United States: Capitol Hill Healthcare Update - February 28, 2017

President Trump will address a joint session of Congress on Tuesday, and the expectation is that he will use the primetime moment to outline – at least in broad strokes – his goals for repealing and replacing the Affordable Care Act (ACA), according to congressional staff. But it's unlikely the president will offer a detailed roadmap for Congress to resolve the thorny policy, procedural and political roadblocks that have thus far stalled Republicans' progress on changing the healthcare law.

To provide clarity for the 20 million Americans who have gained insurance under the ACA, Trump previously called on Congress to approve a new healthcare plan soon after repealing the ACA. But Congress has been stymied, stuck between lawmakers who want to repeal the law and others who want to graft on conservative changes to "repair" it. Fashioning legislation that satisfies the different GOP factions, conforms to the budget rules, and doesn't leave Republicans exposed politically has proven to be a formidable and so far unachievable task.

No House votes this week on ACA repeal-replace

House staff last week confirmed that leaders are not ready to schedule committee votes on language to repeal and replace the ACA, and while some leaders want to introduce draft legislation this week, it's not clear that will happen either. House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said he had hoped to begin voting on legislation this week. News reports of draft legislative text for an ACA replacement plan also fueled speculation that the House was prepared to kick-start voting on the bill. But House staff later cautioned against reading too much into that draft text, which was more than two weeks old. Also, recent calculations by the Congressional Budget Office on the GOPs' replacement plans has created uncertainty on how different provisions would fit together, delaying a bill introduction until lawmakers return to the Capitol after a weeklong recess.

Forty-six of the nation's governors were in Washington beginning last week, including for meetings with President Trump and senior administration officials over Medicaid. The fate of states that expanded Medicaid under the ACA – including those represented by Republican governors – continues to be a thorny issue for GOP leaders on Capitol Hill. Republican members of the House Energy and Commerce Subcommittee on Health, which has jurisdiction over Medicaid, acknowledged coming under intense lobbying pressure over the issue, including by state officials and constituents. Of the subcommittee's 18 Republicans, nine represent states that have expanded their Medicaid programs.

House leaders say they are confident ACA repeal-replace legislation could win a majority vote in that chamber. But they're less certain about whether it could pass the Senate, and that dynamic is creating a political challenge: how to persuade rank-and-file House lawmakers to cast what may be difficult political votes if it's not clear that a House ACA bill could win Senate approval.

Verma committee vote could be this week

The Senate Finance Committee could vote as early as this week on Seema Verma's nomination to lead the Centers for Medicare & Medicaid Services, setting the stage for a confirmation vote by the full Senate in March. Verma is expected to win confirmation in the committee though some Democrats have expressed concern about what they describe as her non-specific answers to several questions, such as those on drug prices, during a hearing earlier this month. The committee has not officially announced a vote for this week.

House hearing reviews FDA user fees

The House Energy and Commerce Subcommittee on Health will hold the first hearing this week on reauthorizing FDA user fee programs. The panel will kick off a series of hearings by examining the user fee proposal for generic drugs and biosimilar programs. FDA and industry stakeholders are scheduled to testify on how the programs have been implemented and offer recommendations for renewing them. The Senate Committee on Health, Education, Labor & Pensions is planning two user fee hearings – one on all the industry user fee agreements, and a second with patient advocacy groups and other stakeholders. Congress has until September 30 to reauthorize the user fees paid by pharmaceutical and medical device manufacturers, which account for nearly half of the FDA's annual budget.

Bill boosting generics gets hearing; drug importation bill introduced

This week, the House Energy and Commerce Subcommittee on Health is scheduled to consider bipartisan legislation designed to increase generic drug development. The legislation – backed by Reps. Gus Bilirakis (R-Fla.) and Kevin Schrader (D-Ore.) – calls on the FDA to expedite generic drug applications when drugs are in short supply or when there is limited competition among manufacturers. The legislation would also create a priority review voucher that a manufacturer could use on a second generic application, shaving about two months off expected review times. The bill is similar to Senate legislation introduced in January by Sens. Susan Collins (R-Maine) and Claire McCaskill (D-Mo).

Meanwhile, in the Senate, Democrats this week are expected to introduce legislation that would authorize the importation of prescription drugs from Canada. Led by Sen. Bernie Sanders (I-Vt.), the bill is expected to pick up several Democrats as co-sponsors – including those who voted against a separate Sanders-backed drug importation amendment in January.

Panel to consider medical malpractice bill

The House Judiciary Committee is scheduled to vote this week on legislation that would limit medical malpractice lawsuits. Rep. Steve King (R-Iowa) said his legislation is designed to reduce healthcare costs by eliminating "defensive medicine" and lowering the cost of doctors' liability insurance. His bill would limit awards for noneconomic damages to $250,000 and cap attorneys' fees. Plaintiffs also would be required to file suits within three years of an injury, and the legislation would protect pharmaceutical and medical device manufacturers from lawsuits for FDA-approved products. The bill will be opposed by most committee Democrats, and the American Association for Justice issued a statement sharply critical of the bill.

Hospitals lobby against expanding physician-owned facilities

The trade associations representing most of the nation's hospitals are lobbying against House legislation that would overturn a prohibition on expanding physician-owned hospitals.  The Federation of American Hospitals and the American Hospital Association last week released a joint letter announcing their opposition to the legislation, which was introduced by Rep. Sam Johnson (R-Texas). Congress, in the ACA, sought to balance the interests of hospitals and doctors by prohibiting future physician-owned hospitals while grandfathering current facilities. Johnson's bill would repeal the prohibition on new physician-owned hospitals.

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