Health Care Policy in Congress and the Administration—Fall Outlook

This time of year, those concerned with policymaking by Congress and the Administration tend to look forward to the August break. Most often we set aside any concerns about September until September arrives. But now is the time to prepare for health care issues which will be pending in September.

The appropriations process came to a screeching halt earlier this month in the U.S. House of Representatives over an anti-Confederate flag amendment to the Fiscal Year 2016 Interior and Environment Appropriations bill offered by Democrats. As a result, the House Majority Leadership pulled the bill from the floor. While the House prepares to go on recess at the end of the week (July 31st), no appropriations bills are scheduled for floor action. The Senate has not attempted to move any appropriations bills since the House incident either.

This means Congress will likely move a temporary continuing resolution at the end of September to keep the government operating. Once again, that means no enactment of a freestanding Labor-Health and Human Services-Education Appropriations Bill. But a CR will likely authorize appropriations at either the current level of spending or something less. There may be attempts to attach policy riders to the CR. Speaker Boehner has said he is opposed to a government shutdown.

The House has passed its bipartisan version of the 21st Century Cures Act (H.R. 6). The bill would reauthorize the National Institutes of Health through FY 2018. It would establish an NIH Innovation Fund to fund a strategic plan, early state investigators, and high-risk, high-reward research. NIH would also work with the Food and Drug Administration to implement a system that furthers research on clinical trial data. The bill passed the House on July 10th, by a vote of 344 to 77. Attention now turns to the Senate Committee on Health, Education, Labor and Pensions.

The Fiscal Year 2016 Budget Resolution Conference Report included reconciliation instructions calling for $1 billion in reduced spending from the Senate Committees on Finance and HELP and the House Committees on Education and the Workforce, Energy and Commerce, and Ways and Means. An additional instruction called for the House to include repeal of the Affordable Care Act. On July 27 during an unusual Sunday Senate session on the highway bill, Budget Committee Chairman Mike Enzi [R-Wyo.] stated the July 24th deadline had passed without compliance by the Senate Committees. However, he noted “the Senate retains the ability to utilize the instructions contained” in the resolution. That means at any time the Senate could take up a reconciliation bill containing proposed reductions in health care spending.

In June, the U.S. General Accountability Office released a report entitled Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals. About 40 percent of all U.S. hospitals participate in the program. GAO noted, “…in both 2008 and 2012, per beneficiary Medicare Part B drug spending, including oncology drug spending, was substantially higher at 340B DSH hospitals than at non-340B hospitals. This indicates that, on average, beneficiaries at 340B DSH hospitals were either prescribed more drugs or more expensive drugs than beneficiaries at the other hospitals in GAO’s analysis”. As a result of this report, Sen. Charles Grassley [R-Iowa] has formally requested the Finance Committee Chair and Ranking Member to hold a hearing on the program.

On the Administration side of the equation, we are awaiting the release of a proposed 340B Program Omnibus Guidelines by the Health Resources and Services Administration. This guidance has been anticipated for some time since the Judicial Branch struck down a portion HRSA’s previous guidance. If cleared by the Office of Management and Budget on time, the guidance ought to be published in August or September.

Finally, the Planned Parenthood controversy over the alleged sale of fetal tissue will almost certainly find traction either as a freestanding piece of legislation or as an amendment on some must-pass vehicle (including the CR). House Majority Leader Kevin McCarthy has stated PP should not receive any further federal funding until Congress completes its investigation of the organization. The House Judiciary and Energy and Commerce Committees will hold a number of hearings, likely beginning in September. Regardless of one’s position on the issue, the matter will most certainly be considered in September. So enjoy the Congressional recess in August because September will be a bear– a grizzly.

Julius W. Hobson, Jr. is Senior Policy Advisor at Polsinelli P.C. and Adjunct Professor of Political Management, Graduate School of Political Management, George Washington University, where he teaches courses on Lobbying, Electoral and Legislative Processes, and Legislative Writing and Research.

Morning Consult