United States: Capitol Hill Healthcare Update - January 18, 2017

The House on Friday gave final congressional approval to a budget blueprint that authorizes separate filibuster-proof legislation Republicans will use next month to repeal much of the Affordable Care Act (ACA).

Republican-led committees in the House and Senate now will begin drafting the so-called reconciliation legislation that will repeal portions of the health law. Lawmakers hope to have that bill ready to send to the White House before the end of February.

Republican leaders want to see the ACA repeal bill also include significant replacement provisions. Complicating efforts for Republicans is that only language changing government spending or revenue qualifies to be included in a reconciliation bill, which Senate Democrats can't block with a filibuster. If Republicans try to test those rules, the Senate parliamentarian, Elizabeth MacDonough, could overrule them.

After approving the reconciliation bill with both significant repeal and replace provisions, Republicans say they will turn their attention to pushing a series of stand-alone bills that would collectively form the balance of their replacement health plan. Unlike the reconciliation legislation, those individual bills could be stopped by Senate Democrats, but Republicans believe they can lure enough Democrats to support the individual replacement bills to shut down filibusters.

Republicans expect to flesh out their plans next week in Philadelphia, where the House and Senate GOP will be holding an annual retreat.

Trump doubles down on drug prices

President-elect Donald Trump shows no signs of backing away from statements he first made last year about cracking down on pharmaceutical manufacturers over drug prices, and his rhetoric may resonate with a surprising number of Republican lawmakers.

During a news conference last week and a media interview this weekend, Trump criticized pharma companies for leaving the United States, making drugs overseas and "getting away with murder." He also said the federal government should be directly negotiating drug prices.

Sparking a populist fight with drug companies may find traction for Trump on Capitol Hill, where the industry's influence has waned in recent years after significant turnover among lawmakers. Medicare's Part D prescription drug benefit, which a Republican-controlled Congress passed in 2003, likely couldn't win approval in the current GOP Congress (indeed, Vice President-elect Pence voted against creating Part D when he served in the House).

Last week 10 Senate Republicans – including a member of the GOP leadership, Sen. John Thune (R-S.D.); conservatives Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah); moderate Sen. Susan Collins (R-Maine); and two committee chairmen, Sens. John McCain (R-Ariz.) and Chuck Grassley (R-Iowa) – voted to allow prescription drugs to be imported from Canada – a policy long opposed by pharma companies. The drug importation vote ultimately failed as seven Senate Democrats broke with their party to block the effort.

Brady says GOP will repeal ACA taxes "immediately"

House Ways and Means Committee Chairman Kevin Brady (R-Texas) told reporters publicly and stakeholders privately last week that Congress will repeal the ACA's tax provisions this year.

Some Republicans had speculated the taxes could stay in place at least during the transition period or to finance whatever replacement plan GOP leaders develop. But Brady shot that down last week, pledging that ACA taxes would be repealed immediately.

The ACA's Cadillac tax on high-cost health plans already had been pushed back to 2020, and the 2.3 percent excise tax on medical devices is entering the last year of a two-year suspension. Other taxes and fees on pharmaceutical manufacturers and upper-income taxpayers are in effect.

Price's confirmation hearings begin Wednesday

The Senate HELP Committee this week will kick off confirmation hearings for Trump's nominee to be Secretary of the U.S. Department of Health and Human Services (HHS), but Rep. Tom Price (R-Ga.) likely won't be confirmed until next month.

Committee Chairman Lamar Alexander (R-Tenn.) said his panel will hold a hearing on Price's nomination Wednesday. The Senate Finance Committee, which has primary jurisdiction over HHS nominees, will hold a separate hearing later this month.

The timing could be important because Trump has said he would announce his plans to replace the ACA only after Price is confirmed.

Although several Senate Democrats have come out against Price, he's currently expected to win confirmation.

User fee hearings may start in February

Hearings on the FDA user fees negotiated with pharmaceutical and medical device manufacturers are expected to begin in the House next month.

The House Energy and Commerce Committee could hold hearings as early as next month on the separate user fee agreements for manufacturers of brand and generic drugs, biologics, and medical technology. The House hopes to complete consideration by early this summer.

The Senate is on a slower track because the Senate HELP Committee is currently focused on confirmation hearings for Trump's incoming cabinet secretaries and senior officials. HELP Committee hearings on the user fees aren't expected to get underway until March.

Although the current user fee authorization won't expire until Sept. 30, lawmakers want to finish consideration of the new agreements by this summer, ahead of a mandated deadline when layoff warnings would have to be distributed to FDA employees. Both committees also say they want to keep the agreements free from other provisions, like efforts to reduce drug prices.

House OKs public health bills

The House last week approved four bipartisan public health bills, including one that would establish a national commission to recommend coordinated care for patients of metabolic syndromes and related autoimmune disorders.

The House also approved legislation that would increase HHS data collection to disperse maternal health professionals in rural and underserved communities. That legislation was introduced by House Energy and Commerce Health Subcommittee Chairman Michael Burgess (R-Texas).

Other legislation that won House approval would ensure sports medicine professionals are covered by their malpractice insurance when providing care to athletes or teams in other states, and legislation streamlining the Drug Enforcement Administration registration process for emergency medical services and permitting EMS professionals to administer controlled substances.

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