HealthCare Roundtable e-News – March 30, 2021

Pelosi Eyes Savings from Bill Lowering Drug Costs to Help Fund Next Major Legislative Package

According to House Speaker Nancy Pelosi (D-Calif.), congressional leaders are discussing the inclusion of legislation that will help to lower drug costs in the next big legislative package, which is expected to be focused on infrastructure improvements and health care provisions. Among the bills being discussed is the Elijah Cummings Lower Drug Costs Now legislation, part of which would allow the Secretary of Health and Human Services to negotiate lower prices, and cap prices for drugs based on the prices paid in other countries.

At a recent Protect Our Care event celebrating the 11th anniversary of the Affordable Care Act, Pelosi and Senate Majority Leader Charles Schumer (D-N.Y.) spoke on the enhanced subsidies available under the newly enacted American Rescue Plan. Pelosi urged her colleagues that Congress “would be missing an opportunity if we did not include lower[ing] cost of prescription drugs,” in the next legislative package. (InsideHealthPolicy)

According to the Congressional Budget Office, the Elijah Cummings Lower Drug Costs Now legislation would help save close to $450 billion, which could then be used to help fund other priorities like the next legislative package. Pelosi also suggested that the savings could also be used for other health-related efforts, including a bill that is being pushed by House Energy & Commerce Chair Frank Pallone (D-N.J.) and Rep. Jim Clyburn (D-S.C.) to expand community health centers and improve broadband services, which would support telehealth.

Lawmakers Introduce Bill Allowing Audio-Only Telehealth in MA Risk Adjustment

A bill introduced last week aims to enable Medicare Advantage (MA) plans to count diagnoses from audio-only telehealth services towards risk adjustment during the 2020-2021 plan years. Titled The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act, the bill will build on flexibilities given to providers by the Centers for Medicare & Medicaid Services (CMS) to reimburse for telehealth services in light of the COVID-19 pandemic.

The bill, which was introduced by Reps. Terri Sewell (D-Ala.) and Gus Bilirakis (R-Fla.), also specifies that only qualified diagnoses—those made during a plan year that matches diagnoses made during one of the last three years—would count towards risk adjustment. The legislation received praise from insurers and advocacy groups, including the National PACE Association and the Better Medicare Alliance.

“Medicare Advantage must be equipped to meet beneficiaries where they are by allowing access to care through a simple phone call where appropriate or when beneficiaries lack other technological means,” said Allyson Schwartz, president of the Better Medicare Alliance. The Better Medicare Alliance has also been pushing for audio-only services to be included in MA risk adjustment and praised the introduction of the bill. (InsideHealthPolicy)

Senate Votes to Pass Extension of Medicare Sequester Moratorium Through the End of the Year

Last Thursday, the Senate passed an extension of the Medicare sequester moratorium by a vote of 90-2. The extension will last beyond April through the end of the year and includes amendments suggested by Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine); however, it does not include a House provision that would initiate additional sequester cuts as a result of the American Rescue Plan. The bill now must go back to the House for a vote once the lower chamber returns from recess next month.

Federation of American Hospitals President and CEO Chip Kahn praised Majority Leader Chuck Schumer (D-N.Y.) and Minority Leader Mitch McConnell (R-Ky.), who “have displayed exceptional leadership in shepherding this important mitigation through the Senate with a resounding bipartisan vote. They are worthy of deep praise for this action as are Sens. Shaheen and Collins, whose proposal to stop the cuts assumed a key role in the successful passage of this legislation.” (InsideHealthPolicy)

The American Hospital Association also praised Thursday’s Senate vote but said CMS could hold claims until the House returns to session in April and has a chance to vote on the Senate version of the extension. The AHA said it will continue to work with Congress to waive the PAY-GO scorecard, as well as push for additional provider relief funding. (InsideHealthPolicy)

Biden Picks for Surgeon General, Assistant Secretary of Health Confirmed by Senate

Last week, the Senate confirmed two new federal appointees to support the Biden administration. Dr. Rachel Levine, the first openly transgender federal official, secured the role of assistant secretary of health, and Obama administration alum Dr. Vivek Murthy was confirmed as surgeon general, his second tour of the role.

Both confirmations received bipartisan support, with the vote on Murthy passing 57-43 and Levine’s vote coming to 52-48, with the support of GOP Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine). Senate health committee Chair Patty Murray (D-Wash.) praised the confirmation of both positions after weeks of pushing for hearings. (InsideHealthPolicy)

Throughout his time as surgeon general, Murthy has drawn opposition from gun rights advocates because of his assessment that mass shootings amount to a public health problem. In his hearing, he assured senators that while he supports the government studying gun violence as a problem, “my focus is not on this issue, and if I’m confirmed it will be on COVID, on mental health and substance use disorder.” Murthy was also a top health adviser to the Biden campaign and served as a co-chair of the President-elect’s COVID-19 advisory board during the transition.

Prior to becoming assistant secretary of health, Levine had served as Pennsylvania’s health secretary since her appointment by Democratic Gov. Tom Wolf in 2017. She won confirmation by the Republican-majority Pennsylvania Senate. President Joe Biden cited Levine’s experience when he nominated her in January, assuring the public that Levine “will bring the steady leadership and essential expertise we need to get people through this pandemic—no matter their zip code, race, religion, sexual orientation, gender identity or disability,” Biden said.

Lawmakers, Children’s Health Advocates Worry CHIP Could Lose Funding as a Result of ACA Supreme Court Decision

Lawmakers and children’s health advocates in support of the Children’s Health Insurance Program have recently expressed concerns that ongoing funding is in jeopardy depending on the Supreme Court’s decision regarding the Affordable Care Act. Advocates worry Congressional leaders may use the program as a bargaining chip due to the Congressional Budget Office low scoring the program’s renewal, which is up in 2027.

According to the CBO, the program’s renewal score has lowered to $800 million compared to its initial estimate of $8.2 billion the last time Congress renewed the program in 2018. This is due to calculations that keeping kids enrolled in CHIP is cheaper than having them enter the ACA marketplace or Medicaid. As a result, any changes to the ACA marketplace or Medicaid—including the Supreme Court’s decision on ACA—would change how much the CBO says CHIP costs or saves the federal government. (InsideHealthPolicy)

There are currently two bills in the pipeline for the House Energy & Commerce Committee’s review that would make funding for the program permanent. There is also a separate plan that would increase Medicaid reimbursements for physicians practicing in family and pediatric medicine. Many children’s health care advocates have spent the last four years pushing lawmakers to make CHIP permanent after funding had temporarily expired in 2017. Carrie Fitzgerald, First Focus on Children vice president in children’s health policy, said that each time the program’s funding has lapsed or been in danger of doing so, parents begin to step away from the program.

“When you are living at 150% of the federal poverty level and you have a CHIP premium and your kid hasn’t been to the doctor in eight months and you don’t know if the program is going to be there, why would you pay it?” says Fitzgerald. (InsideHealthPolicy)