M+ Check-Up: June 16, 2023

THIS WEEK’S DOSE

The House and Senate were both in session this week, with healthcare activity continuing at the committee level. The House Energy and Commerce Committee held hearings on the Pandemic and All Hazards Preparedness Act (PAHPA) and rare diseases. The House Education and the Workforce Committee held a hearing on US Department of Health and Human Services (HHS) policies and a markup of telehealth legislation. The Senate Health, Education, Labor and Pensions (HELP) Committee held a markup of several healthcare bills. On the regulatory front, the Centers for Medicare & Medicaid Services (CMS) released information on drug pricing assistance and updated projections on national health expenditures.

CONGRESS

House Energy and Commerce Committee Examines PAHPA Reauthorization and Rare Diseases. On June 13, the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing on PAHPA, whose current authorization is set to expire on September 30. The hearing also reviewed ways to increase the responsibilities of the Administration for Strategic Preparedness and Response and improve preparedness infrastructure, the strategic stockpile, transparency in communication among agencies and private sector partners, and accountability from public health agencies. Committee Democrats made clear that they want drug shortage issues to be addressed in PAHPA, while committee Republicans countered that such efforts would be outside of the scope of the reauthorization. Rep. Hudson (R-NC), who is leading the reauthorization effort for committee Republicans, has publicly committed to continuing to work with Rep. Eshoo (D-CA) on a compromise.

On June 14, the House Energy and Commerce Health Subcommittee held a hearing to discuss access to care for patients with rare diseases. There was bipartisan support for Children’s Hospitals Graduate Medical Education (CHGME) funding but division on gender-affirming care. Republicans proposed a provision to prohibit CHGME funding for any children’s hospital that provides gender-affirming care, while Democrats viewed such care as crucial for positive health outcomes for transgender youth. Many members also emphasized the need for legislation that safeguards the future of pediatric care specialists and ensures expert care for children without legal interference.

House Education and the Workforce Committee Discusses HHS Priorities and Advances Telehealth Legislation. On June 13, HHS Secretary Xavier Becerra testified before the committee on a wide array of issues, including drug pricing, healthcare access, gender-affirming care, the Medicaid redetermination process, abortion access, pharmacy benefit managers, maternal health, healthcare disparities, mental health, the public health impact of gun violence, and HHS’s role in placing unaccompanied migrant children with vetted sponsors.

The same day, the committee held a markup to consider and advance the Telehealth Benefit Expansion for Workers Act (H.R. 824). The legislation would treat benefits for telehealth services offered under a group health plan or group health insurance coverage as excepted benefits. The bill was advanced by a bipartisan vote of 21–14, with two Democrats, Reps. Wild (D-PA) and Mrvan (D-IN), joining Republicans to advance the bill. The bill will next be taken up by the House Energy and Commerce Committee, which shares jurisdiction.

House Appropriations Committee Advances FDA Funding Bill. FY 2024 appropriations activity continued this week. The House Appropriations Committee advanced the FY 2024 Agriculture, Rural Development, Food and Drug Administration bill, which includes funding for US Food and Drug Administration (FDA) programs for the fiscal year ending September 30, 2024. The discussion included highly partisan votes on banning telehealth for mifepristone and banning FDA regulation of menthol cigarettes. The bill passed by a party line vote of 34–27.

Senate HELP Committee Advances Several Healthcare Bills. On June 15, the Senate HELP Committee held a markup to consider and advance six bills, including five related to healthcare. All five healthcare bills advanced by a bipartisan vote of 20–1, with Sen. Paul (R-KY) voting no. Details on the health-related bills are as follows:

S. 133, the NAPA Reauthorization Act, would extend through 2035 the National Alzheimer’s Project and support coordination of federal planning, programs and other efforts to address Alzheimer’s disease and related dementias.
S. 134, the Alzheimer’s Accountability and Investment Act, would require the National Institutes of Health, beginning in FY 2024, to annually submit an estimate of its budget and personnel needs for National Alzheimer’s Project initiatives directly to the President for review and transmittal to Congress.
S. 265, the SIREN Reauthorization Act, would modify and reauthorize through FY 2028 a grant program for improving emergency medical services in rural areas.
S. 1852, the Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023, would amend the Public Health Service Act to reauthorize a sickle cell disease prevention and treatment demonstration program.
S. 1855, the Special Diabetes Program Reauthorization Act of 2023, would reauthorize the Special Diabetes Program for Type 1 Diabetes and the Special Diabetes Program for Indians.

ADMINISTRATION

HHS Announces New Tools to Lower Prescription Drug Costs. On June 12, HHS released a fact sheet on new resources for reducing prescription drug costs through the Extra Help program, which helps eligible seniors and individuals with disabilities pay for their Medicare Part D premiums and cost-sharing.

HHS noted that the Administration for Community Living has announced targeted efforts, informed by a comprehensive equity analysis, to reach, screen and enroll people in the Extra Help program, with specific focus on Americans living in rural and underserved communities. CMS also released new national data on individuals who are expected to save more on prescription drug costs thanks to the program’s expansion in 2024, and those who are likely eligible for Extra Help but not enrolled.

CMS provided an outreach toolkit to help beneficiary advocates and community-based organizations raise awareness of the Extra Help program’s benefits and how to enroll. The toolkit includes social media content and a consumer-friendly article, and encourages drug plans to assist eligible individuals in enrolling in the program.

CMS Releases Updated Health Spending Projections. On June 14, the CMS Office of the Actuary released projections of national health expenditures (NHE) and health insurance enrollment for 2022-2031. The report, which can signal to policymakers where spending is growing, also highlights impacts from the Inflation Reduction Act (IRA), including projections that those with Medicare prescription drug coverage will experience lower out-of-pocket spending on prescription drugs for 2024 and beyond, as IRA provisions begin to take effect.

Highlights from CMS’s projections include the following:

Average annual growth in NHE (5.4%) is projected to outpace average annual growth in gross domestic product (GDP) (4.6%), resulting in an increase in the health spending share of GDP from 18.3% in 2021 to 19.6% in 2031.
Individuals with insurance are projected to have reached a historic high of 92.3% in 2022 (due to high Medicaid enrollment and gains in Marketplace coverage) and are expected to remain at that rate through 2023.
Medicare is projected to experience the highest rate of growth among the major payers from 2025 through 2031, at 7.8% per year, and 7.2% in 2024. But for 2022, it was 4.8%, partly because fee-for-service beneficiaries used less emergency hospital care and sequester pay cuts returned.
Given the expiration of the Medicaid continuous enrollment condition on March 31, 2023, and the resumption of Medicaid redeterminations, Medicaid enrollment is projected to fall over 2023-2025, most notably in 2024, with an expected net loss of eight million beneficiaries.
Hospital spending growth is expected to average 5.8% annually over 2022-2031. Growth in hospital utilization is expected to rebound, and hospital price growth is projected to accelerate in 2023 partly because of rising labor costs.
Total expenditures for retail prescription drugs are projected to grow at an average annual rate of 4.6% over 2022-2031.

Additional information on the projections can be found here.

COURTS

Update on Braidwood Case Regarding ACA Coverage of Preventive Medicines. On June 13, the US Court of Appeals for the Fifth Circuit signed an agreement that partially halts a Texas district court ruling to strike down the Affordable Care Act (ACA) requirement that health insurance plans cover US Preventive Services Task Force “A” and “B” preventive services without cost sharing for consumers.

The agreement reached by the Texas businesses and the federal government allows HHS to continue enforcing the ACA’s preventive service mandate nationwide while the case proceeds, with the exception of the case’s named plaintiffs.

QUICK HITS

The Medicare Payment Advisory Commission (MedPAC) released the June 2023 Report to the Congress: Medicare and the Health Care Delivery System. The report contains chapters on ways to address high prices of drugs covered under Medicare Part B, assessment of post-sale rebates for prescription drugs in Medicare Part D, standardized benefits in Medicare Advantage plans, favorable selection and future directions for Medicare Advantage payment policy, disparities in outcomes for Medicare beneficiaries with different social risks, behavioral health services in the Medicare program, telehealth in Medicare, alignment of fee-for-service payment rates across ambulatory settings, reforms to Medicare’s wage index systems and an evaluation of a prototype design for a post-acute care prospective payment system.
The Medicaid and CHIP Payment and Access Commission (MACPAC) released the June 2023 Report to Congress on Medicaid and CHIP. The report contains four chapters on automatic adjustments to disproportionate share hospital payments, integration of care for dually eligible beneficiaries, access to Medicaid coverage and care during and after incarceration, and barriers to Medicaid home- and community-based services (HCBS).
On June 14, HHS, through the Health Resources and Services Administration (HRSA), announced awards of almost $9 million to strengthen and expand the mental health and substance use workforce in underserved and rural communities. This funding will provide support to 20 grantees to train healthcare providers to provide care for individuals in need of mental health and substance use services.
On June 13, CMS announced New York’s extension of comprehensive coverage after pregnancy through Medicaid and the Children’s Health Insurance Program for postpartum individuals for a full 12 months. With the approval of New York’s plan, an estimated 509,000 Americans across 35 states and the District of Columbia now have access to extended postpartum coverage.
On June 12, HHS Secretary Becerra wrote a letter to all US governors urging them to adopt all flexibilities on Medicaid redeterminations that HHS has offered, to help eligible individuals and families maintain their health coverage and leverage all state partners to support individuals and families to complete renewal forms. In the letter, he provided a full list of available state strategies, which can be found here.
On June 9, HHS announced, through CMS, the list of 43 prescription drugs for which Medicare Part B beneficiaries’ coinsurances may be lower between July 1 and September 30, 2023. People who take these drugs may save between $1 and $449 per average dose, depending on their individual coverage. HHS also released a new report analyzing trends that have driven growth in spending for Medicare Part B coverage before passage of the IRA.
On June 9, HRSA launched the new Pediatric Specialty Loan Repayment Program, a $15 million investment to recruit and retain clinicians who provide healthcare to children and adolescents. The program seeks to address a broad range of disciplines that serve children, such as neonatal-perinatal medicine and pediatric cardiology. The application deadline is July 20.

NEXT WEEK’S DIAGNOSIS

The House and Senate are both scheduled to be in session next week. Healthcare activity is planned at the committee level, including a legislative hearing to address substance use disorder and a hearing to examine the successes and remaining challenges of the Medicare Access and CHIP Reauthorization Act.

For more information, contact Debra Curtis, Kristen O’Brien, Priya Rathakrishnan or Erica Stocker.

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M+ Check-Up: June 16, 2023

THIS WEEK’S DOSE

CONGRESS

ADMINISTRATION

COURTS

QUICK HITS

NEXT WEEK’S DIAGNOSIS

Authors

Debra Curtis

Erica Stocker

Kristen O’Brien

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