Health Policy Report

The Week in Review

 Legislative action last week was highlighted by ongoing deliberation on how to raise the nation’s debt limit by a November 3 deadline – the date the Treasury Department has determined the country’s borrowing capacity will be exceeded. House Republicans have been deliberating on a solution and considered a proposal last week from the Republican Study Committee (RSC) that would link a $1.5 trillion increase in the borrowing authority with a freeze on all major regulations through July 1, 2017, and a vote on a balanced budget amendment by the end of 2015. However on Thursday, House Republicans backed away from the RSC plan, and a clear path forward has yet to emerge. The issue is expected to dominate discourse in Congress this week as the country slowly inches towards default and the financial turmoil that would likely accompany it. 

While Republicans failed to compromise on a debt ceiling solution, the chaos revolving around the House’s top post seems to have finally been resolved. After two weeks of deliberation and calculation, House Ways and Means Chairman Paul Ryan (R-WI) announced that he would run to succeed Speaker of the House John Boehner (R-OH) when the Ohioan steps down at the end of the month. Ryan was seen by analysts as the only Member who could unite the party establishment with its more conservative members, including the Freedom Caucus who announced their “support” of Ryan last week (notably falling short of providing him a full endorsement). Regardless, Ryan is expected to be formally elected by the Republican Conference on Wednesday and approved by the House floor on Thursday, bringing an end to a frenzied few weeks for the Republican Party’s leadership. 

In significant legislative action, the House took another swing at defunding Planned Parenthood and chipping away at the Affordable Care Act (ACA) in a reconciliation package (H.R. 3762) that passed on Friday by a largely party-line vote of 240-189. While the bill passed the House with little conservative opposition, its prospects are less certain in the Senate. A three-senator opposition of Sens. Ted Cruz (R-TX), Mike Lee (R-UT) and Marco Rubio (R-FL) announced late last Thursday that they would oppose any partial repeal of the ACA through reconciliation, favoring a more complete repeal of the law’s root and branch. With the three senators now declared against the bill, Senate Majority Leader Mitch McConnell (R-KY) will need to keep the rest of his 54-member caucus united to secure the 51 votes needed for passage.

Other legislative action in Congress included the markup of a long-awaited $325 billion transportation package (H.R. 3763) in the House Transportation and Infrastructure Committee. The six-year measure is the House’s answer to the Senate’s version (H.R. 22) of long-term transportation funding, and the two sides need to agree to a reauthorization for highway funding prior to its expiration on Thursday. Late last Friday, Republican leaders introduced a plan to pass a three-week authorization patch that would allow for the Senate and House to make the final negotiations on a long-term deal by Thanksgiving. Finally, in news from the White House, President Obama followed through on his veto threat over the 2016 National Defense Authorization Act (NDAA), a funding bill (H.R. 1735) opposed by the President due to its use of designated war funds for regular Pentagon operations and maintenance.

The Week Ahead

The pressing nature of raising the debt limit will make it a priority this week, but the lasting news is likely to be the election Paul Ryan as House Speaker. With party elections set for Wednesday and a floor vote due Thursday, the current House Ways and Means Chairman will be looking to mend fractures within the Republican Party ahead of the 2016 general election.

On the debt ceiling, bipartisan talks for addressing the issue reportedly took place over the weekend. House Majority Leader Kevin McCarthy (R-CA) said on Friday that the chamber is expected to address the borrowing limit this week, but it remains unclear what—if any—policy riders will be included. Freedom Caucus member Rep. John Fleming (R-LA) said that he believes Republican leadership is working on a clean hike and will rely on Democratic votes to get it passed.

While the week will be dominated by conversation on the debt ceiling and new Speaker, it is set to begin with a House floor vote on reauthorizing the Export-Import Bank, thanks to 42 Republicans who teamed up with Democrats to sign a discharge petition forcing consideration of the measure. Under parliamentary rules governing discharge petitions, today is the only day that the measure will be guaranteed a vote, and as such, opponents may seek to attempt a type of House-filibuster, delaying the final vote into the night by seeking a series of procedural votes. The Senate, meanwhile, is set to continue its work on cybersecurity legislation (S. 754) that would provide legal protection to companies that voluntarily share data on cyber threats with the government and others in the industry.

Reconciliation Package Repealing Parts of ACA Passes House

On Friday, the House passed a long-awaited budget reconciliation bill (H.R. 3762) by a largely party-line vote of 240-189. Only seven House Republicans voted against the bill that would repeal parts of the ACA, and Rep. Collin Peterson (D-MN), a vocal opponent of abortion, was the only Democrat to break ranks. The bill would aim to cut the deficit by $78.9 billion through fiscal 2025 using standard rules and $130 billion over the same period if “dynamic scoring” is used to take into account effects on the economy. Specific measures in the bill include repeals of the ACA’s individual and employer mandates, as well as the medical device tax and tax on high-cost insurance plans, known as the ‘Cadillac’ tax. The bill would also bar federal payments to Planned Parenthood following release of covertly made videos purporting to show the organization’s medical director discussing reimbursements for fetal tissue extracted from abortions to be used for medical research.

A small core of conservatives in both chambers, including Sens. Ted Cruz (R-TX), Mike Lee (R-UT) and Marco Rubio (R-FL) were unhappy with the bill’s passage as the legislation does not include a full repeal of the law. They argued that Republican leaders need to pursue full repeal and stand up against the one obstacle that appears to be in their way: the Senate parliamentarian.  Although the bill passed in the House, its prospects are less certain in the Senate. With the three Republicans now opposed to the bill, Senate Majority Leader Mitch McConnell (R-KY) would have to keep the rest of his 54-member caucus united to secure the 51 votes needed for passage. As budget reconciliation bills do not require the 60-vote threshold typically required of major legislation in the Senate, Republicans have viewed the bill as a way to push conservative priorities to the president’s desk – even if they are likely to meet a veto.

Senate's '21st Century Cures' Bill Set to Be Introduced in HELP Committee

The Senate Health, Education, Labor, and Pensions (HELP) Committee will soon be introducing their version of a medical innovation bill as a counterpart to the House’s 21^st Century Cures Act (H.R. 6), which overwhelmingly passed the lower chamber in July. HELP Committee Chairman Lamar Alexander (R-TN) is aiming to shape the Senate’s bill through committee markup and floor debate, a strategy that diverges from the traditional approach of moving a manager’s package crafted behind the scenes through committee with few changes. The Senate version is expected to reflect many of the provisions in the House-passed ‘Cures’ bill, including increased financial support for medical innovation initiatives that focus on areas in need of improvement within the Food and Drug Administration (FDA) and the National Institutes of Health (NIH).

The Committee aims to use a robust markup process—similar to the Committee’s action on the replacement to No Child Left Behind—to hammer out details on controversial issues in the medical innovation bill, such as maintaining mandatory funding for the NIH in an era of government-wide spending caps.  Under such a process, the initial bill will likely only include provisions that both parties can agree upon, and will then let committee members debate numerous amendments during markup. While the bill is expected to include a number of the same provisions as its House counterpart, answers to issues such as the implementation of electronic health records and the regulation of laboratory developed tests remain contentious.

Obama and GOP Find Common Ground on Fighting Drug Abuse

Last Wednesday, President Obama traveled to West Virginia, a state that has been hit particularly hard with drug abuse problems, to announce new executive actions focusing on the issue. Among the proposals outlined in the speech, the President ordered that the federal government’s healthcare professionals be trained about safe prescribing practices for drugs that can be misused. Additionally, as part of this initiative, more than 40 healthcare provider groups have committed to ensuring that 540,000 health professionals complete opioid prescriber training.

 Major network TV channels and sports leagues are expected to join the cause, with organizations such as the NBA donating media space for public service announcements about the risks of prescription drug misuse. Although there remain some points of contention, the speech represented a rare moment of bipartisanship between President Obama and congressional Republicans. Both parties have moved towards an approach that highlights treatment over incarceration, but, as always, the issue of funding may get in the way of tangible action. The President’s proposal includes a request for an additional $133 million to fight drug abuse, but such a move will require the approval of budget hawks in Congress.

Clinton Raises Concerns Over Insurance Mergers

On Wednesday, Democratic presidential candidate Hillary Clinton took a stab at the health insurance industry by criticizing the big-ticket mergers of Aetna-Humana and Cigna-Anthem as moves that would stifle competition and shift power away from consumers. The trade association American Health Insurance Plans (AHIP) was quick to defend the industry by accusing prescription drug prices and medical services costs for consumers’ increased out-of-pocket spending. Clinton, who recently released plans to lower prescription drug prices and out-of-pocket costs, announced that she would publish more delivery reform ideas in the near future. While many provider groups, such as the American Hospital Association and the American Medical Association, have raised concerns over the mergers, AHIP argues that plans' efforts to keep coverage affordable have been undercut by years of hospital consolidation. On Monday, shareholders approved the Aetna-Humana merger and it is now expected to undergo an anti-trust review by the Department of Justice.