Capitol Hill Healthcare Update

PELOSI INTRODUCES DRUG PRICING BILL WHILE TRUMP PUSHES SENATE VERSION

House Democrats introduced legislation last week to lower prescription drug prices – including allowing Medicare to negotiate prices with manufacturers – and set an aggressive timeline to approve the bill by Halloween.

The legislation would allow the government to negotiate prices annually for at least 25 of the highest-cost brand-name drugs that lack generic or biosimilar competition in the Medicare Part D and Part B programs. It also would require manufacturers to cover 30% of the costs of Part D catastrophic coverage, which Medicare currently covers.

Republicans criticized the proposal, focusing on the behind-closed-doors process by which Democratic leaders developed the legislation. But Republicans lack the votes to stop it – or even amend it – in the House, where rules give majority Democrats the power to advance their bill.

Pelosi said three committees will each vote on portions of the bill, and then leaders will combine them into a final package, likely late next month. The Energy and Commerce Health Subcommittee will hold the first hearing Wednesday on the bill. The panel also will review three other Democratic drug pricing measures.

Meanwhile, the Trump administration has been pushing for separate drug pricing legislation, which won Senate Finance Committee approval in July. But that bill, by committee Chairman Chuck Grassley, R-Iowa, bitterly divided committee Republicans. Some of those committee members – including Sens. John Cornyn, R-Texas; Mike Crapo, R-Idaho; and Rob Portman, R-Ohio – are separately working on provisions that could unify Republican support for a Grassley-backed package.

The Trump White House is actively backing Grassley’s bill mostly because it sees it as the most likely to win Senate approval. That’s key to the White House’s strategy: If both chambers can pass prescription drug bills, the administration believes it can work with congressional leaders to develop final legislation that could get Trump’s signature.

As the House moves to pass its bill, Trump is expected to increase pressure on Senate Republicans. Majority Leader Mitch McConnell, R-Ky., has thus far refused to allow a floor vote on drug pricing legislation that divides his party and unites Democrats. Trump aides believe the political dynamic could change if the president engages publicly, especially if he targets Senate Republicans to act.

Still, that effort to get 60 Senate votes would require a delicate policy and political balance to secure a plurality of Republicans and Democrats needed to advance the bill – and by no means is it guaranteed to succeed.

GOVERNMENT SHUTDOWN UNLIKELY AS SENATE READIES VOTE ON STOPGAP SPENDING

The Senate is expected to give final congressional approval this week to a stopgap budget bill that would fund the government until nearly Thanksgiving, buying more time for lawmakers to resolve thorny political questions and approve fiscal 2020 spending.

The House last week approved a continuing resolution to fund the government through Nov. 21. The 301-123 vote provided a strong show of support for the Senate, which is similarly expected to easily approve the bill this week.

The resolution also extended several federal health programs set to expire next week, including funding for community health centers, teaching hospitals and Type 1 diabetes research. It delays payment cuts to safety-net hospitals and reauthorizes the Patient-Centered Outcomes Research.

SENATE STRUGGLES WITH BUDGET FOR HEALTH PROGRAMS

Despite this summer’s deal on overall budget numbers, lawmakers writing individual spending bills – including those that fund major health agencies and programs – have been bogged down by partisan fights over funding levels, abortion and President Donald Trump’s border wall.

Legislation funding the Health and Human Services Department stalled earlier this month amid those disagreements. The Senate Appropriations Committee has not rescheduled its markup.

The committee last week did manage to approve several bills, including boosting funding by $80 million for the Food and Drug Administration (FDA), which is funded partially by congressional appropriations and partially by industry user fees.

The Senate bill includes $3.1 billion in congressionally approved FDA funding; adding user fees, the agency’s overall budget would be nearly $5.8 billion.

SENATE TASK FORCE STALLS ON HEALTH TAX BREAKS

The Senate Finance Committee last week failed to reach consensus on a way forward for expiring health tax extenders, including taxes on medical device manufacturers and insurers.

The committee in May established five task forces to examine sector-specific temporary tax provisions that expired, will soon expire or will soon go back into effect. The task force examining health-sector taxes – led by Sens. Pat Toomey, R-Pa., and Bob Casey, D-Pa. – hoped to recommend bipartisan permanent solutions.

But the senators couldn’t agree on whether to extend the health provisions or allow them to expire, so they made no recommendations. The Toomey-Casey panel reviewed tax credits for health coverage, paid family and medical leave; deductions for medical expenses; and excises taxes on the black lung disability trust fund, the medical device industry and insurers.

Meanwhile, House Speaker Nancy Pelosi, D-Calif., speaking at a fundraising event last week, threw cold water on prospects that she would support further suspending the 2.3% tax on medical devices, which will go back into effect Jan. 1 unless Congress acts before then. She said the device industry agreed to the $20 billion annual tax as part of the Affordable Care Act – a position hotly disputed by device companies.

Still, Pelosi said she “likes to do trades,” holding out the prospect that a year-end budget and tax package could include relief for the device industry as well as relief from the tax on high-cost health plans, a priority for Democrats.

The House voted 419-6 in July to repeal the so-called Cadillac tax, which would impose a 40% surcharge on employer-provided plans costing more than $11,200 for individuals and $30,100 for families. The tax is scheduled to take effect in 2022 after already being delayed twice by Congress.

The Weekly Hill Update

Washington D.C. The capitol, the seat of the government of the United States.Below is the Federal Policy team’s weekly preview, posted when Congress is in session.

HEADLINES

• President Donald Trump and other leaders are gathering in New York City for the United Nations General Assembly.

• The Senate plans to approve a House-passed short-term spending bill to keep the government open.

• Lawmakers are investigating a whistleblower complaint about Trump’s interactions with Ukrainian leaders regarding allegations against former Vice President Joe Biden’s son.

HOUSE

  • The House is in session Tuesday through Friday. The agenda focuses on legislation to improve border detention facilities and procedures.
  • Acting Director of National Intelligence Joseph Maguire will testify before the House Intelligence Committee regarding a whistleblower complaint about Trump’s interactions with Ukrainian President Volodymyr Zelenskiy.
  • The House Education and Labor Committee will mark up legislation addressing labor relations.
  • The full list of this week’s House committee activity can be found here.

SENATE

  • The Senate will continue to take up House-passed legislation funding the federal government into November, and will continue voting on Trump’s nominees.
  • The Health, Education, Labor and Pensions Committee will vote on the nomination of Eugene Scalia to be secretary of labor.
  • The Senate Energy and Natural Resources Committee plans to mark up 21 bills including legislation to enhance security of the nation’s electric grid.
  • The current list of Senate committee activity can be found here.

WHITE HOUSE

  • Trump is in New York for United Nations events, returning to Washington on Thursday.
  • Among his meetings with world leaders, Trump will meet Japanese Prime Minister Shinzo Abe as the two countries work toward a trade agreement.
  • Trump on Friday will speak to Jewish leaders ahead of Rosh Hashana.

The Weekly Hill Update

Washington D.C. The capitol, the seat of the government of the United States.Below is the Federal Policy team’s weekly preview, posted when Congress is in session.

HEADLINES

• Lawmakers are working on a stopgap spending bill to keep the government funded into at least November. Current government spending expires Oct. 1.

• President Donald Trump will travel west for several political events between visits from foreign leaders from Bahrain and Australia bookending his week.

• Trump presents New York Yankee legend and Hall of Famer Mariano Rivera with the Presidential Medal of Freedom.

HOUSE

  • The House is in session Tuesday through Friday. The agenda includes legislation to fund the government into November.
  • The House Natural Resources Committee on Wednesday will mark up 16 bills focused on conservation.
  • Environmental Protection Agency Administrator Andrew Wheeler will testify Thursday on science and technology at EPA in a hearing before the House Science Committee.
  • The full list of this week’s House committee activity can be found here.

SENATE

  • The Senate will continue to work through Trump’s nominees for ambassadorships and other administration positions.
  • Labor Secretary nominee Eugene Scalia will appear Thursday before the Senate HELP Committee.
  • Senate appropriators hope to pass three funding bills this week, after partisan sniping over abortion and border wall funding delayed progress last week.
  • The current list of Senate committee activity can be found here.

WHITE HOUSE

  • Trump today will award the Presidential Medal of Freedom to Rivera and later will meet with Bahrain’s Crown Prince Salman bin Hamad Al-Khalifa.
  • Tonight Trump will hold a political rally in Albuquerque, New Mexico, before traveling to California for several fundraisers Tuesday and Wednesday.
  • Trump on Friday will host his administration’s second state dinner, this time with Australian Prime Minister Scott Morrison.

Capitol Hill Healthcare Update

PELOSI DRUG PRICE PLAN EXPECTED THIS WEEK

House Speaker Nancy Pelosi, D-Calif., is expected to release her long-awaited plan this week to address prescription drug costs, according to congressional staff.

A draft summary of the proposal that circulated last week would allow the government to negotiate prices with manufacturers on 250 drugs and impose sweeping fines on companies that failed to participate. The negotiated price – which manufacturers say would be de facto price controls – also would extend to the prices of drugs sold through commercial insurance.

Two House committees plan to vote on Pelosi’s bill in the coming weeks, setting up a potential vote on the House floor by the end of October. In an apparent nod to President Donald Trump’s proposal to base physician-administered drug prices on an index of prices paid in certain European countries, Pelosi would copy that formulation for Medicare Part D drugs, too.

Trump so far hasn’t said – or tweeted – anything about the Democrats’ proposal. A White House statement last week praised Pelosi for offering the proposal but didn’t address specific policies.

A full-throated Trump endorsement of even the International Pricing Index portion of the speaker’s proposal could upend the political dynamic among congressional Republicans. But for now, House Republican leadership aides say they don’t expect any GOP lawmakers to support Pelosi’s plan.

Meanwhile, Senate Finance Committee Chairman Charles Grassley, R-Iowa, is pushing for a floor vote on his committee-passed drug price legislation – in part by saying his proposal is more moderate than the emerging House Democrats’ plan. But Grassley’s bill, which would impose inflationary caps on price increases on Part D drugs, split committee Republicans and has drawn sharp criticism from other GOP lawmakers.

It’s doubtful Grassley’s bill as currently written could win the 60 votes needed for passage in the Senate, where aides say the mostly likely outcome is that bipartisan provisions get plucked from Grassley’s bill and other legislation and are added to a year-end spending and tax measure. Continue Reading

Capitol Hill Healthcare Update

UPDATE ON DRUG PRICING LEGISLATION AS CONGRESS RECONVENES

Congress reconvenes this week after a monthlong summer recess and begins what likely will be a final push toward overhauling prescription drug prices, but lack of consensus on the underlying policy and the intensifying 2020 presidential campaign will complicate efforts to advance a bill to President Donald Trump’s desk.

House Speaker Nancy Pelosi, D-Calif., is finalizing long-awaited legislation centering on price negotiation for drugs that lack competition, and she could introduce legislation as soon as this week. But the secretive process – even to most members of the Democratic Caucus – is causing frustration. Progressive lawmakers say the speaker’s plan may not go far enough on calling for government negotiation with manufacturers over prices.

Also in the House, the bipartisan leadership of the Ways and Means and Energy and Commerce committees are trying to work out details of a separate bill, which could see committee votes in the coming weeks. That effort focuses on the Medicare Part D prescription drug benefit, including creating an out-of-pocket cap for beneficiaries. Other provisions, such as cracking down on surprise medical bills, could be attached, too.

Continue Reading

The Weekly Hill Update

Washington D.C. The capitol, the seat of the government of the United States.Below is the Federal Policy team’s weekly preview, posted when Congress is in session.

HEADLINES

• Congress returns this week from its six-week summer recess, with 40 legislative days remaining in 2019.

• Democrats this week are focusing on gun control measures, attempting to pressure Republicans in the wake of multiple mass shootings this summer.

• Senate appropriators are taking up several bills this week as lawmakers face a Sept. 30 deadline to fund the government.

HOUSE

  • The House is in session tonight through Thursday. The agenda includes legislation to block oil and gas drilling in the Arctic National Wildlife Refuge, off the Atlantic and Pacific Coasts, and in the eastern Gulf of Mexico.
  • The House Judiciary Committee will vote on a series of bills addressing gun violence, and also expects a procedural vote on authorizing rules for potential impeachment proceedings against President Donald Trump.
  • The Energy and Commerce Environment Subcommittee will hold a hearing on protecting chemical facilities from terrorism.
  • The full list of this week’s House committee activity can be found here.

SENATE

  • The Senate plans to take up the nomination of Kelly Craft to be the U.S. ambassador to the United Nations.
  • The Senate Appropriations Committee plans to vote on four different funding bills.
  • Treasury Secretary Steven Mnuchin, HUD Secretary Ben Carson and Federal Housing Finance Agency Director Mark Calabria tomorrow will testify before the Senate Banking Committee on housing finance reform.
  • The current list of Senate committee activity can be found here.

WHITE HOUSE

  • Trump tonight will hold a political rally in Fayetteville, North Carolina, in support of Republican congressional candidate Dan Bishop, who faces Democrat Dan McCready in a special election.
  • On Wednesday, Trump will participate in a moment of silence in observance of the Sept. 11, 2001, terrorist attacks and will also participate in a remembrance ceremony at the Pentagon.
  • Later in the week, he will travel to Baltimore to speak at the Republican congressional retreat.

Capitol Hill Healthcare Update

Below is this week’s “Capitol Hill Healthcare Update,” which is posted on Mondays when Congress is in session.

MAJOR HEALTH POLICY UNLIKELY IN POTENTIAL DEBT-SPENDING DEAL

As House Speaker Nancy Pelosi, D-Calif., and the Trump administration edge closer to a sweeping agreement to avoid a government shutdown and debt default, it’s increasingly unlikely major healthcare provisions will be included.

Pelosi and Treasury Secretary Steven Mnuchin have been working to permanently lift sequester-imposed budget caps as well as the extend the government’s borrowing authority through July 2012. Mnuchin has warned that without congressional action Washington could reach the debt ceiling shortly after Labor Day. Continue Reading

The Weekly Hill Update

Washington D.C. The capitol, the seat of the government of the United States.Below is the Federal Policy team’s weekly preview, posted when Congress is in session.

HEADLINES

• Negotiators are seeking to wrap up an agreement on raising the debt limit and budget caps, with the House in its final week before a six-week August recess.

• President Donald Trump today is hosting Pakistani Prime Minister Imran Khan.

• Special Counsel Robert Mueller will testify on the Hill regarding the findings of his investigation into Russian interference in the 2016 presidential election.

HOUSE

  • The House is in session Tuesday through Friday. The agenda includes legislation to address the multiemployer pension system, as well as noncontroversial health program reauthorizations. Lawmakers also could vote on a debt limit and budget caps bill.
  • Special Counsel Robert Mueller will testify Wednesday at the House Judiciary Committee regarding possible obstruction of justice by Trump, followed by testimony before the House Intelligence Committee on Russian interference in U.S. elections.
  • The House Oversight Committee on Friday will hold a hearing on patient perspectives on drug prices.
  • The full list of this week’s House committee activity can be found here.

SENATE

  • The Senate plans to vote on a House-passed bill to permanently extend funding for first responders and others suffering from health problems resulting from the 9/11 attacks. Senators will also take up Mark Esper’s nomination to be Defense secretary, among other Trump nominations.
  • The Senate Agriculture Committee will hold a hearing Tuesday on the derivatives market and Commodities Futures Trading Commission.
  • The Senate Judiciary Antitrust Subcommittee on Tuesday will hold an oversight hearing on enforcement of antitrust laws.
  • The current list of Senate committee activity can be found here.

WHITE HOUSE

  • Trump today is hosting Pakistani Prime Minister Imran Khan to discuss counterterrorism, energy and trade.
  • Trump on Tuesday will speak at Turning Point USA’s Teen Student Action Summit, and meet with Republican senators.
  • Later in the week, he will speak at a fundraiser in West Virginia for his re-election campaign.

The Weekly Hill Update

Washington D.C. The capitol, the seat of the government of the United States.Below is the Federal Policy team’s weekly preview, posted when Congress is in session.

HEADLINES

• The House will vote to hold in contempt Attorney General William Barr and Commerce Secretary Wilbur Ross, and will also vote on raising the federal minimum wage.

• Senators will vote on four bilateral tax treaties, and continue votes on President Donald Trump’s nominees for judgeships and ambassadorships.

• Big tech faces a potentially tough week on the Hill, with multiple hearings in both chambers.

HOUSE

  • The House is in session today through Thursday. A contempt resolution targets Barr and Ross for failing to comply with Oversight Committee subpoenas regarding the 2020 census. The House agenda also includes legislation to raise the minimum wage, and reauthorization of intelligence activities.
  • The House Judiciary Antitrust Subcommittee will hold a hearing Tuesday on competition in the tech industry, with executives from Google and other tech companies.
  • The House Energy and Commerce Communications Subcommittee will hold a hearing Tuesday on wireless policy and spectrum.
  • The full list of this week’s House committee activity can be found here.

SENATE

  • The Senate plans to take up tax treaties with Spain, Switzerland, Luxembourg and Japan, and also will vote on two judicial nominees and two ambassadorships.
  • The Senate Judiciary Subcommittee on the Constitution will hold a hearing Tuesday on “Google and Censorship through Search Engines.”
  • The Senate Armed Services Committee will hold a hearing on the nomination of Acting Defense Secretary Mark Esper to lead the Pentagon.
  • The current list of Senate committee activity can be found here.

WHITE HOUSE

  • Trump today is participating in his third annual Made in America product showcase.
  • Trump on Tuesday will hold a Cabinet meeting.
  • Later in the week, he will hold a campaign rally in North Carolina, then host Dutch Prime Minister Mark Rutte at the White House.

Capitol Hill Healthcare Update

Below is this week’s “Capitol Hill Healthcare Update,” which is posted on Mondays when Congress is in session.

SENATORS RACE TO FINISH DRUG PRICING BILL AS TRUMP PLANS STALL

With only 15 legislative days before a scheduled monthlong recess, Senate leaders are scrambling this week to seek consensus on ambitious legislation to lower prescription drug prices, particularly after major pharmaceutical industry initiatives by the Trump administration were derailed last week.

Senate Finance Committee leaders Charles Grassley, R-Iowa, and Ron Wyden, D-Ore., have been working for months on a package of bills to lower drug prices – and they are hinting a deal is close.

The senators appear to have agreed on the outlines of a plan that would impose inflation caps on prices for drugs in the Medicare Part D program by requiring manufacturers to pay rebates to the government if prices rise faster than inflation. Multiple price transparency provisions are also expected to be included. Continue Reading

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