United States: Capitol Hill Healthcare Update- February 2017

GOP leaders delay ACA action amid "repeal," "repair" debate

House Speaker Paul Ryan last week set a deadline of the end of March for repealing most of the Affordable Care Act (ACA), as other Republican leaders and conservative rank-and-file lawmakers advocated competing policy alternatives for what would follow the health law.

Congressional Republicans had hoped to fast-track ACA repeal by passing legislation repealing most of the law by early February. Although Congress last month authorized the use of filibuster-proof legislation known as budget reconciliation, the GOP has been hampered trying to determine which parts of the ACA can be repealed and what new parts can be included in the reconciliation bill.

Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) continued to propose a methodical approach, saying during a committee hearing last week that he favored "repairing" the ACA and detailing what Republicans would do next before repealing the law.

Senate Finance Committee Chairman Orrin Hatch (R-Utah) last week said he could support efforts to repair the law rather than scrapping it totally and starting from scratch. Hatch, during a speech before the U.S. Chamber of Commerce, also endorsed Speaker Paul Ryan's (R-Wis.) plan of offering a framework for the GOP's replacement plan at the same time as the underlying law is repealed, and then debate other replacement provisions separately.

President Trump, during a pre-Super Bowl interview Sunday, also seemed to reset expectations for when Republicans' full ACA replacement would be implemented. "Maybe it'll take till some time into next year," Trump said. "I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year."

While the ACA repair rhetoric is gaining traction among key Republican committee chairmen, it's politically toxic to House conservatives, who believe it is akin to lawmakers breaking their promise to voters to fully repeal the law. Rep. Mark Meadows (R-N.C.), the leader of the conservative House Freedom Caucus, told reporters last week that the ACA was "unrepairable."

GOP advances Price's nomination

With Democrats boycotting and effectively blocking a Senate Finance Committee vote on Rep. Tom Price's (R-Ga.) nomination to be secretary of the U.S. Department of Health and Human Services (HHS), Republicans suspended the panel's rules last week and voted to send the nomination to the full Senate.

Finance Committee Chairman Orrin Hatch defended suspending the committee's rules by saying the panel wouldn't be held hostage by Democrats' "political stunt." Democrats are demanding more information from Price on his investment in an Australian biotechnology manufacturer.

Republicans have the votes in the Senate to approve Price, and Republicans leaders say a vote could come as early as this week but is likely to slip into the following week.

Price's confirmation is critical to President Trump's and congressional Republicans' plans to unwind portions of the ACA that can be affected by HHS regulations. Price also will play a critical role in crafting what policies will be included in the GOP's plans to replace the health law.

Hatch, Brady: Repeal all ACA taxes now

Congress' top tax writers left no doubt where they stand on the fate of provider taxes and fees included in the Affordable Care Act – they should be repealed immediately.

While congressional Republicans are still trying to figure out a path forward on what parts of the law to repeal and when, House Ways and Means Chairman Kevin Brady (R-Texas) and Senate Finance Committee Chairman Orrin Hatch said last week that the taxes on pharmaceutical and medical device manufacturers, hospitals, and insurers should be stricken right away.

Hatch, during a speech last week at the U.S. Chamber of Commerce, called for all ACA taxes to be repealed effective as soon as Congress repeals most of the health law using budget reconciliation, likely in March.

Still, some Republicans say the GOP should keep the taxes in place to help finance a transition to a new plan and also to provide revenue for whatever health policy Congress passes to replace the ACA. Brady, in a media interview last week, acknowledged a split among Republicans over the issue, but said, "Personally, I don't want any more small businesses or patients or medical device makers to suffer under the burden of Obamacare taxes any longer."

House leader outlines timeline for health bills

House Majority Leader Kevin McCarthy (R-Calif.) last week sketched out the schedule for considering major healthcare legislation, beginning with a vote next month on repealing most of the ACA.

McCarthy, the No. 2 Republican in the House, also said he hoped Congress would complete consideration of pharmaceutical, generic, biologic, and medical device user fees for FDA by the end of June. Although Congress has until Sept. 30 to reauthorize the user fees, the law requires that lay-off notices be sent to FDA employees in August, warning that jobs could be jeopardized if Congress doesn't meet the deadline.

The House Energy and Commerce Committee is expected to begin hearings on the user fees – starting with the medical device industry's – in mid-February.

McCarthy pegged July as the target date for renewing the Children's Health Insurance Program, which also expires September 30.

House panel delays vote on drug pricing bill

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said his panel will delay a scheduled vote this week on legislation to lower prescription drug prices by incentivizing generic drug development.

The bipartisan legislation, backed by Reps. Gus Bilirakis (R-Fla.) and Kevin Schrader (D-Ore.), calls on FDA to expedite generic drug applications when drugs are in short supply or when there are limited manufacturers in the market. It's similar to bipartisan legislation introduced last week in the Senate by Sens. Susan Collins (R-Maine) and Claire McCaskill (D-Mo).

Democrats on the committee asked Walden to delay a vote on the bill. Democrats hope to gain Republican support for adding other provisions to the legislation and also want a more thorough vetting of the bill and the underlying issue.

Walden attended a White House meeting last week with President Trump and pharmaceutical industry executives. Trump previously said the industry was "getting away with murder," and he vowed to require Medicare to negotiate directly with manufacturers over drug prices. The president backed off that rhetoric in the meeting, and instead focused on the need to consider speeding generic drug applications.

Emerging from the White House meeting, Walden announced his committee would vote on the generic drug pricing bill. Now that the vote has been delayed, the panel's Subcommittee on Health will vote Tuesday on legislation designed to tighten financial eligibility for Medicaid, including banning state lottery winners from being eligible.

Pascrell praises UDI device proposal

Rep. Bill Pascrell (D-N.J.), one of Congress' leading voices on unique device identifiers for medical technology, praised a decision last week from the standards committee ASC X-12 that UDIs should be included on insurance claims forms.

Pascrell has previously advocated that Congress enact legislation mandating the change, which he said would allow FDA and others to track defective implantable devices like cardiac stents and artificial hips. Opponents argue the data could be misleading because it wouldn't take into account the overall condition of the patient, the skill of the surgeon or other unique factors.

The standards committee's proposal faces a three-month public comment period as well as final approval by HHS and the Centers for Medicare and Medicaid Services. HHS secretary nominee Rep. Tom Price (R-Ga.) previously voiced opposition to efforts by Pascrell; CMS administrator nominee Seema Verma's position on the issue is not clear.

Both Price and Pascrell are senior members of the House Ways and Means Subcommittee on Health, which has jurisdiction over Medicare Parts A and B as well as CMS.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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