The House’s scheduled Memorial Day recess was cut short after President Biden and House Speaker McCarthy (R-CA) announced last weekend that they had reached a deal on raising the debt limit. The House quickly took up the package, advancing the bill by a bipartisan vote of 314–117 on May 31, and the Senate acted June 1 to pass the bill by a bipartisan vote of 63–36, successfully averting a debt default.
House and Senate Consider Debt Limit Package. On May 27, President Biden and House Speaker McCarthy reached an anxiously awaited agreement to raise the federal debt limit. In addition to raising the debt limit into 2025, the Fiscal Responsibility Act (H.R. 3746) includes government spending cuts, addresses the speed of permitting for energy projects, redirects $20 billion from the Internal Revenue Services to other agencies, makes modest reforms to the student loan program, modifies work requirements for the Temporary Assistance to Needy Families program and the Supplemental Nutrition Assistance Program (but does not touch Medicaid work requirements), establishes a new administrative Pay-As-You-Go (PAYGO) requirement for executive branch rules that would increase direct spending, and rescinds $28 billion in unspent COVID-19 funding. Many of these policies involve nuances and time limits that will impact how they work, and we’ll learn more as implementation moves forward.
The policy changes in the carefully crafted agreement allow both Republicans and Democrats to find points that fit their own narratives for supporting the measure. Republicans can note that there are several real cuts and policy changes. Democrats can state that they protected Medicare, Medicaid and Social Security and echo the most common refrain heard from Democrats—it could have been much worse. Of course, members on both sides of the aisle can also find policy rationales in the deal to express their opposition.
After the agreement was announced, Speaker McCarthy and his team moved quickly to call the House back from a previously scheduled recess and begin consideration of H.R. 3746. On May 30, the package cleared its first procedural hurdle, advancing out of the House Rules Committee by a narrow partisan margin. The bill then proceeded to the House floor on May 31, where it passed by a strong bipartisan vote of 314–117, with 149 Republicans and 165 Democrats voting to support the bill. The vote was a notable victory for Speaker McCarthy, who was able to hold together a significant percentage of his often-fractious caucus. That credit extends to President Biden and House Minority Leader Jeffries (D-NY), as the leadership trio demonstrated their ability to work together to advance necessary legislation in a divided government.
The bill quickly moved to the Senate, where it was passed by a bipartisan vote of 63–36, successfully averting a debt default. During consideration of the bill, much of the concern came from Senate Republicans, who demanded a written statement from Senate leaders committing not to block supplemental defense funding and consideration of appropriations bills. Senate Democrats also raised concerns regarding other domestic priorities. A total of 11 amendments were offered to the bill, all of which failed. The swift Senate passage of the bill marks a victory for Congress in averting the debt default deadline. The legislation now heads to the President’s desk to be signed into law.
CMS Withdraws COVID-19 Vaccination Mandate, Enhances Focus on Quality Measures. On May 31, the Centers for Medicare & Medicaid Services (CMS) issued a final rule formally rescinding the Omnibus COVID-19 Health Care Staff Vaccination interim final rule. With this withdrawal, various Medicare and Medicaid certified healthcare facility types are no longer required to enforce COVID-19 vaccination among all staff and contractors. CMS notes, however, that it will now use quality reporting and value-based measures and incentives to encourage entities to keep workers “up-to-date” on COVID-19 vaccinations. The final rule also acknowledges staffing challenges created by the vaccine mandates and makes permanent policies requiring long-term care providers to educate and offer COVID-19 vaccines to staff and residents.
The final rule is expected to be published on June 5, 2023, and will become effective 60 days after the date of publication in the Federal Register. CMS explicitly notes, however, that it will use enforcement discretion even prior to the 60-day effective date and will no longer enforce the staff vaccination provisions.
CMS Announces Plan to Ensure Availability of New Alzheimer’s Drugs. On June 1, CMS Administrator Chiquita Brooks-LaSure announced how beneficiaries can obtain Medicare coverage for drugs that may slow the progression of Alzheimer’s disease. The agency noted that if the US Food and Drug Administration (FDA) grants traditional approval, then Medicare will cover the drugs in appropriate settings that also support the collection of real-world information to study the usefulness of these drugs for people with Medicare. The FDA’s Peripheral and Central Nervous System Drugs Advisory Committee will discuss the results of a confirmatory trial of the Eisai product Leqembi on June 9, with a decision on traditional approval possible within weeks. Broader Medicare coverage would begin on the same day that FDA grants traditional approval.
Medicare will cover drugs with traditional FDA approval when a physician and clinical team participates in the collection of evidence about how these drugs work in the real world via a registry. Clinicians will be able to submit this evidence through a nationwide CMS-facilitated portal that will be available when any product gains traditional approval and will collect information via an easy-to-use format. Other registries for drugs that may slow the progression of Alzheimer’s disease may become available in the coming weeks and months. Information will be available here as studies come online. Read the full CMS press release here.
The House and Senate are both in session next week, with healthcare activity expected at the committee level. This includes a House Energy and Commerce Oversight and Investigations Subcommittee hearing focused on the CDC, an anticipated House Education and Workforce Committee markup of bills impacting employer-sponsored health coverage, an anticipated House Ways and Means Committee markup of health savings account legislation, a Senate Finance Committee hearing on health care consolidation, and a Senate Health Education Labor and Pensions (HELP) Committee hearing on youth mental health.
For more information, contact Debra Curtis, Kristen O’Brien, Priya Rathakrishnan or Erica Stocker.
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