United States: Capitol Hill Healthcare Update

While Some Republicans Press For New ACA Repeal, Vote This Month Unlikely

Some Republican lawmakers, led by Sen. Lindsey Graham (R-S.C.), are pushing new plans to overhaul the Affordable Care Act (ACA), but other policy priorities and tight legislative deadlines this month are likely to thwart attempts to rekindle ACA repeal efforts.

Congress faces a daunting series of must-pass bills, including a funding measure to keep the government open and legislation to increase Washington's borrowing authority. Funding for other key programs – from the Children's Health Insurance Program (CHIP) to the Federal Aviation Administration – expires September 30 unless renewed. Moreover, lawmakers will likely face multiple votes this month to approve tens of billions of dollars in emergency funding for Hurricane Harvey relief.

That workload is exacerbated by the short amount of time lawmakers are scheduled to be in Washington in September. The House is in session for only 12 days and the Senate for 17 days.

Republicans' ACA repeal drive stalled in late July when Sen. John McCain (R-Ariz.) voted to block advancing a pared-down repeal bill in the Senate. It was a decisive defeat, but some GOP lawmakers do not want to abandon their effort to repeal a law they campaigned against for seven years.

Graham and Sens. Bill Cassidy (R-La.) and Dean Heller (R-Nev.) have proposed giving governors $500 billion in ACA funding as block grants along with a virtual free hand in creating state-based coverage programs. Senior White House officials are bullish on Graham's plan, but others in the Senate far are less optimistic.

In an effort to ensure Republicans do not go down another ACA rabbit hole, GOP leaders have said no repeal legislation would be scheduled for a vote unless there are 50 publicly committed senators in support of a plan.

In addition to the crowded legislative calendar, Republicans face another deadline that further complicates their repeal efforts: The fast-track legislation known as budget reconciliation they had been using earlier this year to repeal the ACA will expire Sept. 30, the end of the current fiscal year. Without that reconciliation legislation, any repeal effort would need 60 Senate votes to pass; Republicans hold 52 seats in the Senate.

ACA Effort Shifts From Repeal to Possible Repair

With the effort by Congress to overhaul the ACA likely dead, one key senator is trying to develop consensus legislation to stabilize the ACA's individual insurance markets while also giving states flexibility to implement the law.

Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) plans two days of hearings this week focusing on stabilizing premiums and creating new options for enrollees. The hearings will feature testimony from several state insurance commissioners and governors from Colorado, Massachusetts, Montana, Tennessee and Utah.

Alexander says he wants to see Congress vote this month – a quick deadline designed to aid insurers before they finalize 2018 coverage and rates. He wants to extend for one year the ACA's cost-sharing subsidies, which President Trump has threatened to stop and which are central to an ongoing federal legal challenge. Insurers say premiums will rise an additional 20 percent without the government's payments to subsidize low-income enrollees.

Sen. Patty Murray (D-Wash.), the committee's top Democrat, has encouraged Alexander's effort to find bipartisan consensus on changes to the law. However, it is not clear that the legislation they might devise could generate sufficient bipartisan support and be able to compete for House and Senate floor time in September given the jam-packed agenda.

Congress Readies Stopgap Funding Bill for Federal Health Programs

With more than $77 billion in funding for health programs operated by the U.S. Department of Health and Human Services, the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention, and dozens of other federal agencies set to expire September 30, Congress is likely to approve a stopgap bill to keep them operational until mid-December.

Facing a budget deadline and a crammed legislative agenda, lawmakers are likely to extend current fiscal 2017 funding levels for about 75 days into the 2018 fiscal year, which starts October 1. The move is designed to give the Trump administration and Congress time to resolve funding disputes and thorny policy issues, including constructing a wall on the U.S.-Mexican border.

Creating a new funding deadline in December would effectively kick the can down the road and only defer fights that had elevated the risk of a government shut down this month.

CHIP Faces Senate Hearing This Week as Deadline Looms

The Senate Finance Committee will hold its first hearing on CHIP this week, only three weeks before the popular initiative is slated to expire.

Earlier plans to renew the federal-state program that serves 8.9 million children fell victim to separate efforts to repeal the ACA. Backers of the program are concerned its widespread bipartisan support could make it an attractive target for amendment by other more contentious provisions, like those related to the ACA.

Children's advocates and providers have been calling for a five-year CHIP renewal, but many lawmakers believe a two-year extension will be Congress' likely landing spot. Lawmakers will need to add provisions to offset new federal CHIP spending, and legislation to speed generic manufacturers' access to REMS-protected branded drugs is a prime target as a pay-for.

Although the law expires September 30, the Medicaid and CHIP Payment and Access Commission (MACPAC) said states would not run out of funding before the end of the year. Still, providers say families already are worrying coverage may be denied or delayed if Congress does not act this month.

Mylan Settlement Draws Bipartisan Criticism

Mylan's recent $465 million settlement with the U.S. Department of Justice triggered a new round of bipartisan criticism for the company, as lawmakers also accused the Trump administration of going too soft on the EpiPen manufacturer.

Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa) said the settlement that Mylan overbilled Medicaid for its anti-allergy device "shortchanges taxpayers." He said Mylan over-charged Medicaid by $1.27 billion over 10 years.

Rep. Lloyd Doggett (D-Texas) called the agreement "unacceptable," and Sen. Richard Blumenthal (D-Conn.) said it was "completely insufficient."

Meanwhile, more than two dozen House Democrats are accusing several pharmaceutical manufacturers of colluding to raise prices on multiple sclerosis drugs. Led by Reps. Elijah Cummings (D-Md.) and Peter Welch (D-Vt.), the lawmakers wrote to several drug companies seeking information on sales, profits, marketing costs and other data. The companies targeted were Bayer, Biogen, Genzyme, Novartis, EMD Serono, Roche and Teva Pharmaceuticals.

Advocates of Repealing ACA Provider Taxes Ponder Plan B

When Congress stalled on repealing the ACA earlier this summer, lawmakers left nearly $1 trillion in taxes on the books. Now providers are looking at tax reform legislation as a potential vehicle to repeal some of those levies created by the 2010 healthcare law.

Repealing the medical device industry's 2.3 percent excise tax has generated the most bipartisan support, including from a majority of House members. The industry successfully persuaded Congress to suspend the tax for years, but it is scheduled to take effect again January 1 unless lawmakers act before year-end.

Insurers also are working to raise visibility into their industry's ACA fee, which is expected to total $14 billion next year while increasing consumers' premiums by 3 percent. The pharmaceutical industry has been quieter about its ACA fees, knowing the political environment in Congress will make aiding the industry more difficult.

Providers are looking at potential tax reform legislation to carry industry-specific tax cuts, and Senate Finance Committee Chairman Orrin Hatch (R-Utah) said he would be looking at the ACA taxes as part of a tax reform package. Republicans expect to make an all-out push for tax reform beginning this fall.

Senate Confirms Anesthesiologist as Surgeon General

Just before adjourning last month for its summer recess, the Senate confirmed Jerome Adams as the nation's new surgeon general. Adams previously served as Indiana's health commissioner, a position to which he was appointed by Vice President Pence when Pence `was the state's governor.

Adams, an anesthesiologist, was supported by several physician provider groups, including the American Medical Association and the American Psychiatric Association. He succeeds Vivek Murthy, whom President Trump fired earlier this year.

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