United States: Capitol Hill Healthcare Update - December 6, 2016

House Oks "Cures," Senate Votes This Week

The Senate this week is likely to give final congressional approval to legislation that adds billions of dollars for biomedical research and aims to speed the discovery and development of new drugs and medical devices. The "21st Century Cures" legislation won House approval last week 392-26. Although several Senate Democrats oppose the bill, the White House said it "strongly supports" its passage.

The bill authorizes $4.8 billion to NIH and $500 million to the FDA over 10 years, and states could apply for $1 billion in federal grants over two years to address opioid abuse. Congress would have to approve the funding each year. It also includes a series of provisions designed to accelerate the approval of new medical treatments. The legislation creates a new breakthrough approval pathway for medical devices but doesn't include any new exclusivities for drug makers.

Some Democrats, like Sens. Elizabeth Warren (D-MA) and Bernie Sanders (I-VT), have sharply criticized the bill as a "giveaway" to drug companies because it didn't include provisions addressing drug prices. "I know the difference between compromise and extortion," Warren said last week. Still, with the overwhelming House vote and President Obama's approval, the bill is expected to pass the Senate this week before Congress adjourns for the year.

GOP Will Repeal ACA, But Slowly

During the campaign, Donald Trump called the Affordable Care Act a "complete disaster" and vowed to repeal it as soon as he became president. Congress in early January will begin the process of unwinding Obamacare, but it will be several years before the law is wiped from federal statutes – if ever. Republicans are planning by late January or early February to approve fast-track legislation that would repeal most of President Obama's signature legislative achievement. Republicans will use a procedural budget maneuver called "reconciliation," which will allow them to bypass a Democratic-led filibuster in the Senate and approve the bill with only GOP votes.

That will be a powerful political moment for Republicans and for voters who backed Trump's call to repeal the law. But for the 20 million Americans who have insurance through Obamacare, not much will change. That's because Republicans are devising a long runway to transition to Trumpcare. The GOP will need that time because there isn't unanimity within the party over what comes next. Some Republicans want ACA 2.0 to include popular Obamacare provisions, like barring insurers from denying coverage based on pre-existing conditions, but exclude others, like mandates and provider taxes.

Despite the GOP's rhetoric on repealing Obamacare, the ACA will stay on the books at least through 2018 – and maybe longer. The real legislative action will not be on repeal but on devising what comes next, sparking both partisan clashes and what could be prolonged Republican arguments among themselves.

Walden Wins Key Healthcare Gavel

Rep. Greg Walden (R-OR) won support of House Republican leaders last week and was elected the next chairman of the House Energy and Commerce Committee. The committee has wide jurisdiction over healthcare regulatory policy, including at the FDA, NIH and CDC. The panel also oversees Medicare Part D. It will be the lead House committee next year reviewing the FDA's user fee agreements with medical device, pharmaceutical, biologic and generics manufacturers. Walden, who will succeed Rep. Fred Upton (R-MI), will take over the committee after successfully leading the House GOP's campaign arm and defending the party's majority status in 2014 and last month.

The committee's Health Subcommittee also will have a new leader next year after the retirement of Rep. Joe Pitts (R-PA). Rep. Michael Burgess (R-TX), an OB/GYN doctor for nearly 30 years, is likely to lead the subcommittee beginning in January.

Dems Vow to Fight GOP's "War on Seniors"

After President-elect Donald Trump nominated Rep. Tom Price (R-GA) to be HHS secretary, incoming Senate Democratic Leader Chuck Schumer (D-NY) accused Republicans of "plotting a war on seniors" by repealing the Affordable Care Act and backing Medicare changes. Schumer is aiming to rally Democrats to fight the GOP's healthcare agenda, especially the 10 Senate Democrats who are seeking re-election in 2018 in states Trump won last month. Although he lacks the votes to stop Republicans, Schumer is hoping to build public pressure among seniors to force the GOP to back off potential Medicare and ACA changes.

House Ways and Means Committee Chairman Kevin Brady (R-TX) said last week that Republicans won't push a Medicare overhaul early next year. Instead, he identified ACA transition issues as key GOP priorities early in 2017. Brady did say his committee early next year would push reform legislation focusing on post-acute care, including nursing homes, home health care agencies and rehabilitation facilities.

Price's Senate confirmation battle will begin next month. Already, Sen. Joe Donnelly (D-IN) – one of 10 Democrats seeking re-election in 2018 in states Trump won – said he would vote against Price because of his views on Medicare.

GOP Wants to Keep NIH's Collins

Leading House and Senate Republicans last week urged President-elect Donald Trump to carry over NIH Director Francis Collins into the new administration. House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Senate HELP Committee Chairman Lamar Alexander (R-TN) organized the letter to Trump supporting Collins' continued service. Both committees have legislative jurisdiction over NIH. Also joining the effort were Rep. Tom Cole (R-OK) and Sen. Roy Blunt (R-MO), both of whom chair appropriations subcommittees that fund NIH's budget.

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