HealthCare Roundtable e-News – March 21, 2022


Top News

Senate Finance Committee Debates Drug Pricing Reform but Party Positions Do Not Change

This week, the Senate Finance Committee held a hearing on drug pricing. Though there was vigorous debate on both sides of the aisle, the hearing did not seem to move members of either part off their positions. That is, across the board, Democrats were in favor of removing the Medicare “non-interference” clause, which prevents Medicare from negotiating directly with manufacturers over drug prices. While Republicans opposed this position and highlighted the potential pitfalls of such policy, like losing innovation in the drug market.

Finance Chairman, Sen. Wyden (D-OR) said his goal of the hearing was to change Republicans’ minds about Democrats’ legislation to allow drug pricing negotiations, but that did not appear to happen. It is not yet clear what the Finance Committee’s next steps will be. We know Democrats have identified drug pricing as a policy they would like to pass through the budget reconciliation process, which his designed to avoid the need for Republican votes.

Though each side seemed to be dug into their respective perspectives, there was some lively debate at the hearing. Sen. Grassley (R-IA), who chaired the Finance committee last Congress, urged Democrats to pass the Grassley-Wyden drug pricing legislation from the last Congress. Sen. Grassley argued that Republicans were likely to take control of Congress next year and that if Democrats hope to pass any type of drug pricing reform they should do it before then, indicating that under Republican control, Congress was likely not going to do much to curb drug prices. Other Republics repeated their long-standing stance that what Democrats call negotiation is really government price controls. Sen. Pat Toomey (R-PA) warned that drug companies will stop improving drugs if the government controls prices.

There was, however, some common ground. Bipartisan senators, including Sen. Cornyn (R-TX), discussed areas like intellectual property reform and prevent drug companies from creating “patent thickets” which extend the exclusivity of a brand-name drug.


32BJ Health Fund – A Union Health Fund Calls for Greater Hospital Price Transparency

A union health fund, 32BJ Health Fund, which covers unionized building workers in 11 states and Washington, D.C. said it will spend about $1.3 billion on medical claims this year on behalf of 200,000 members. More than half of which will go to hospitals. As a result, 32BJ is urging leaders in New York to rein in high prices at private hospitals in a new report that reveals how costs for similar services can vary vastly among medical facilities in the same market.

Costs for common medical procedures underscore the disparity. The union health plan said it pays $55,000 for cesarean-section deliveries at Montefiore hospital, compared with $30,000 at Mount Sinai Health System, and less than $18,000 at New York City’s public Health + Hospitals system. The fund is now in discussions with other unions about how they might band together to aggregate their buying power and jointly negotiate with hospitals, as employers in Colorado have done. 

Administrative Action

study of 2016-2020 National Survey of Children’s Health was published today. Annual data compared over five years revealed increased prevalence of mental health challenges for youth aged 3-17 in addition to increased family stress from parental employment disruptions. Thirty-six health-related measures were utilized in the survey, including health behaviors, health care access and utilization. The study also covers the first year of the pandemic, giving insight into how COVID-19 challenged mental health and emotional well-being. This research is relevant to inform the Biden Administration’s continued investment in expanding pediatric mental health services and supporting the mental health of children and their family’s post-pandemic.

Congressional Action

Last month, Representative Burgess (R-TX), the co-chair of the GOP Doctors Caucus, introduced the Insulin Savings for Patients Act. The bill aims to lower out-of-pocket costs through two avenues: 1) Passing through 100% of the rebate dollars for insulin to patients in Medicare Part D at the pharmacy counter (directly reducing the out-of-pocket cost for the drug) and 2) Requiring the Comptroller General to submit a report to Congress on the effect of insulin point-of-sale rebates, trends in the list and net prices of insulin, and trends in out-of-pocket costs of insulin for patients. The bill is co-sponsored by Representative Miller-Meeks (R-IA).
The Senate Health, Education, Labor, and Pensions (HELP) Committee held a markup on the Murray-Burr PREVENT Pandemics Act, subsequently advancing the legislation to the full Senate. PREVENT Pandemics Act reflects ideas from 41 bills and 35 Senators. The legislation passed the HELP Committee with a vote of 20-2. The legislation contains provisions intended to strengthen the nation’s public health and medical preparedness and response systems. Text of the legislation can be found here.
The House Energy & Commerce Health Subcommittee on Thursday debated nearly two dozen bills that could be attached to a reauthorization of the Food and Drug Administration user fees. Three bills dominated discussion: H.R. 5585 Advanced Research Project Agency – Health Act, which would establish the Advanced Research Projects Agency for Health that President Biden has advocated for and Congress appropriated $1 billion for; H.R. 6000 Cures 2.0, which is a wide-ranging public health bill that would life Medicare telehealth restrictions and grant automatic Medicare coverage to cutting-edge devices, among other things; and H.R. 6963 Accelerated Approval Integrity Act of 2022 that would increase oversight of the FDA’s accelerated approval process. To watch a recap of the hearing click here.
Senators Markey (D-MA), Kaine (D-VA), and Duckworth (D-IL) sent a letter to Acting Commissioner of the Social Security Administration (SSA) Kijakazi to advocate for publication of additional guidance for individuals living with long COVID who apply for disability benefits. Current SSA guidance requires applicants for disability benefits to provide a positive COVID-19 test or diagnosis with limited exceptions, which many individuals cannot produce due to barriers in accessing testing and difficulties in diagnosing long COVID patients who also experience other disorders (e.g., Postural Orthostatic Tachycardia Syndrome or Chronic Fatigue Syndrome). 


The Medicare Payment Advisory Commission (MedPAC) released their March 2022 report to Congress focused on Medicare payment policy. MedPAC is required by law to report on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). Healthsperien will be publishing a comprehensive summary of the MedPac report shortly. 


The Medicaid and CHIP Payment Advisory Commission (MACPAC) released its March 2022 Report to Congress. This report contains three chapters of interest to Congress: (1) transition Medicaid beneficiaries out of institutions and back into the community under Money Follows the Person (MFP) demonstration program, (2) improving access to vaccines and vaccination rates for adults enrolled in Medicaid, and (3) MACPAC’s statutorily required review of hospital payment policy for the nation’s safety-net hospitals. Click here to view Healthsperien’s summary.
The Kaiser Family Foundation (KFF) released results of their 20th annual survey of state Medicaid and CHIP agency officials, providing insight into the actions states are taking to prepare for redeterminations once the federal Public Health Emergency (PHE) ends. The survey provides a snapshot as of January 2022, which is notably before CMS released new redetermination guidance in March. As such, the findings in this report may have changed since the survey was fielded. Key findings in the survey include:
  • Over half (27) of states have determined their approach to prioritize outstanding eligibility and renewal actions when the PHE ends.
  • Fifteen states will conduct electronic data matches to identify and target enrollees for priority action who may no longer be eligible after the continuous enrollment requirement is lifted.
  • Most states (39) plan to take the full 12 months to process redeterminations; 9 states plan to conduct redeterminations more quickly.
  • Most states (41) plan to follow-up with enrollees when action must be taken to avoid a loss of coverage due to missing information. States are not required to follow-up with enrollees if they do not respond to a renewal request within 30 days.
  • Most states (46) are planning to take actions to update mailing addresses, working with USPS and MCOs.
  • Thirty states plan to take steps to boost staff capacity during the redetermination process.
  • Almost all states (50) report they are capable of tracking call center statistics and a majority (41) can report the share of disenrollments that were determined ineligible versus disenrollments due to procedural reasons.
  • In the 20 states that can report, they estimate on average 13% of Medicaid enrollees will be disenrolled after the end of the PHE, with increases in come being the primary reason.
  • States continue to streamline application processes and integrate non-MAGI and non-health programs into the system that determines MAGI Medicaid eligibility.
  • While states cannot disenroll people, as of January 2022, most states (42) report processing ex parte renewals and sending renewal forms (30 states) to reduce backlogs in renewals at the end of the PHE.