TRP Health Policy Report
December 22, 2014
Last Tuesday, the Senate adjourned for the year, approving an omnibus spending bill, dozens of judges, many executive branch nominees and a tax ‘extenders’ bill during the post-election lame duck session. Senators left town, however, without approving terrorism risk insurance legislation (S.2244), electing to put off a vote until 2015. The Senate also voted 76-16 to approve a package of tax cuts that had expired in 2013. The $41 billion legislation (H.R. 5771) provides the breaks for both individuals and businesses but only retroactively, through 2014. The House passed the measure December 3rd on a 378-46 vote. One of the Senate’s final moves was confirming a series of executive branch and judicial nominees. It was a victory for the outgoing Democratic majority and a blow to Republicans, who objected to several of the nominees but were unable to block them under new Senate rules that allow confirmations with just 51 votes.
Elsewhere, President Obama on Tuesday signed a $1.1 trillion spending bill passed by Congress that lifted the threat of a government shutdown. The legislation – known as the “CRomnibus” for “continuing resolution” (CR) and “omnibus” spending bill – funds most government agencies through September 2015. The Department of Homeland Security will be treated differently, getting a funding extension only through February 27, by which time Republicans will control both chambers of Congress. Passage of the 1,603-page bill was a long struggle in the House and Senate marked by bitter disputes over changes to banking regulations and the President's recent executive action on immigration. In healthcare-related news, federal officials announced on Tuesday that ACA enrollment appears on track to meet White House goals for 2015, with almost 2.5 million people selecting plans on HealthCare.gov in the first month. The website has been handling the increased traffic as the Obama Administration works toward its scaled-back goal of having 9.1 million Americans covered in the exchanges by the end of next year.
The Week Ahead
The House and Senate are adjourned until Tuesday, January 6.
Appropriators Ask HHS to Review 340B, Hep C Drug Costs
The $1.1 trillion ‘CRomnibus’ spending bill includes two provisions related to the debate over drug prices — one on the 340B drug discount program and the other on hepatitis C drug prices. On 340B, the report accompanying the legislation urges HHS to investigate whether the most vulnerable patients benefit from the program. Administered by HRSA, the 340B program makes drugmakers discount the price of outpatient drugs for certain hospitals and other healthcare providers. Safety net hospitals and drug makers are battling over the scope of the program, as HRSA drafts guidance clarifying its policy. Congress has significantly expanded the program since its creation in 1992. Drugmakers argue the program no longer lives up to its original mission, while entities that receive the discount say the program helps the poor get prescription drugs. The appropriations report asks HRSA to review how the program is working.
Drug pricing for hepatitis C is the second healthcare issue that the appropriations report addresses. The current cure for the infection costs $94,500 for a 12-week course, and Medicaid directors and health plans accuse the drug industry of price gouging. “The agreement encourages CMS to consider the prevalence of chronic viral hepatitis among beneficiaries and the cost of providing care to those who are in the late stages of this disease,” the report states. “The agreement encourages CMS to educate Medicare beneficiaries and healthcare providers about hepatitis C and the need for screening while identifying opportunities to improve the quality of treatments and services.” The CDC has already researched the prevalence of hepatitis C among Americans. The CDC estimates that 3.2 million people are infected, but many others believe the actual number is higher.
In Surprise Move, Enzi to Chair Senate Budget Panel
Last Wednesday, Senator Mike Enzi (R-WY) announced that he will take over as chairman of the Senate Budget Committee next year, after ranking member Jeff Sessions (R-AL) agreed to step aside. Enzi, who had previously served as the top Republican on the HELP Committee, had decided to exert his remaining seniority to become the Budget Committee chairman instead. The Wyoming senator, along with Senators Mike Lee (R-UT), Ted Cruz (R-TX) and Rand Paul (R-KY), has pushed to erase funding for the ACA since the law’s inception. Enzi’s position is still pending a vote from the Budget Committee and approval from the Republican caucus, which is expected when Congress returns in January. Aides said Enzi will likely team up with incoming House Budget Chairman Tom Price (R-GA), as they aim to pass identical budget resolutions in the first half of 2015. This will allow them to pursue “reconciliation,” which permits the Senate to pass tax or spending legislation with a simple majority vote instead of the 60 votes needed to break a filibuster. Senator Bernie Sanders (I-VT) will be the Budget Committee's ranking Democratic member. The panel's exiting chairwoman, Senator Patty Murray (D-WA), will become the top Democrat on the HELP Committee.
In related news, Sen. Orrin Hatch (R-UT), the incoming chairman of the Senate Finance Committee, announced Monday that Senators Dan Coats (R-IN), Dean Heller (R-NV) and Tim Scott (R-SC) will be join the panel for the 114th Congress. The full list of Republicans on the Senate Finance committee next session also includes: Senators Chuck Grassley (R-IA), Mike Crapo (R-ID), Pat Roberts (R-KS), Mike Enzi (R-WY), John Cornyn (R-TX), John Thune (R-SD), Richard Burr (R-NC), Johnny Isakson (R-GA), Rob Portman (R-OH) and Pat Toomey (R-PA). GOP leadership also announced that Sen.-elect Bill Cassidy (R-LA) will join the HELP panel in the next Congressional term. Cassidy is a physician and professor of medicine whose campaign against Senator Mary Landrieu (D-LA) focused largely on healthcare issues. Republicans are poised to take a 54-46 Senate majority in January, and as a result, Democrats are losing a seat or two on each committee.
NYT/CBS Poll: Healthcare Affordability a Growing 'Hardship'
According to a poll released last Thursday by the New York Times and CBS News, a growing number of Americans are finding it tougher to afford their healthcare costs in the first year of the Affordable Care Act. The poll found that just fewer than 50 percent of people said paying for basic healthcare was a “hardship” in 2014, compared to 36 percent one year ago. Most poll respondents said they’ve seen costs rise markedly in the last few years. Just over half of people said they're paying more out-of-pocket than they were several years ago; about one-third said the costs had gone up “a lot.” For about one-quarter of people, the cost of care is so expensive that they are less likely to see a doctor when they are sick or injured.
For most Americans, the frequency with which they go to the doctor when they are sick hasn't changed much over the last few years, but a quarter are less likely to go, and that figure rises to 35 percent among those who report their out-of-pocket health costs have increased. Americans cite cost as the reason they are less likely to see a doctor when they are injured or sick. In addition, 50 percent of poll respondents said their doctor discusses how much treatment will cost ahead of time almost always or sometimes, but 49 percent say their doctor rarely or never does. Even though some respondents expressed concern about their healthcare costs, most remain satisfied with the quality of it. Nearly seven in 10 are at least somewhat satisfied with their healthcare quality, although satisfaction has dropped in the last year. The poll also found that a 59 percent of Americans favor a government-administered health insurance plan like Medicare for everyone, but support drops to 43 percent when asked about a single-payer health insurance system funded by taxpayers.
Despite Opposition, Senate Confirms Surgeon General Nominee
Last Monday, the Senate voted 51-43 to confirm Vivek Murthy as the nation's next surgeon general. He will become the 19th surgeon general and will replace Regina Benjamin, who resigned in July 2013. President Obama nominated Murthy, an attending physician at Brigham and Women's Hospital and a medical instructor at Harvard Medical School, for the position last year. However, the nomination had been stalled in the Senate because of Murthy's stance on guns as a public health issue. Senate Majority Leader Harry Reid (D-NV) delayed a vote in March because as many as 10 Democrats might have opposed Murthy’s confirmation.
GOP lawmakers also expressed concern over Murthy's support for the Affordable Care Act and past political advocacy for President Obama. Murthy helped found the group Doctors for Obama, which supported the President's 2008 campaign and advocated for the ACA's passage under the group's new name, Doctors for America. Just one Republican voted to approve Murthy's confirmation – Sen. Mark Kirk (R-IL). Several Democrats voted against Murthy, including Sen. Joe Manchin (D-WV) who expressed concerns about his past “political activism.” For his part, President Obama celebrated Murthy's approval, noting that his “confirmation makes [the U.S.] better positioned to save lives around the world and protect the American people here at home.” Specifically, the President cited the threat of an Ebola epidemic in West Africa. He added that Murthy will “bring his lifetime of experience promoting public health to bear on priorities ranging from stopping new diseases to helping our kids grow up healthy and strong.”
The Week Ahead
The House and Senate are adjourned until Tuesday, January 6.
Appropriators Ask HHS to Review 340B, Hep C Drug Costs
The $1.1 trillion ‘CRomnibus’ spending bill includes two provisions related to the debate over drug prices — one on the 340B drug discount program and the other on hepatitis C drug prices. On 340B, the report accompanying the legislation urges HHS to investigate whether the most vulnerable patients benefit from the program. Administered by HRSA, the 340B program makes drugmakers discount the price of outpatient drugs for certain hospitals and other healthcare providers. Safety net hospitals and drug makers are battling over the scope of the program, as HRSA drafts guidance clarifying its policy. Congress has significantly expanded the program since its creation in 1992. Drugmakers argue the program no longer lives up to its original mission, while entities that receive the discount say the program helps the poor get prescription drugs. The appropriations report asks HRSA to review how the program is working.
Drug pricing for hepatitis C is the second healthcare issue that the appropriations report addresses. The current cure for the infection costs $94,500 for a 12-week course, and Medicaid directors and health plans accuse the drug industry of price gouging. “The agreement encourages CMS to consider the prevalence of chronic viral hepatitis among beneficiaries and the cost of providing care to those who are in the late stages of this disease,” the report states. “The agreement encourages CMS to educate Medicare beneficiaries and healthcare providers about hepatitis C and the need for screening while identifying opportunities to improve the quality of treatments and services.” The CDC has already researched the prevalence of hepatitis C among Americans. The CDC estimates that 3.2 million people are infected, but many others believe the actual number is higher.
In Surprise Move, Enzi to Chair Senate Budget Panel
Last Wednesday, Senator Mike Enzi (R-WY) announced that he will take over as chairman of the Senate Budget Committee next year, after ranking member Jeff Sessions (R-AL) agreed to step aside. Enzi, who had previously served as the top Republican on the HELP Committee, had decided to exert his remaining seniority to become the Budget Committee chairman instead. The Wyoming senator, along with Senators Mike Lee (R-UT), Ted Cruz (R-TX) and Rand Paul (R-KY), has pushed to erase funding for the ACA since the law’s inception. Enzi’s position is still pending a vote from the Budget Committee and approval from the Republican caucus, which is expected when Congress returns in January. Aides said Enzi will likely team up with incoming House Budget Chairman Tom Price (R-GA), as they aim to pass identical budget resolutions in the first half of 2015. This will allow them to pursue “reconciliation,” which permits the Senate to pass tax or spending legislation with a simple majority vote instead of the 60 votes needed to break a filibuster. Senator Bernie Sanders (I-VT) will be the Budget Committee's ranking Democratic member. The panel's exiting chairwoman, Senator Patty Murray (D-WA), will become the top Democrat on the HELP Committee.
In related news, Sen. Orrin Hatch (R-UT), the incoming chairman of the Senate Finance Committee, announced Monday that Senators Dan Coats (R-IN), Dean Heller (R-NV) and Tim Scott (R-SC) will be join the panel for the 114th Congress. The full list of Republicans on the Senate Finance committee next session also includes: Senators Chuck Grassley (R-IA), Mike Crapo (R-ID), Pat Roberts (R-KS), Mike Enzi (R-WY), John Cornyn (R-TX), John Thune (R-SD), Richard Burr (R-NC), Johnny Isakson (R-GA), Rob Portman (R-OH) and Pat Toomey (R-PA). GOP leadership also announced that Sen.-elect Bill Cassidy (R-LA) will join the HELP panel in the next Congressional term. Cassidy is a physician and professor of medicine whose campaign against Senator Mary Landrieu (D-LA) focused largely on healthcare issues. Republicans are poised to take a 54-46 Senate majority in January, and as a result, Democrats are losing a seat or two on each committee.
NYT/CBS Poll: Healthcare Affordability a Growing 'Hardship'
According to a poll released last Thursday by the New York Times and CBS News, a growing number of Americans are finding it tougher to afford their healthcare costs in the first year of the Affordable Care Act. The poll found that just fewer than 50 percent of people said paying for basic healthcare was a “hardship” in 2014, compared to 36 percent one year ago. Most poll respondents said they’ve seen costs rise markedly in the last few years. Just over half of people said they're paying more out-of-pocket than they were several years ago; about one-third said the costs had gone up “a lot.” For about one-quarter of people, the cost of care is so expensive that they are less likely to see a doctor when they are sick or injured.
For most Americans, the frequency with which they go to the doctor when they are sick hasn't changed much over the last few years, but a quarter are less likely to go, and that figure rises to 35 percent among those who report their out-of-pocket health costs have increased. Americans cite cost as the reason they are less likely to see a doctor when they are injured or sick. In addition, 50 percent of poll respondents said their doctor discusses how much treatment will cost ahead of time almost always or sometimes, but 49 percent say their doctor rarely or never does. Even though some respondents expressed concern about their healthcare costs, most remain satisfied with the quality of it. Nearly seven in 10 are at least somewhat satisfied with their healthcare quality, although satisfaction has dropped in the last year. The poll also found that a 59 percent of Americans favor a government-administered health insurance plan like Medicare for everyone, but support drops to 43 percent when asked about a single-payer health insurance system funded by taxpayers.
Despite Opposition, Senate Confirms Surgeon General Nominee
Last Monday, the Senate voted 51-43 to confirm Vivek Murthy as the nation's next surgeon general. He will become the 19th surgeon general and will replace Regina Benjamin, who resigned in July 2013. President Obama nominated Murthy, an attending physician at Brigham and Women's Hospital and a medical instructor at Harvard Medical School, for the position last year. However, the nomination had been stalled in the Senate because of Murthy's stance on guns as a public health issue. Senate Majority Leader Harry Reid (D-NV) delayed a vote in March because as many as 10 Democrats might have opposed Murthy’s confirmation.
GOP lawmakers also expressed concern over Murthy's support for the Affordable Care Act and past political advocacy for President Obama. Murthy helped found the group Doctors for Obama, which supported the President's 2008 campaign and advocated for the ACA's passage under the group's new name, Doctors for America. Just one Republican voted to approve Murthy's confirmation – Sen. Mark Kirk (R-IL). Several Democrats voted against Murthy, including Sen. Joe Manchin (D-WV) who expressed concerns about his past “political activism.” For his part, President Obama celebrated Murthy's approval, noting that his “confirmation makes [the U.S.] better positioned to save lives around the world and protect the American people here at home.” Specifically, the President cited the threat of an Ebola epidemic in West Africa. He added that Murthy will “bring his lifetime of experience promoting public health to bear on priorities ranging from stopping new diseases to helping our kids grow up healthy and strong.”