Summary
Infrastructure
President Joe Biden is slated to unveil the American Families Plan, “the human infrastructure” component of his broader infrastructure plan, in his first address to a joint session of Congress on Wednesday (April 28). The American Families Plan is expected to focus on child care, paid family leave, and education. With questions remaining on whether health care and prescription drug pricing reforms will be part of Biden’s new plan, congressional Democrats are ramping up pressure on the White House to prioritize these issues.
Yesterday, Sen. Bernie Sanders (I-VT) and 16 Senate Democrats sent a letter to Biden urging him to include structural reforms to Medicare in his forthcoming plan. Several members of Democratic leadership signed on to the letter, including Sen. Dick Durbin (D-IL) who serves as Democratic Whip and Sen. Debbie Stabenow (D-MI) who chairs the Policy and Communications Committee, indicating the proposals’ broad support. They asked Biden to:
- Lower the eligibility age for Medicare. Stabenow recently reintroduced the Medicare at 50 Act, which would allow individuals between the ages of 50 and 64 years old to buy into Medicare.
- Expand Medicare benefits to include hearing, dental, and vision care.
- Establish an out-of-pocket spending maximum in traditional Medicare similar to the limits for Medicare Advantage and private insurance plans under the Affordable Care Act (ACA).
- Allow Medicare to negotiate drug prices with pharmaceutical companies to pay for these reforms.
Similarly, House Speaker Nancy Pelosi (D-CA) is advocating for the inclusion of Medicare drug price negotiation and other health reforms in Biden’s plan. “Lowering health costs and prescription drug prices will be a top priority for House Democrats to be included in the American Families Plan,” said Pelosi at the reintroduction of the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3). She also called on Congress to make permanent the temporary increase in ACA premium tax credits for 2021 and 2022 that were included in the American Rescue Plan Act (P.L. 117-2).
As for the infrastructure-focused American Jobs Plan, the White House appears to be considering the $568 billion counterproposal from Republicans, roughly a quarter of the size of Biden’s proposal and narrowly focused on what they consider to be traditional infrastructure (i.e., transportation, drinking water, and broadband). In response to Biden’s proposal to increase the corporate tax rate to 28 percent from 21 percent, Republicans propose reprogramming unused appropriated COVID-19 funds and imposing new user fees (e.g., on electric vehicles) to pay for the investments in infrastructure.
Hearings
On Wednesday, the House Ways and Means Subcommittee on Health will discuss the future of Medicare’s coverage of telehealth services once the COVID-19 public health emergency ends. In its March report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended a conservative approach to telehealth expansion, calling for a time-limited period in which Medicare coverage of telehealth remains broadly available to beneficiaries and gives lawmakers additional time to examine the impact of telehealth on access, quality and cost.
As noted in our calendar below, committees in both chambers will hold hearings this week on various components of Biden’s infrastructure plan, such as child care, education, and workforce development. Regarding COVID-19, House committees will hold a hearing to better understand what is needed to care for patients with “long COVID” and a hearing on the status of the emergency temporary standard (ETS) intended to protect workers from COVID-19. In an executive order, Biden directed the Occupational Safety and Health Administration (OSHA) to issue an ETS by March 15 if one was determined to be necessary. Labor Secretary recently requested the ETS be put on hold to allow for additional analysis.
Additionally, the Senate Health, Education, Labor and Pensions (HELP) Committee will discuss how lessons learned from the COVID-19 response might address mental health and substance use disorder, both major spending priorities for the Biden Administration.
HHS and CMS Nominations
Later this week, the Senate may vote on the nomination of Andrea Joan Palm to be Deputy Secretary of Health and Human Services (HHS), who was approved by the Senate Finance Committee (SFC) in a 20-8 vote. The timing of full Senate consideration of Chiquita Brooks-LaSure, Biden’s pick to lead the Centers for Medicare and Medicaid Service, is less clear following the tied vote in SFC and objections by Senate Republicans to the Biden Administration’s revocation of Texas’s Medicaid waiver. Both Palm and Brooks-LaSure are expected to be confirmed.
Regulatory Update
The Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) proposed rule has now cleared review at the Office of Management and Budget (OMB). Its release is now expected imminently and could appear as early as today for public inspection at the Federal Register. In addition to payment updates for inpatient hospital care and other policy changes, the rule may also include a request for information seeking input on ways to advance health equity through improving data collection. Such a request was included in the other proposed FY 2022 Medicare payment updates released earlier this month.