United States: Capitol Hill Healthcare Update - June 2017

Senate Republicans return to Washington this week after a 10-day recess facing a key inflection point in their effort to repeal and replace the Affordable Care Act (ACA) as GOP leaders will outline policy options they hope can unify their fragmented caucus.

None of the options is a silver bullet, and each effort to appeal to one group of Republicans risks triggering new opposition from another. Majority Leader Mitch McConnell faces the seemingly herculean task of fashioning legislation that can satisfy at least 50 senators, allowing Vice President Pence to cast the tie-breaking vote to pass a repeal-and-replace bill. McConnell's margin for error is narrow as Republicans hold 52 Senate seats.

Among the policy choices Republicans will begin weighing this week is postponing ACA repeal until 2020 to allow Congress additional time to draft an overhaul of the law. Under that plan, the Senate would provide additional subsidies to try to stabilize individual insurance premiums and to incentivize insurers to return to states they've abandoned. Most Republicans would likely view punting for two years as a viable alternative only to doing nothing.

Senators also will discuss slowing the phase out of the ACA's Medicaid expansion, in a nod to the 16 GOP governors who accepted federal funding to increase their programs. Several key Republican senators, led by Sen. Rob Portman (R-Ohio), are working to protect their states' expanded Medicaid programs, while other senators would support keeping the expanded programs but with lower federal contributions.

Other options include shoring up the insurance exchanges, but senators could get tripped up as they decide whether to include House-passed language that prohibits subsidies for insurance plans that include abortion coverage.

Some GOP senators say they need to keep – or delay the repeal of – the ACA's taxes on providers and individuals. Those lawmakers say the tax revenue would be needed to finance new subsidies to insurers for covering patients with pre-existing conditions or for keeping expanded Medicaid coverage. But Finance Committee Chairman Orrin Hatch (R-Utah), in a speech on the Senate floor before the recess, warned of a political backlash if the party failed to repeal the ACA taxes after "spending the better part of a decade railing against Obamacare's burdensome, job-killing taxes."

McConnell wants a Senate vote on the GOP's healthcare plan in June, but Republicans will be hard pressed to meet that deadline. Even after Republicans coalesce on the underlying policy – and they're not close to doing that – the legislation will need to undergo a thorough analysis by the Congressional Budget Office (CBO). Depending on how much Senate Republicans change the House-passed bill, that CBO review could take a week or longer.

The CBO analysis will be an important benchmark for the Senate parliamentarian, who will largely set the ground rules for how the healthcare bill will be debated on the Senate floor. Republicans are using a legislative procedure called budget reconciliation for their bill. The principal advantage of reconciliation is that the GOP can pass the bill with a simple majority, not the usual 60 votes needed to approve legislation.

The downside is that not every provision is eligible to be included in a reconciliation bill, which generally is confined to policies that have direct impact on government spending. So that means Republicans can repeal ACA taxes and subsidies but cannot include medical liability reform or provisions allowing insurers to sell policies across state lines. The nonpartisan parliamentarian effectively decides what's in and what's out, and overturning her rulings requires 60 votes.

Despite McConnell's push for a vote before the scheduled Fourth of July recess, all signs point to a more likely timetable for a vote after that holiday and before the beginning of the month-long August recess.

Price to Face Budget Hot Seat on Capitol Hill

HHS Secretary Tom Price is expected to face double-barreled scrutiny Thursday when he testifies before two congressional tax-writing committees about his department's fiscal 2018 budget request. Price will testify before the Senate Finance Committee on Thursday morning and the House Ways and Means Committee that afternoon.

Lawmakers in both parties are expected to sharply question Price over the Trump administration's budget proposal. It calls for sharp spending reductions for several healthcare agencies and programs, including NIH, FDA, CDC and substance abuse programs.

Trump's budget would reduce future increases in Medicaid spending by $610 billion over 10 years. The federal government last year spent $368 billion on Medicaid, and even with its lower projected spending the Trump budget forecasts Medicaid spending will almost double in 10 years to $688 billion.

Republicans and Democrats have questioned Trump's spending priorities, including for NIH and FDA. It's unlikely many of Trump's proposed healthcare spending cuts will find support in Congress.

Timing Unclear on Advancing FDA User Fee Bills

House and Senate leaders have not yet announced a timeline for considering separate legislation to reauthorize the user fees that drug and medical device companies pay to support FDA product reviews.

Senate leaders haven't set a schedule for floor consideration as the Senate HELP Committee continues to try to strike a bipartisan agreement that would limit floor amendments. But there's also worry that some Democrats may try to hijack the usually bipartisan user fee renewal because of Republicans' separate effort on repealing the ACA.

In the House, the Energy and Commerce Committee is expected to hold a vote this week on its plan, although a formal notice had not been announced as of this morning.

The Trump administration is still pressing its plan to substantially increase industry user fees and ratchet down government spending for FDA. But the current five-year user fee plan expires Sept. 30, and key lawmakers in both parties have said there isn't time to re-open the pending agreement, which FDA and industry representatives negotiated over nearly two years.

House GOP Questions Expansion of 340B Drug Discounts

The House Energy and Commerce Committee last week initiated an investigation of the 340B drug discount program, questioning whether the federal agency responsible for the program is effectively overseeing it.

The committee sent a letter last week to the Health Resources and Services Administration (HRSA), asking the agency to provide information on its fiscal 2015 and 2016 audits of hospitals and other covered providers. The letter was signed by committee Chairman Greg Walden (R-Ore.), Health Subcommittee Chairman Michael Burgess (R-Texas), and Oversight and Investigations Subcommittee Chairman Tim Murphy (R-Pa.).

The lawmakers said they were "concerned about the 340B program's rapid growth without additional and proportional oversight." Sales of outpatient drugs under the 340B program more than doubled between 2010 and 2015 and expanded by 66 percent between 2013 and 2015 alone, the committee said. As of 2011, nearly a third of all U.S. hospitals participated in the program.

Although Congress in recent years has questioned whether hospitals and other participating facilities are appropriately using the 340B savings, the committee's letter focused squarely on HRSA. The committee said the agency's "lack of follow-up audits when it finds violations is troubling," and the high rate of hospital noncompliance "indicates a need for additional oversight of this program."

Panel to Examine Medicare Advantage Care Payment Models

The House Ways and Means Health Subcommittee will hold a hearing Wednesday to review Medicare Advantage programs that serve high-cost, high-need beneficiaries with integrated care and value-based models. Subcommittee Chairman Pat Tiberi (R-Ohio) said the committee is examining Special Needs Plans and other Medicare Advantage models like the Program for All-Inclusive Care. He said the panel is interested in new models that allow for increased flexibility and value-based insurance design focused on delivering integrated and coordinated care for seniors and people living with disabilities. The committee has not announced the names of the witnesses who will be testifying at the hearing.

Grassley: Mylan Overcharged Taxpayers

Senate Judiciary Committee Chairman Charles Grassley (R-Iowa) last week accused Mylan of "gaming the system" as he released an independent report that found taxpayers overpaid the company by $1.2 billion for its anti-allergy device EpiPen. The report, by the HHS inspector general, found Mylan had for years misclassified EpiPen as a generic drug rather than a brand-name product – allowing the company to bypass significant discounts it was required to pass on to Medicaid beneficiaries.

The company last year agreed to pay the government $465 million to settle claims that it overcharged taxpayers. Grassley had been critical of that arrangement, saying at the time the settlement was far short of the amount overcharged to taxpayers. The senator said he is continuing his review, including why CMS didn't follow up with Mylan after the agency told the company it was misclassifying EpiPen as a generic drug.

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.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

In association with
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.