TRP Health Policy Report

The House and Senate are adjourned until November 12. Despite the break, last week saw lawmakers hold another hearing on the Obama Administration’s response to the Ebola crisis, a day after a doctor who treated patients in Guinea tested positive for the virus in New York City. Last Friday, the House Government Reform Committee held a hearing featuring testimony from officials from the Defense Department, Homeland Security and HHS that cast the federal government’s response and preparedness under a harsh light. Reports of inconsistent Ebola guidelines around the country have prompted calls for significant improvements to stop the virus's spread in New York, Dallas and elsewhere. At a hearing two weeks ago, CDC Director Dr. Tom Frieden faced strong criticism from House Energy and Commerce Committee members, many of whom questioned the credibility of his agency and the Obama Administration in handling the Ebola crisis. In related news, senior Capitol Hill aides say the White House has held preliminary discussions with the Senate about a new funding request to fight Ebola. Last Monday, Senate Appropriations Committee Chairwoman Barbara Mikulski (D-MD) announced that her full panel would meet to discuss the Ebola crisis on November 6, two days after the midterm elections.

Elsewhere, House Majority Leader Kevin McCarthy (R-CA) released a memo last Wednesday outlining the GOP leadership’s goals in the 114th Congress, which begins in January. McCarthy said streamlining government agencies will be a central goal in the House and he expects a Republican Senate to take up energy-related legislation in the new Congress. McCarthy’s memo was released two weeks before Election Day, when many prognosticators expect the House GOP to expand its numbers and Senate majority to flip to the Republicans.
 
When legislators return to Washington following the November elections, the House and Senate are expected to be in session for two weeks before breaking for the Thanksgiving holiday. Lawmakers will return in December, when work will continue on appropriations, expired tax provisions and efforts to curb corporate inversions. Other issues that could be considered during the lame-duck session include defense and intelligence operations reauthorizations and terrorism risk insurance (TRIA) reauthorization, as well as bills related to commerce, sanctions and trade. Healthcare-related items could also theoretically be on the agenda, including a permanent fix of Medicare's sustainable growth-rate formula (SGR) and an extension of funding for the Children's Health Insurance Program (CHIP). Congress may also take up a bill providing additional funds to combat Ebola in Africa and boosting domestic preparedness against the virus.
 
Amid Criticism, CDC Updates Ebola Treatment Guidelines
 
Last Monday, the CDC issued new guidelines for healthcare providers caring for patients with Ebola. CDC Director Dr. Tom Frieden said that anyone who treats Ebola should wear protective gear that does not expose any parts of the skin. Appearing at a press briefing, Frieden also said that health workers will undergo more intense training and be watched carefully while they put on or take off their gear. The preparedness of U.S. healthcare workers is under scrutiny, after two Dallas nurses became infected while treating an Ebola patient and a New York doctor tested positive for the virus. Reportedly, the infected nurses did not wear special protective gear for several days because the patient had not been diagnosed with Ebola.
 
Texas Health Presbyterian Hospital, which cared for the Ebola patient, has blamed the CDC for the spread of the disease. The hospital argued that all workers followed federal guidelines while treating patients, suggesting that the guidelines themselves were insufficient. Many healthcare experts also took issue with CDC's previous hospital guidelines, saying they were too loose. They said the original guidelines did not outline adequate protective gear for health workers. Frieden said the two infections in Texas showed that the existing protocols were not stringent enough. “We may never know exactly [how two health workers became infected], but the bottom line is [the guidelines] didn't work for that hospital,” he said.
 
According to Frieden, the new guidelines were created with input from medical personnel who have already treated Ebola patients in the U.S. They are based on the strict protocols that Doctors Without Borders has been using for years and were reviewed by that organization. Frieden also said that people infected with Ebola are likely better off at specialized centers. The comments mark a shift in stance, as the CDC previously said that any hospital with an intensive care unit could safely treat the disease. Frieden added that the new standards represented a “consensus” by the healthcare workers who have treated people with Ebola in the United States, including those workers at hospitals in Atlanta and Nebraska that have treated the deadly virus without further transmission.
 
HHS Announces $840M Initiative to Improve Care, Reduce Costs
 
Last Thursday, HHS announced that it will provide up to $840 million over four years to improve care quality and efficiency and share best practices among providers. The bulk of the funding will be provided by the Center for Medicare and Medicaid Innovation (CMMI), while $40 million of the funds will come from the Quality Improvement Organization program. Under the Affordable Care Act (ACA), CMMI received $10 billion to develop and test new healthcare delivery models as part of an effort to move away from the traditional fee-for-service model, improve quality of care and lower costs. The practices could include better use of electronic health records, better coordination of care among providers and expanding ways patients can communicate with doctors, federal health officials said.
 
In a statement, HHS Secretary Sylvia Mathews Burwell said that value-based care, as opposed to volume-based care, can improve the experience for patients and help the industry grapple with rising costs. The program will operate on an application-basis, allowing healthcare systems, provider advocacy groups and other players in the medical sector to receive funds to coach individual medical practices on improving services. Applicants will be judged based on their ability to achieve measurable goals, such as reducing unnecessary hospitalizations, the announcement stated. CMS began accepting applications on Thursday, and applications are due by Jan. 6, 2015. CMS expects to announce award recipients in the spring or summer of 2015.
 
Pallone, Eshoo Compete for Top Energy and Commerce Post
 
After 10 months of courting their colleagues, Reps. Frank Pallone (D-NJ) and Anna Eshoo (D-CA) remain in a hotly contested battle to win the top Democratic slot on the influential House Energy and Commerce Committee. The committee is among the top-tier assignments in the House and has principal authority over healthcare legislation. The panel and its ranking member will play crucial roles in any efforts to amend or replace the Affordable Care Act in the next Congress. The current ranking minority member of the committee, Rep. Henry Waxman of California (D-CA) is retiring, as is Rep. John Dingell (D-MI) the Democrat with the most seniority on the panel.
 
Eshoo has the support of her fellow Californian, Minority Leader Nancy Pelosi (D-CA), who has sent out two endorsement letters on her behalf. Other Democrats of the California delegation have been whipping for her, including Rep. Mike Thompson (D-CA) and Education and the Workforce ranking member George Miller (D-CA). While he has not been as outspoken as Pelosi, Minority Whip Steny Hoyer (D-MD) has been actively working for Pallone. Before the October recess, Pallone released a “Dear Colleague” letter, signed by 50 members of the Pallone whip team, including CBC and Hispanic Caucus members, and some more moderate lawmakers as well. Pallone is serving his 13th term representing his New Jersey district and has the most seniority of the remaining members of the committee. He currently serves as the ranking minority member of the Subcommittee on Health.
 
While Pelosi’s endorsement was not surprising, some Hill insiders say her public support gives Eshoo an advantage. But Pallone is two notches above Eshoo in panel seniority – an important factor in a House Democratic Caucus where members put significant stock in tenure. The CBC and Hispanic Caucus are especially adamant about honoring seniority in committee assignments to ensure against slights to minority lawmakers who might be next in line for plum committee assignments. Their support for Pallone suggests that this tradition lives on. Democratic Caucus members won’t vote on race until late-November at the earliest, meaning Pallone and Eshoo will have to stay on the offensive, showing they’re both team players who are willing to help their friends. Since Waxman announced his retirement at the end of January, both lawmakers have both been working to expand their inner circles and bases of support. Pallone and Eshoo's campaign have also ramped up its political contributions, spreading their contributions among current members and Democratic challengers.
 
House Panel Looks to Release Draft '21st Century Cures' Bill in January
 
Last week, key Hill staffers on the House Energy and Commerce Committee said panel leaders hope to release a “21st Century Cures” discussion draft bill in January. In the past year, the committee has held a series of hearings and roundtables, at which lawmakers have examined policies that could accelerate the pace medical treatments are discovered and approved in the United States. Among the priority items under discussion are speeding medical product development process by streamlining FDA reviews, providing added exclusivity, centralizing Institutional Review Board (IRB) reviews and targeting NIH grants, aides say. The committee has collected and posted numerous comments and suggestions from stakeholders on its website. Once a draft bill is released, aides say there will be more hearings to fine-tune the bill, with the goal of generating more ideas and suggestions. Senior sources say the committee has held conversations with the White House and Senate staff in recent weeks, but those interactions could become more concrete once the policies form.
 
Aides for Rep. Diana DeGette (D-CO), who is championing the committee's initiative with full committee Chairman Fred Upton (R-MI), said lawmakers want to make sure NIH and FDA have enough resources and expertise to ensure those agencies are efficient and effective. Committee staffers say other changes also could be made, such as streamlining the grant process so researchers could devote more time to their projects and ensuring young researchers receive grants and are motivated to remain in the field. Among other areas that could be explored are building on patient engagement directives included in the FDA Safety and Innovation Act, providing companies incentives such as additional exclusivity, accelerated approval and fast track designations, devising other methods for expediting drug development, modernizing clinical trials and easing the ability to leverage vast amounts of data.
 
KFF Survey: Most Uninsured Unaware of Next ACA Open Enrollment Period
 
According to a new Kaiser Family Foundation survey, nearly nine of 10 uninsured poll respondents did not know that the Affordable Care Act's next open enrollment period begins in November. The finding comes from the most recent Kaiser Health Tracking Poll, for which researchers surveyed 1,503 U.S. adults between October 8 and October 14. It showed insurers face a tough challenge for the open enrollment period running from November 15 through February 15, during which government officials are aiming to enroll twice as many participants. While experts say it’s better not to heavily promote health coverage when people can’t actually sign up, messages about when enrollment begins, and the availability of help paying premiums, could get the period off to a more robust start.
 
KFF officials said their poll mirrors what other surveys showed before the first open enrollment period. However, they said it was surprising so few people were aware this time around, given recent news coverage of the ACA. The survey also found that two-thirds of uninsured respondents said they know “only a little” or “nothing at all” about the ACA's insurance exchanges and more than half said they did know that they might qualify for financial assistance to purchase exchange coverage. HHS officials have acknowledged that spreading awareness among the uninsured will be difficult compared with last fall, as the first uninsured residents to enroll in coverage likely were more motivated.