Health Policy Report (3/2)

The Week in Review

Former Vice President Joe Biden scored a key victory in the 2020 Democratic presidential primary over the weekend with a commanding victory in Saturday’s contest in South Carolina. Vice President Biden won the Palmetto State with 48 percent of the vote, with Sen. Bernie Sanders (I-VT) finishing second and earning a small share of the delegates. Sen. Sanders and Vice President Biden are now neck and neck on the delegate leaderboard heading into the “Super Tuesday” primaries, where 14 states will hold primaries that will allocate a more than 1,300 delegates.

In Washington, House lawmakers cleared a comprehensive tobacco-related measure that seeks which seeks to curb the use of e-cigarettes among youths and promulgate further regulations on flavored tobacco products. The bill passed narrowly after some Democrats expressed concerns that the legislation would lead to discrimination. The Reversing the Youth Tobacco Epidemic Act faces a difficult path forward after the Trump administration issued a veto threat yesterday, arguing that it contains provisions that are not supported by available evidence regarding tobacco harm reduction and use habits.

Meanwhile, the Senate took a pair of procedural votes on abortion-related measures aimed at messaging for the 2020 election. The bills would have established requirements for the degree of care a health care practitioner must exercise in the event a child is born alive following an abortion or attempted abortion (S. 311); as well as seek to boost protections for pain-capable unborn children (S. 3275). Neither measure earned the required 60 votes needed for advancement in the upper chamber.

The Week Ahead

Both chambers of Congress will resume legislative business later this afternoon. As Congressional appropriators continue work on an emergency spending package to bolster coronavirus response efforts, consideration of the supplemental funding bill could occur as early as the Wednesday in the House amid rising concerns about a domestic outbreak of the virus. The final figure for the measure is expected to fall within the $6-8 billion range after lawmakers expressed bipartisan concerns that President Donald Trump’s $2.5 billion request would be inadequate. Also on the floor this week, the House will consider a bill aimed at providing Transportation Security Officers Title 5 employment status and enhanced worker rights.

Meanwhile, Senators are set to begin consideration of a massive, bipartisan package of energy-related bill this week. Sponsored by Sens. Lisa Murkowski (R-AK) and Joe Manchin (D-WV), the American Energy Innovation Act compiles more than 50 bills that were considered by the Senate Energy and Natural Resources Committee over the last year that are aimed at fostering more innovation in clean energy technologies. In particular, the 555-page measure focuses on energy efficiency, emerging renewable energy sources, energy storage, carbon capture, nuclear power, and electric vehicles.

Sec. Azar Testifies on Proposed HHS Budget Before Congress

Department of Health and Human Services (HHS) Secretary Alex Azar had a busy week testifying before a slew of House and Senate Committees on the president’s proposed fiscal year (FY) 2021 budget for HHS, as well as a supplemental funding request to combat the Coronavirus. Members of the Senate Appropriations, House Appropriations, House Energy & Commerce, and House Ways & Means Committees focused the majority of their questioning on specifics of the administration’s plan to prepare for and prevent the Coronavirus epidemic, and many stated that President Trump’s $2.5 billion request did not seem substantial enough to cover the response efforts. Members of both parties questioned why the administration had cut funding for four agencies responsible for response efforts to pandemic events like the Coronavirus in the president’s proposed budget. In response, Sec. Azar assured members that the administration was aggressively responding to the epidemic and would brief Congress on the specifics of their response plan. He assured questioners that any treatment or vaccine developed with taxpayer funding would be affordable and accessible to all.

Sec. Azar stated that the president’s budget reprioritized funding for programs that worked for patients, and refocused funding in public health programs on the most vulnerable populations. Azar also answered queries related to drug pricing reform, noting that the president’s budget had allocated funding for policies aimed at lowering drug prices. He pointed to the Grassley-Wyden drug pricing package as an option the administration was willing to work on with Congress and said that Part D reform was also greatly needed. He noted that the President wanted “importation” for drugs like injectable insulin “yesterday” and was willing to work with Congress on the issue.

Republicans in the House pointed to the Coronavirus epidemic as an example of situations in which H.R. 3 could stifle necessary innovation. In response to claims from Democrats that the administration did not have patients’ best interests in mind, the Secretary noted that no Obamacare replacement plan was needed before the Supreme Court issued a final decision on the Affordable Care Act, and that the president would not sign any legislation without robust protections for pre-existing conditions.

Administration Ramps Up Coronavirus Response

The administration announced several actions to increase efforts to prepare for and prevent Coronavirus in the U.S. this past week. Last Monday, the administration submitted a request to Congress for $2.5 billion, although provided little detail on how that funding would be used. $1.25 billion of the fund would need to be offset by Congress, and Members of both parties criticized the administration for proposing $533 million of the offsets come via cuts to an Ebola prevention and treatment fund. Members of both parties found fault with the lack of detail in plans to use the additional funding, and HHS Sec. Azar had difficulty answering questions about specific spending for each of the administration’s four factors of response — (1) expanding the virus surveillance system, (2) supporting state and local governments, (3) supporting research development and procurement of vaccines and therapies, and (4) expanding access to personal protective equipment. Democrats on Capitol Hill argued significantly more funding is needed and floated appropriating $6 to $8 billion for response efforts.

Last Wednesday, President Trump also appointed Vice President Mike Pence to head intergovernmental efforts to combat the Coronavirus, although HHS Sec. Azar maintained he would remain in charge of the task force. Additionally, Members of Congress have raised alarm over potential shortages in the drug supply chain due to the majority of ingredients and supplies being manufactured in China. The administration released a report last week identifying 20 ingredients or therapeutics manufactured solely in China, and Sec. Azar assured Congress that the administration is actively monitoring for potential shortages. Last Friday, Reps. Tim Ryan (D-OH) and Bill Posey (R-FL) introduced legislation to protect U.S. consumers from potentially contaminated foreign drugs by giving the Food and Drug Administration the authority to require black box warnings on products that are manufactured without adequate supervision.

House Bipartisan Opioid Task Force Readies Wide-Ranging Legislation

The House Bipartisan Opioid Task Force has outlined an ambitious agenda to tackle issues related to addiction this year, ahead of an Energy and Commerce Health Subcommittee legislative hearing this week. The 100-plus-person caucus hopes for the agenda to be a catalyst for another large package to combat the drug crisis, building on recent legislation such as the 2016 law known as the Comprehensive Addiction and Recovery Act (CARA) and a 2018 opioid law known as the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The 27-bill agenda includes a range of bipartisan bills touching on prevention, treatment, rural health care, law enforcement, prescription drugs, criminal justice, veterans, interdiction, veterans and families. 

This week’s legislative hearing will feature 14 bills related to addiction and opioids, nine of which appear in the task force’s agenda. Task force Co-Chairwoman Ann Kuster (D-NH) signaled that this would be the first of many related hearings. Key legislation to be considered at this week’s hearing include:

• Legislation (HR 2466) by Rep. David Trone (D-MD) that would authorize State Opioid Response Grants and Tribal Opioid Response Grants for five years at $1 billion per year. It has 67 cosponsors.
• A bill (HR 3878) from Rep. David B. McKinley (R-WV) that would require drugmakers and distributors that find a suspicious order for controlled substances to report and stop the shipment. The bill is based on a 2018 investigative report from the committee.
• Another bill (HR 2482) from Rep. Paul Tonko (D-NY) that would eliminate the requirement for providers to get a special waiver in order to prescribe a form of medication-assisted treatment known as buprenorphrine. It has 107 cosponsors.
• A bill (HR 3414) from Rep. Brad Schneider (D-IL) that would authorize funding for 1,000 additional residency positions in hospitals that have addiction-related residency programs.

Democratic Debate Highlights Candidates’ Health Platforms

The latest Democratic debate in Charleston, SC last week highlighted the candidates’ health care priorities and featured a heavy dose of criticism for Sen. Bernie Sander’s (VT) “Medicare for All” plan. Former South Bend, IN mayor Pete Buttigieg noted that the “price tag” for the Sanders plan had changed several times, from $40 trillion to $17 trillion. In the past, Sanders has cited different spending totals based on varying academic analysis from the Urban Institute and The Lancet. Sanders responded that analysis from the Lancet found that a public option similar to ones championed by Mayor Pete would cost more than a single-payer system over 10 years.

Sen. Amy Klobuchar (MN) touted her leadership on rural health care, including policies to revitalize rural hospitals and attract additional health professionals to rural areas. Sanders proposed incentives, including debt forgiveness, for providers in rural areas.

The Coronavirus was also a hot topic, and former mayor Mike Bloomberg, former Vice President Joe Biden, and Sen. Klobuchar all highlighted President Trump’s previous decision to cut global health experts from his national security team. They alleged that this has left the U.S. underprepared to face the Coronavirus epidemic. Former Vice President Biden, whose campaign got a huge boost from a convincing win in the South Carolina Democratic Primary this weekend, also criticized President Trump for proposing to cut funding to the Centers for Disease Control and Prevention every year, and highlighted his role in helping to set up the Ebola response team at HHS in 2014. Sen. Elizabeth Warren added that the U.S. should be taking action now to mitigate any possible supple chain impacts due to the epidemic. The next Democratic Debate will be held Sunday, March 15.