowa., echoed McConnell's statement, saying any healthcare legislation advancing in the divided Congress would need to be "very, very bipartisan." When asked by reporters whether he's working on ACA replacement legislation, Grassley flatly said, "no."

Meanwhile, sensing Republicans' political peril, House Democrats scheduled a vote Tuesday on a resolution reaffirming support for popular items in the ACA, such as coverage for pre-existing conditions, while criticizing Trump's decision to try to overturn the health law in the courts.

HOUSE PANEL TO PROBE SURPRISE MEDICAL BILLS

The House Education and Labor Subcommittee on Health will hold a hearing Tuesday on surprise medical bills, which can occur when patients receive invoices for hospital services or physician treatments outside their insurance networks.

The hearing will mark the first House action on the issue, which has gained increasing attention in recent months. The White House in February hosted a roundtable with patients who received surprise medical bills.

Sens. Bill Cassidy, R-La., Michael Bennet, D-Colo., and Maggie Hassan, D-N.H., are working on bipartisan legislation to address the issue. Senate HELP Committee Chairman Lamar Alexander said he and the panel's top Democrat, Sen. Patty Murray, D-Wash., would introduce legislation later this year putting limits on surprise billing.

Scheduled subcommittee witnesses include Christen Linke Young, a health fellow at the Brookings Institution; Ilyse Schuman, a senior vice president of health policy at American Benefits Council; Frederick Isasi, executive director of Families USA; and Jack Hoadley, a public policy professor at Georgetown University.

NIH'S BUDGET SUBJECT OF APPPROPRIATIONS HEARING

NIH Director Dr. Francis Collins will highlight a House Appropriations subcommittee hearing Tuesday on his agency's fiscal 2020 budget request.

President Donald Trump last month proposed reducing NIH's budget by 12 percent, or about $5 billion.

Funding for the government's basic medical research agency has been a favorite for lawmakers, and Congress is unlikely to acquiesce to the White House's request to cut NIH's funding this year.

In fact, Rep. Rosa DeLauro, D-Conn., the chairwoman of the Appropriations Committee's health panel, told reporters: "It would be a cold day in hell before I helped pass a budget like this."

In addition to Collins, scheduled witnesses include Dr. Diana Bianchi, director of the National Institute of Child Health and Human Development; Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; Dr. Gary Gibbons, director of the National Heart Lung and Blood Institute; Dr. Doug Lowy, deputy director of the National Cancer Institute; and Dr. Nora Volkow, director of the National Institute on Drug Abuse.

HOUSE OKs LEGISLATION ON MEDICAID DRUG MISCLASSIFCIATION

The House last week approved legislation that would permit HHS to fine pharmaceutical manufacturers that knowingly overcharge Medicaid by misclassifying their prescription drugs as generics.

An HHS inspector general report in 2017 found 3 percent of drugs in the Medicaid program may have been misclassified, with Medicaid being overcharged $1.3 billion in 2016 for just 10 of those drugs.

Drugmamkers face a maximum $100,000 penalty today for each item of false information provided to HHS. The bill would force companies to repay the government the difference for not properly classifying their drugs as generics.

The House-approved measure enjoys bipartisan support in the Senate, where Finance Committee Chairman Chuck Grassley, R-Iowa, and the panel's top Democrat, Sen. Ron Wyden, D-Ore., back the bill.

ANOTHER GOP SENATOR WEIGHS IN WITH DRUG PRICING LEGISLATION

Freshman Sen. Rick Scott, R-Fla., last week introduced legislation that would prohibit pharmaceutical manufacturers from setting retail prices higher than those of prescription drugs sold in other industrialized countries.

Scott, Florida's former two-term governor, would block drug companies from charging U.S. consumers more than the cost of drugs sold in Canada, France, the United Kingdom, Japan or Germany. The legislation takes a cue from President Donald Trump's controversial proposal to fix U.S. prices for physician-administered drugs to an index of prices paid in foreign countries where governments set prices.

Scott's bill would also require pharmacies to inform patients if paying cash for prescription drugs would be cheaper than using their insurance.

HOUSE SUBCOMMITTEE APPROVES DRUG-PRICING BILLS

The House Energy and Commerce Subcommittee on Health last week approved legislation addressing prescription drug prices and provisions to shore up Affordable Care Act markets.

The drug-pricing bills focused on limiting the practice of delaying generic products from coming to market, including pay-for-delay arrangements and so-called exclusivity parking.

The subcommittee also approved legislation by Rep. David Cicilline, D-R.I., that would allow generic manufacturers to gain access to drugs protected by the FDA's risk evaluation and mitigation strategy safety program. The legislation is a priority for full committee Chairman Frank Pallone, D-N.J., and its Senate version is being pushed by Finance Committee Chairman Chuck Grassley, R-Iowa.

HOUSE SUBCOMMITTEE HEARING TO PROBE INSULIN PRICES

Keeping up Congress' scrutiny on rising insulin costs, a House subcommittee on Tuesday will hear from patient advocates and researchers about ways to reverse recent price spikes.

The Energy and Commerce Subcommittee on Oversight and Investigations will examine supply chain issues for insulin and a lack of competition.

Subcommittee Chairwoman Diana DeGette, D-Colo., has frequently questioned manufacturers over insulin prices. DeGette is also co-leader of the Congressional Diabetes Caucus.

Scheduled witnesses include Gail DeVore, a patient advocate from Colorado with type 1 diabetes; Dr. William Cefalu, chief scientific officer at the American Diabetes Association; Dr. Alvin Powers, director of the division of diabetes, endocrinology and metabolism at Vanderbilt University Medical Center; Dr. Kasia Lipska, a clinical investigator at Yale University Medical Center; Christel Marchand Aprigliano, CEO of Diabetes Patient Advocacy Coalition; and Aaron Kowalski, chief mission officer of the Juvenile Diabetes Research Foundation.

Last month, Sens. Dick Durbin, D-Ill., Kevin Cramer, R-N.D., Bill Cassidy, R-La., and Tina Smith, D-Minn., called on the FDA to change a recent agency guidance that the lawmakers said would block new generic insulin products.

The Senate Finance Committee and the Senate Aging Committee are also examining insulin prices.

Rep. Peter Welch, D-Vt., introduced legislation in February that would allow patients, pharmacists and wholesalers to import insulin from Canada and other countries.

BIPARTISAN BILL CALLS FOR ALZHEIMER'S STUDY

Bipartisan legislation introduced in the House last week would require CMS to implement a study on antipsychotic prescribing practices in non-nursing home settings for individuals with Alzheimer's.

Introduced by Reps. Annie Kuster, D-N.H., Christopher Smith, R-N.J., and Maxine Waters, D-Calif., the bill would extend the current CMS practice of data collection on prescribing practices in nursing homes to other settings. The lawmakers said the bill would provide Alzheimer's patients, caregivers, doctors and lawmakers with information needed to reduce inappropriate use of medications and improve overall care.

Antipsychotic medications are typically used to treat individuals with illnesses such as schizophrenia and bipolar disorder, and they are sometimes prescribed to dementia patients to control behavior. More than 170,000 Medicare beneficiaries living outside of nursing homes were prescribed antipsychotic drugs in 2012, the lawmakers said.

Smith and Waters are the co-leaders of the Congressional Alzheimer's Caucus.

Meanwhile, the Senate Aging Committee will hold a hearing Tuesday on new directions in biomedical research and caregiving for Alzheimer's disease.

HOUSE OKs BILL RELATING TO KIDS WITH MEDICALLY COMPLEX CONDITIONS

The House last week approved on a voice vote bipartisan legislation that would allow states to provide coordinated care for children with medically complex conditions through pediatric health homes.

Introduced by Rep. Raul Ruiz, D-Calif., the legislation includes several Medicaid provisions previously introduced but not enacted, including the provision creating a state option to coordinate care for kids with medically complex conditions. The overall bill is co-sponsored by Reps. Kurt Schrader, D-Ore., Markwayne Mullin, R-Okla., and Fred Upton, R-Mich.

The legislation also aims to protect Medicaid recipients of home- and community-based services against spousal impoverishment by renewing through September a federal provision that disregards a spouse's income when determining Medicaid eligibility.

BIPARTISAN BILL WOULD BOOST PHSYICIANS IN RURAL AREAS

Bipartisan legislation introduced in the Senate last week aims to increase the number of doctors in rural and other medically underserved areas.

Introduced by Sens. Amy Klobuchar, D-Minn., Susan Collins, R-Maine, and Jacky Rosen, D-Nev., the legislation also would allow international doctors to remain in the United States after completing their residency under the condition they practice in underserved areas, such as rural communities.

Currently doctors from other countries working in America on J-1 visas are required to return to their home country for two years after their residency expires before they can apply for another visa or green card.

The senators' bill won endorsements from the American Medical Association, the American Hospital Association and the Association of American Medical Colleges.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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