Summary
Please note that Wynne Health Group will be closed for the winter holidays beginning Mon., Dec. 20 through Fri., Dec. 31, reopening Mon., Jan. 3, 2022. We are grateful for your continued partnership and look forward to our work together in the new year. Happy Holidays!
Reconciliation
Over the weekend, the Senate Finance (SFC) and Health, Education, Labor and Pensions (HELP) Committees released updated legislative text (SFC; HELP) of the House-passed reconciliation bill, the Build Back Better Act (BBBA) (H.R. 5376; WHG summary of House-passed BBBA). The updated Senate measure includes both technical and policy changes denoted below.
Senate Democrats hope to advance President Biden’s $1.9 trillion social spending and climate framework by Christmas, leaving only two short weeks to meet the upper chamber’s ambitious self-imposed deadline. Meanwhile, significant hurdles to reconciliation passage persist. Chiefly, securing the vote of centrist Sen. Joe Manchin’s (D-WV), who has not yet indicated his support, especially amid its significant cost which could add more than $3 trillion to the deficit if the programs included in the package are made permanent (updated CBO score). Sen. Manchin also opposes key coverage provisions on which Congressional Democrats are united, including the addition of Medicare coverage of hearing services, a provision that the SFC retained in its updated legislative text. Senate deliberations on the updated reconciliation text are expected to continue this week, with additional changes to the bill, especially amid conversations with Sen. Manchin and the Senate parliamentarian.
On the former, President Biden spoke with Sen. Manchin late last week and plans to speak with the hold-out senator again, as early as today. If the Senate fails to secure the 50 necessary votes over the next two weeks, the chances for the legislation’s passage wane as we head into a contentious election year. Congressional Democrats hope to deliver President Biden a legislative victory to tout before the President’s State of the Union address in late January or early February of next year.
Highlights of the updated Senate BBBA text follow. Note that our comprehensive summary of the bill is forthcoming.
- Coverage Provisions:
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- Hearing: Coverage for hearing services under Medicare would go into effect on Jan. 1, 2023.
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- Medicaid and CHIP: The Senate bill retains the House-backed phase-down of the enhanced federal medical assistance percentage (FMAP) provided to states during COVID-19, as well as key maternal and child health improvements, such as the requirement of 12 months continuous eligibility (CE) to postpartum women and children under Medicaid and CHIP.
Notably, the Senate legislation omits the contentious House language that would have reduced Medicaid disproportionate share hospital (DSH) payments to facilities in non-expansion states. However, the Senate bill does include a new provision that adjusts uncompensated care (UC) pools by excluding from Medicaid federal matching funds services provided under section 1115 waiver authority to the newly eligible group in states that have not expanded Medicaid pursuant to the Affordable Care Act (ACA). The updated Senate language also enhances the federal medical assistance percentage (FMAP) for individuals in the newly eligible group.
- ACA Marketplace: The Senate bill largely follows the House with the retention of provisions that aim to expand access to ACA Marketplace coverage and lower costs.
- Capital and Public Health Infrastructure – The updated Senate language retains several House provisions aimed at bolstering the health care workforce, including critical investments in Medicare graduate medical education (GME) residency training programs, as well as the one-time $200 million funding bump for the Children’s Hospital Graduate Medical Education (CHGME) program. Consistent with the House measure, the updated Senate text does not include the $10 billion in Hill-Burton program funding for hospital and other infrastructure projects included in an earlier iteration of the House bill.
- Drug Pricing: Overall, the drug price negotiations section remains largely unchanged in the updated Senate text from the House passed version. The Senate bill still features a drug price negotiations program, Medicare Part D redesign, and inflation rebates, but features minor policy changes including modifying the maximum ceiling price for negotiated drugs; establishing a premium stabilization for Part D; and exempting generics from inflation rebates.
- Long-term Care and HCBS: The Senate bill retains investments in Medicaid home and community-based services (HCBS) via state planning grants and a six percentage point FMAP increase, as well as most of the skilled nursing facility (SNF)-focused provisions incorporated in the House bill, such as the provisions on SNF data, cost report audits, survey and enforcement process improvements, and nurse staffing requirements (though no longer enforces the minimum ratio requirements).
- Other Issues, Tax Reforms: Regarding climate change, the bill provides $85 million for establishing a program to award grant to medical schools or other schools or programs for the purpose of identifying and addresses health risk associated with climate change. The Senate Finance Committee released separate draft legislation that addresses tax reform (section-by-section, summary) and features closing tax loopholes for pass-through entities, primarily partnerships.
Medicare Sequester Cuts Extended + Debt Limit and NDAA Votes
Late last week, the Senate cleared a major procedural hurdle to fast-track the legislative vehicle (House amendment to S.610) to raise the debt limit prior to the December 15 debt ceiling deadline estimated by Treasury Secretary Janet Yellen. A final vote on the measure is anticipated this week. As part of the legislative package teeing-up expedited debt limit deliberations that are still unfolding, last week Congress passed, and the President signed, legislation staving off automatic statutory cuts to Medicare through March 31, 2022 (WHG summary). Finally, the Senate is expected to vote on the fiscal year (FY) 2022 National Defense Authorization Act (NDAA) legislation (House amendment to S.1605), following House passage last week.
FDA Commissioner Nominee
In addition to the key events ahead this week, we call your attention to the Senate HELP Committee’s consideration of President Biden’s nominee to the lead the Food and Drug Administration (FDA), Dr. Robert Califf, who previously led the FDA from 2016-2017 under the Obama Administration.