Health Policy Report (3/15)

March 15, 2021

After President Joe Biden signed the $1.9 trillion American Rescue Plan Act into law last Thursday, Congress will next look to ensure that the massive increase in deficit spending does not trigger statutorily-required across-the-board spending cuts. According to House Majority Leader Steny Hoyer (D-MD), lawmakers will take up a bill this week that seeks to avert billions of dollars in automatic spending cuts — known as sequestration — to Social Security, Medicare, Medicaid, and other programs required under the 2010 pay-as-you-go (PAYGO) law. If lawmakers do not act on the PAYGO sequester prior to the end of this year’s session, the Congressional Budget Office (CBO) estimated that the increase in spending would trigger roughly $381 billion in funding cuts annually over five years, beginning in fiscal year (FY) 2022. In the past, Members have typically coalesced behind a PAYGO waiver in a bipartisan manner, most recently in 2017 following passage of the GOP’s Tax Cuts and Jobs Act (TCJA).

Meanwhile, leaders of the House Small Business Committee reached a bipartisan deal to extend the Small Business Administration’s (SBA) Paycheck Protection Program (PPP) as the end-of-March expiration date for loan applications approaches. The agreement brokered by Chairwoman Nydia Velazquez (D-NY) and Ranking Member Blaine Luetkemeyer (R-MO) would extend the PPP loan application date to May 31 and allow SBA to continue processing pending applications for 30 days after the new expiration date. House lawmakers will take up the bipartisan measure under suspension of the rules early this week, after which the Senate will look to reach a unanimous consent agreement to swiftly place the bill on President Biden’s desk for signature. 

In addition to votes on the PAYGO waiver and PPP measure, House lawmakers will meet to consider two immigration-related measures. Specifically, Members will take up a bill to provide a pathway to citizenship for recipients of the Deferred Action for Childhood Arrivals (DACA), Temporary Protected Status (TPS), and Deferred Enforced Departure (DED) programs. House Democrats will also call up a measure that seeks to provide legal status for migrant farmworkers and reform the H-2A agricultural visa program. In addition to the immigration legislation, lawmakers will also consider a bill that would reauthorize the Violence Against Women Act, as well as a resolution that would remove the deadline for ratification of the Equal Rights Amendment. The expected passage of these bills in the lower chamber is likely to increase pressure on Senate Democrats to modify or eliminate the filibuster as Democrats seek to clinch legislative wins on key policy priorities.

When the Senate convenes for legislative business this week, Senators will resume consideration of pending presidential nominations, starting with Rep. Deb Haaland’s (D-NM) nomination to lead the Department of Interior. A final confirmation vote for Rep. Haaland is expected at 5:30 PM this evening. Other Biden nominees up for consideration next week include Isabella Guzman to be Administrator of SBA and Katherine Tai to be U.S. Trade Representative. It is also possible that Majority Leader Chuck Schumer (D-NY) will call up Xavier Becerra’s nomination to be Secretary of Health and Human Services (HHS) after the Senate voted (51-48) last week to discharge his nomination from the Finance Committee. 

Biden to Mandate States Make All Adults Eligible for COVID-19 Vaccines by May 1

In remarks marking the year anniversary of the COVID-19 public health emergency last Thursday, President Biden outlined plans to compel states make all adults eligible for the COVID-19 vaccine by May 1. He noted he would use every power he has to put the nation on “war footing” to eradicate the virus, and would direct all states, tribes, and territories to make all individuals 18 and older eligible to be vaccinated no later than May 1. He clarified that the federal government would accomplish expedited vaccination by upping the rate to over two million shots a day. The administration will also launch new tools to make it easier for individuals to find available vaccine appointments, including a new federal website. The president urged Americans to get vaccinated and continue to listen to science, noting that if everyone does their part, there could be normalcy by the Fourth of July holiday.

Earlier last week, the administration announced it had purchased an additional 100 million doses of the Johnson & Johnson COVID-19 vaccine. President Biden explained that the nation would have enough doses for all adults by the end of May and reach his goal of 100 million shots by his 60th day in office — 40 days ahead of schedule. Biden also announced the Centers for Disease Control will continue to release guidance for vaccinated individuals regarding the workplace, places of worship, and travel to help lessen the confusion.

Former FDA Commissioners Urge Biden to Fill Role

Six former Food and Drug Administration Commissioners wrote to President Biden last week urging him to nominate a permanent chief. President Biden is currently on schedule to nominate an FDA Commissioner later in his tenure than both President Trump and President Obama. The former commissioners stated that it is essential for the president to prioritize FDA leadership so that the agency can advance its mission and emphasized the FDA’s role in responding to the COVID-19 pandemic efficiently and effectively. Those signing the letter included former commissioners Robert Califf, Mark McClellan, Scott Gottlieb, Andrew von Eschenbach, Jane Henney and Margaret Hamburg.

While the commissioners do not explicitly endorse a candidate for the role, they note Acting FDA Commissioner Janet Woodcock is a “highly effective advocate” for advancing FDA’s mission. Dr. Woodcock is currently considered a frontrunner for the position, along with former FDA Principal Deputy Commissioner Joshua Sharfstein. Dr. Woodcock has received endorsements from a great variety of advocacy organization and doctors, although has been opposed by a group of Democratic lawmakers for her role in the opioid crisis. Meanwhile, Dr. Sharfstein largely has the support of members of academia.

Biden Administration Vacates Public Charge Rule

The Department of Homeland Security formally removed the Trump administration’s public charge rule through a new rulemaking set to be published in the Federal Register this Monday. The administration will return to a 1999 interpretation of the public charge policy that does not include the Medicaid program or Children’s Health Insurance Program enrollment in public charge determinations. The formal removal comes shortly after the Biden administration informed the courts it would not defend the previous administration’s rule. The Supreme Court dismissed three cases challenging the Public Charge policy Tuesday after the Department of Justice and lawyers for immigration advocacy groups and states filed joint stipulations calling for the cases to be dismissed. The cases dismissed include Department of Homeland Security v. New York, Mayorkas v. Cook County, and United States Citizenship and Immigration Services v. City and County of San Francisco.  Despite these actions, public charge litigation could return as 12 states filed a motion on Wednesday to intervene in a public charge case at the Ninth Circuit, arguing that invalidating the 2019 public charge rule will cost the states an estimated $10.1 billion.

President Biden to Direct $2.5 Billion to Address Mental Health and Substance Abuse Crisis

President Biden will direct $2.5 billion to address the rising mental health and substance abuse crises as a result of the pandemic, according to Department of Health and Human Services officials. The funding will be aimed at increasing access to behavioral health services and will be allocated to states by the Substance Abuse and Mental Health Services Administration. The Substance Abuse Prevention and Treatment Block Grant will be awarded $1.65 billion to improve existing treatment infrastructure and implement additional prevention and treatment programs, whereas $825 million will be allocated to the Community Mental Health Services Block Grant to assist states in bolstering behavioral health services.

President Biden emphasized the need to address the growing mental health and substance abuse crises on the campaign trail. Surveys conducted by the Centers for Disease Control and Prevention (CDC) found that 41 percent of Americans are struggling with mental health or substance abuse related to pandemic stressors, and HHS officials expect the number of suicides to increase due to COVID-19. Additionally, preliminary data from the CDC shows the number of drug overdoses through July 2020 increased 24 percent from 2019.

Supreme Court Cancels Arguments in Medicaid Work Requirements Case

Following a request by the Department of Justice, the Supreme Court announced last Thursday it would cancel arguments in a case challenging the legality of Medicaid work requirement demonstrations in Arkansas and New Hampshire. The Biden administration asked SCOTUS to suspend the arguments while it reviews the approval of work requirement waiver approvals in several states. The administration indicated in a court brief that it could withdraw waivers in the nine states with approved demonstrations, making the case before the Supreme Court moot. The brief noted that imposing work requirements on Medicaid benefits was at odds with the program goal of providing health care to low-income individuals. Oral arguments had been scheduled for March 29.