United States: Capitol Hill Healthcare Update – January 9, 2018

BILL TO AVERT GOVERNMENT SHUTDOWN COULD INCLUDE HEALTHCARE PROVISIONS

With less than two weeks before another deadline to avert a government shutdown, Republican leaders on Capitol Hill say they're cautiously optimistic about crafting a budget agreement that also would include several key healthcare provisions.

The budget outline would include setting top-line budget numbers for two fiscal years, a long-term reauthorization of the Children's Health Insurance Program (CHIP), renewal of Medicare payment provisions and a series of changes to Affordable Care Act (ACA) provider taxes. While that framework has been discussed among Republicans and Democrats, congressional staff warn it has not been agreed to and could stall over a number of unrelated issues. For example, some Democrats say they will withhold support for a budget agreement or another stopgap spending bill to keep the government open unless their demands for immigration provisions are met.

Passage of a CHIP renewal should be easier after an estimate last week by the Congressional Budget Office found that a five-year renewal would cost only $800 million, down from earlier estimates of $8.2 billion. CBO said the new forecast comes after Congress approved separate tax legislation last month that repealed the ACA's individual mandate, which the agency found would reduce the government's overall healthcare spending.

Dozens of children's hospital executives are in Washington this week, and they are stepping up criticism of Congress for failing to renew the bipartisan program, which expired last September. They are expected to press lawmakers to vote immediately on a five-year renewal.

Under the tentative budget framework, the ACA taxes that could be targeted for a suspension or even repeal include the medical device tax, the tax on insurers and the so-called Cadillac tax on high-cost health plans. But there's disagreement among congressional Republicans on whether to include the ACA tax provisions now or later in a separate tax-only bill.

DEMOCRATS EXPECTED TO GRILL AZAR AT CONFIRMATION HEARING

The Senate Finance Committee on Tuesday will hold a confirmation hearing on Alex Azar, whom President Donald Trump in November nominated for Health & Human Services (HHS) secretary.

Azar enjoys widespread support among Senate Republicans and is likely to be confirmed. But Democrats on the committee are expected to grill Azar over what they say has been Trump's inaction on prescription drug prices and Azar's role in boosting prices while he was a senior executive at Eli Lilly.

Democrats who are likely to pose the sharpest questions to Azar will be the top committee Democrat, Sen. Ron Wyden, D-Ore., as well as Sens. Bill Nelson, D-Fla., Sherrod Brown, D-Ohio, and Claire McCaskill, D-Mo.

Sen. Chuck Grassley, R-Iowa, is a frequent pharma critic, and he is expected to push Azar on prescription drug importation and on manufacturers that use patent laws to extend drug exclusivity. Grassley last year called on HHS to fast-track the importation of prescription drugs from Canada.

Committee Chairman Orrin Hatch is expected to quickly move for a vote by the full committee, and GOP leaders want to get Azar confirmed by the Senate this month.

WILL GOP CONGRESS TARGET MEDICAID REFORM IN 2018?

Congressional Republicans and President Donald Trump met at Camp David over the weekend to plot their 2018 legislative agenda with House GOP leaders, making the case that a Medicaid overhaul tied to welfare reform would help the party's political fortunes in this year's midterm elections.

House Speaker Paul Ryan has long said he wants to focus on entitlement reforms this year, even using budget reconciliation legislation to force a party-line vote and bypass a Democratic-led filibuster in the Senate. But after failing twice last year to repeal the Affordable Care Act (ACA), Senate Republicans are cool to the idea of tackling even Medicaid reform. Senate Majority Leader Mitch McConnell said a Medicaid overhaul could be approved only with support from Democrats, who oppose GOP efforts to block-grant the program.

Although there isn't a clear path for Republicans to enact broad Medicaid reforms this year, House Republicans are not giving up. Even with McConnell signaling the Senate won't pass a Medicaid bill, the House is expected to draft and vote on a Medicaid reform package. House leaders say Medicaid and welfare reform not only align with conservatives' political outlook but also would boost Republicans as they battle to retain their House majority.

Sen. Lindsay Graham, R-S.C., one of the authors of last year's failed ACA repeal bill, said he will press for a new vote this year on his legislation with Sen. Bill Cassidy, R-La., that among other things would transform Medicaid into a block-grant program. But it's not clear Republicans are any closer to gaining the 50 votes they need. The GOP faces a slimmer majority after losing the Alabama special election in December, and two GOP lawmakers – Sens. John McCain, R-Ariz., and Thad Cochran, R-Miss. – have missed votes in recent months due to illnesses.

SENATE APPROVES BIPARTISAN VETS' TELEHEALTH BILL

The Senate last week approved bipartisan legislation that would expand veterans' access to telehealth services, including mental health treatment.

The bill by Sens. Joni Ernst, R-Iowa, and Mazie Hirono, D-Hawaii, is similar to legislation that won House approval last year.

The Senate bill targets disabled and rural veterans by expanding telehealth services to allow Department of Veterans Affairs' (VA) officials to practice telemedicine across state lines. It also calls on the VA to study the effectiveness of telehealth services with the hope it could be expanded to cover other treatment areas.

GROUP PRESSES HOUSE GOP ON 'RIGHT-TO-TRY' LEGISLATION

The Senate last year approved legislation that would give terminally ill patients wider access to prescription drugs that haven't yet won Food and Drug Administration (FDA) approval, and now a conservative political advocacy group is calling on Republican leaders to schedule a vote in the House.

Americans for Prosperity, which is funded by Republican activist brothers David Koch and Charles Koch, wants House Energy and Commerce Committee Chairman Greg Walden, R-Ore., to schedule a vote on a House version of the bill. In a letter to Walden, the group said the FDA's compassionate use program, which allows terminally ill patients to access experimental drugs, is "costly, onerous and overly complicated."

Vice President Michael Pence last year endorsed the so-called right-to-try legislation backed by Sen. Ron Johnson, R-Wis. Pharmaceutical manufacturers have resisted the bill, saying early access to unapproved drugs could give patients false hope and threatens the integrity of ongoing clinical trials if those patients have adverse reactions.

CONSERVATIVE GROUPS NOT GIVING UP ON ACA REPEAL

A group of conservative policy and political activists is calling on congressional Republicans to vote again on repealing the Affordable Care Act (ACA).

The group includes think tanks Heritage Action, the Hoover Institution and the American Enterprise Institute, as well as former Sen. Rick Santorum, R-Pa.

"Health costs are rising faster than before [the ACA], and there's no real prospect of a reversal without legislative action," the group wrote in a letter to Republican congressional leaders.

While a new push to repeal the ACA is unlikely in Congress, the letter reflects political pressure congressional Republicans continue to feel from conservative grassroots activists, who will play a key role in contested House and Senate Republican primary elections that begin next month.

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