HealthCare Roundtable e-News – May 22, 2023


Save the Date

2023 Federal Advocacy Workshop

Washington, DC | Wednesday, July 12, 2023

The Public Sector HealthCare Roundtable will present a hybrid Federal Advocacy Workshop on Wednesday, July 12, 2023. The Workshop will focus on the Roundtable’s federal priorities, particularly as they relate to current initiatives of the Biden Administration and timely Congressional activity. In addition to hearing from Administration officials and Congressional staff, the workshop will include engagement and networking with many of the Roundtable’s allies and friends.

The Workshop agenda will include the following presentations:

  • Federal Health Care Policy: Progress and Priorities
  • What’s Next in Health Care: Perspectives from Capitol Hill
  • Past, Present, and Future: Trends in the Employer-Sponsored Market and the Potential Impacts of Policy Reforms
  • Trends in Specialty Drug Spend
  • Partnerships for Success: Advancing Shared Priorities
  • Amplifying Your Voice: Advocacy as a Tool

Whether your health plan is able to actively advocate on behalf of our shared priorities or not, the agenda will include information that is very relevant to your role as a public sector health care purchaser. Whether we call it advocacy, education, or simply information-sharing, it’s important for federal officials to understand how their policies and programs impact the benefits you provide to the public employees, retirees, and survivors of your plans.

The Workshop – which will be complimentary for Roundtable members and friends – will take place at the Healthsperien Office, 601 Massachusetts Avenue, NW, Suite 520 West, Washington, DC. The program will begin at 11:00 AM and will conclude at 3:30 PM.

For those attending in person – The agenda has been developed to make it possible for many to come to DC in the morning and leave in the early evening. For those who choose to arrive on Tuesday, July 11, the Roundtable will be hosting a casual reception and dinner. Roundtable staff will also be available to help attendees plan (contact lists and handouts) Hill visits on Tuesday, July 11, Thursday, July 13, or both. Although the Roundtable hasn’t secured a block of hotel rooms, we have prepared a list of hotel recommendations that are within easy walking distance to the Healthsperien office. Click here for hotel recommendations.

For those attending virtually – The agenda will be presented in two segments – a morning program and an afternoon program – for the convenience of online participants.

Registration for the Federal Advocacy Workshop will open on June 1st.

Innovations in Virtual Care: How Public Sector Purchasers Are Navigating the Changing Telehealth Policy Landscape

Webinar: Tuesday, June 20 at 2 PM (EDT)

As a result of the pandemic, policymakers, providers, and payers have had to acclimate to an increased need and interest in virtual care options. Telehealth has demonstrated the potential to support more equitable access to high-quality, affordable health care. Following the unwinding of the Public Health Emergency (PHE), policymakers and members of the health care community are navigating how to maintain, and increase, access to telehealth services and make permanent PHE telehealth flexibilities. Join us to hear from the Public Sector HealthCare Roundtable senior policy team and policy experts on the evolution of telehealth policy and how it’s enabled the development of new virtual care solutions. 

This webinar is being presented in conjunction with Hinge Health.

Registration for this webinar will open on June 1st.

Top News

House Ways and Means Committee Holds Hearing on Increasing Transparency for Health Care Patients

On Tuesday, the House Committee on Ways and Means held a full committee hearing on health care price transparency. The hearing focused specifically on methods for increasing consumer involvement, data sharing, and price transparency across the U.S. healthcare system. Chairman Jason Smith (R-MO) opened the hearing by highlighting the upward trend in medical service prices in recent years compared to other industries. Representative Adrian Smith (R-NE) and several other House Republicans expressed frustration with CMS’ enforcement actions citing a lack of clarity regarding the enforcement of the previous administration’s transparency rules. Ranking Member Richard Neal (D-MA) pushed for increased transparency in health care while stressing the need to explore additional measures to lower healthcare costs for Americans. The hearing featured witness testimony from current and former representatives of several organizations, including Clark Grave Vault Company, Wellbridge Surgical, the RAND Corporation, Healthcare Bluebook, Ameriflex, and Trinity Health.


House Committee on Energy and Commerce Conducts a Markup of 17 Bills

On Wednesday, the United States House Committee on Energy and Commerce conducted a markup of 17 bills, many of which focused on price transparency, the 340B Drug Pricing Program, and pharmacy benefit managers. The markup featured several pieces of bipartisan legislation, where there was a split among some Democrats over a proposal allowing states to participate in value-based purchasing agreements for drugs. The committee amended the following bills: 1) H.R. 3281, the Transparent PRICE Act (Rep. Cathy McMorris Rodgers) – amended bill was forwarded to the full committee with 27 in favor and none opposed; 2) H.R.2666 – the Medicaid VBPs for Patients (MVP) Act (Rep. Brett Guthrie) – forwarded to the full committee with 16 in favor and 11 opposed; 3) H.R. 3285, the Fairness for Patient Medications Act (Rep. Morgan Griffith) – forwarded to the full committee without a rollcall; 4) H.R. 3284, the Providers and Payers COMPETE Act (Rep. Michael Burgess) – forwarded to the full committee with 27 in favor and none opposed; 5) H.R. 3290, To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (Rep. Larry Bucshon) – forwarded to the full committee with 16 in favor and 11 opposed.


FTC Deepens Inquiry into Prescription Drug Middlemen

As part of its ongoing inquiry into the pharmacy benefit managers (PBMs) and their impact on the accessibility and affordability of prescription drugs, the Federal Trade Commission has issued compulsory orders to two group purchasing organizations that negotiate drug rebates on behalf of other PBMs. The compulsory orders will require these entities to provide information and records on their business practices. The largest PBMs are part of vertically integrated companies and act as middlemen and negotiate rebates and fees with drug manufacturers, create drug formularies and policies, and reimburse pharmacies for patients’ prescriptions. The FTC is issuing the orders under Section 6(b) of the FTC Act, which authorizes the Commission to conduct studies without a specific law enforcement purpose. The companies will have 90 days from the date they receive the order to respond. 

Executive Action

  • On Monday, President Biden announced his intent to nominate Dr. Monica Bertagnolli as Director of the National Institutes of Health (NIH). As current head of the National Cancer Institute (NCI), Dr. Bertagnolli is a renowned surgical oncologist, cancer researcher, educator, and physician-leader. Before NCI, she was chief of surgical oncology at Dana-Farber Brigham Cancer Center. She is a graduate of Princeton University and the University of Utah and trained in surgery at Brigham and Women’s Hospital and was a research fellow in tumor immunology at the Dana-Farber Cancer Institute. Dr. Bertagnolli would replace Francis Collins, who stepped down after 12 years as director of the NIH.

  • On Thursday, in honor of the Mental Health Awareness Day of Action, the Biden-Harris Administration announced several actions to tackle the nation’s mental health crisis, including making it easier for schools to provide critical mental health care services to students across the U.S. The White House announcement advances the President’s mental health strategy across its three key objectives: 1) Strengthening the mental health workforce and system capacity 2) Connecting more Americans to care and 3) Creating a continuum of support. In addition, the U.S. Department of Education (ED) is proposing a new rule that would streamline Medicaid billing permissions for students with disabilities. The ED predicts that of the 500,000 new students eligible under the Individuals with Disabilities Education Act (IDEA) Part B each year, nearly 300,000 will likely qualify for Medicaid and be impacted by this rule. 

Administrative Action

On Wednesday, Commissioner for Health and Food Safety, Stella Kyriakides, and U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra met in Brussels to launch the EU-U.S. Health Task Force. The Health Task Force will primarily focus on cooperation under three strands: priorities in the area of cancer, global health threats, and strengthening the global health architecture. HHS issued a joint press release detailing the reaffirmation of the commitment taking place between the United States and the European Union. The release provided specific details on cancer given the mutual desire for increased collaboration between the U.S. Cancer Moonshot and National Cancer Plan and the EU’s Beating Cancer Plan and Cancer Mission and global health and global health architecture; the U.S. and EU discussed current and emerging health threats such as avian influenza, Marburg disease, and anti-microbial resistance. 

Regulatory Action

On Thursday, the Federal Trade Commission (FTC) announced its proposal to amend the Commission’s Health Breach Notification Rule (the HPN Rule) and requested public comment on the proposed changes. The HBN Rule requires vendors of personal health records (PHR) and related entities that are not covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals, the FTC, and, in some cases, the media of a breach of unsecured personally identifiable health data. The amendments would: 1) Clarify the Rule’s scope, including its coverage of developers of many health applications (“apps”); 2) Amend the definition of breach of security to clarify that a breach of security includes data security breaches and unauthorized disclosures; 3) Revise the definition of PHR-related entity; 4) Clarify what it means for a vendor of personal health records to draw PHR identifiable health information from multiple sources; 5) Modernize the method of notice; 6) Expand the content of the notice; and 7) Improve the Rule’s readability by clarifying cross-references and adding statutory citations, consolidating notice, and timing requirements, and articulating the penalties for non-compliance.

Congressional Action

  • U.S. Representatives Lauren Underwood (D-IL) and Alma Adams (D-NC), and Senator Cory Booker (D-NJ) reintroduced the Black Maternal Health Momnibus Act, which is made up of thirteen bills and aims to address drivers of maternal mortality, morbidity, and disparities (fact sheet). The legislation would make investments to address social determinants of health, expand access to maternal mental health care, grow and diversify the perinatal workforce, provide funding for community-based organizations, and improve the data collection process.

  • On Tuesday, U.S. Senator Bernie Sanders (I-VT) in a POLITICO interview outlined a health spending plan that would provide almost $200 billion to the health care system. The package would provide $130 billion for community health centers and $60 billion in funding to grow the workforce, $15 billion of which would focus on expanding graduate medical education programs and boosting primary care access. In addition to funding, the plan would consider scope of practice changes to increase patient access and boost the number of Black doctors. HELP Committee Ranking Member Bill Cassidy (R-LA) told reporters that his team had engaged in dialogue with Sanders’s team, but the plan is unlikely to pass as is. Next Wednesday, the House Energy and Commerce Committee will mark up a bill that would extend current community health center funding levels through 2028, which would vastly undercut Sanders’ proposal to increase funding by 550%.


Last Friday, the Centers for Medicare and Medicaid Services (CMS) issued draft guidance on the Medicare Part D Manufacturer Discount Program. The guidance outlines the proposed implementation of the Inflation Reduction Act’s (IRA) provisions related to manufacturer discounts. Key policies shared in the draft guidance include: 1) Coverage Discount Program Sunset; 2) Conditions for Part D Coverage; 3) Applicable Drugs; 4) Manufacturer Discounts. Comments are due to CMS no later than 5:00 PM ET on June 12, 2023. 


On Monday, the U.S. Fifth Circuit Court of Appeals issued an administrative stay of a previous Texas District Court March ruling on Affordable Care Act preventive care requirements. In that previous District Court ruling, Judge Reed O’Connor had determined that preventive care recommendations made by the U.S. Preventive Services Task Force (USPSTF) do not have to be complied with, blocking the Affordable Care Act’s (ACA) requirement that most private health plans cover certain preventive health-care services without cost to patients. He reasoned that USPSTF’s members are not subject to Senate confirmation and their recommendations are not reviewed by constitutionally appointed government officials. O’Connor had already ruled in September that HIV pre-exposure prophylaxis (PrEP) pills should not have to be covered under the ACA, ruling that its coverage violated the Religious Freedom Restoration Act. The Fifth Circuit Court of Appeals is expected to hear arguments on the case in the coming months.


On Wednesday, the National Center for Health Statistics released a report highlighting estimates of health insurance coverage for the U.S. civilian noninstitutionalized population based on data from the 2022 National Health Interview Survey (NHIS). The National Center for Health Statistics is releasing these estimates before final editing and weighting to provide access to the most recent information from NHIS. The estimates are disaggregated by age, group, sex, family income (as a percentage of the federal poverty level (FPL)), race and ethnicity, and state Medicaid expansion status. Notably, in 2022, 27.6 million people of all ages (8.4%) were uninsured at the time of interview. This was lower than 2021, when 30.0 million people of all ages were uninsured (9.2%). And among children aged 0–17 years, 4.2% were uninsured, 43.7% had public coverage, and 54.3% had private health insurance coverage.