Summary
Happy Election Eve! After one of the longest, most expensive and least predictable election cycles in modern history, we are just hours away from election day. This election cycle has been full of surprises and unprecedented actions. In the past several months we have seen a switch in the Democratic nominee, two assassination attempts on the Republican nominee, and some truly ugly rhetoric. As the nation goes to the polls tomorrow the election outcome is still very much a toss-up, and we are unlikely to know who the next President will be for days or even weeks. Furthermore, with several House seats being rated as a toss-up and recent Democratic momentum in the Texas and Nebraska Senate races, it is increasingly likely that control of the House and maybe Senate could also be up in the air for a number of days. Washington has been at a standstill for months awaiting the outcome of this election, and unfortunately, we may have to wait a little bit longer. Impact Health Policy Partners will be closely watching the election results and will put out a comprehensive memo as soon as there are definitive results and analyses to share.
As we have covered over the last several weeks, Congress is scheduled to return next Tuesday, November 12 with a very long list of “to-dos,” all of which are very dependent upon the outcome of the election. At the top of the list will be:
- Leadership Votes: First on the agenda for both the House and Senate Republicans are leadership elections, currently scheduled for November 13. Speaker Mike Johnson (R-LA) is hoping to stay as the leader of House Republicans, though if the Republicans lose the majority his position is very much in jeopardy. Meanwhile, Senate Republican leader Mitch McConnell is stepping down and Senators John Thune (R-SD), John Cornyn (R-TX), and Rick Scott (R-FL) are all running to replace him. Leadership of the House and Senate Democratic caucuses are expected to stay the same with Hakeem Jeffries (D-NY) and Chuck Schumer (D-NY) keeping their respective positions as House and Senate Democratic leaders. Once the leaders have been chosen, the party caucuses will move on to determining the Committee leadership positions. We will cover the leadership changes and changes in Committee rosters in the weeks to come.
- Government Funding: The Continuing Resolution is going to expire on December 20, leaving Congress just 6 weeks to pass a budget…five weeks if you take out the Thanksgiving holiday recess. Not only are the House and Senate over $30 billion apart in their spending packages, but the House bills contain a plethora of “poison pill” riders that the current Senate will refuse to accept.
- Disaster Relief: In the five weeks since Congress recessed, two major storms have hit the southeastern United States and the Federal Emergency Management Agency (FEMA) and the Small Business Administration (SBA) are in dire need of replenishing their coffers to deal with the storms aftermath.
- Expiring Authorizations: There is a significant list of key programs that will expire at the end of the year if Congress fails to act. This includes the popular COVID-19 Telehealth flexibilities; a delay in a scheduled 2.8 percent payment cut for Medicare providers; the Acute Hospital Care at Home waiver; a delay to the Medicaid Disproportionate Share Hospital (DSH) payment cuts; and funding for several health care and public health programs including community health centers, the National Health Service Corps, the Teaching Health Center Graduate Medical Education Program, Special Diabetes Program, and National Health Security Extensions.
As we have previously shared, there is potential for additional health policy action in the lame duck, though it is also entirely dependent on what happens this week.
Regulatory Update
The Office of Management and Budget (OMB) is reviewing the following:
Medicare
- Medicare Advantage – The proposed rule would make policy and technical changes to the Medicare Advantage, Medicare Prescription Drug Benefit, and Medicare Cost Plan Programs, and PACE for contract year 2026 (September 2024).
Other Topics
- Healthcare System Resiliency and Modernization – The proposed rule would revise and update national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers (was set for December 2023).
- Retail Pharmacy Standards – The final rule would require pharmacies and vendors to modify the currently adopted National Council for Prescription Drug Programs (NCPDP) standards to the Telecommunications Standard Implementation Guide Version F6 (F6); Batch Standard Implementation Guide version 15; and Batch Standard Subrogation Implementation Guide version 10 (was set for February 2024).
- Organ Transplants – The final rule would establish a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model), that would test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures.
- Cybersecurity – The proposed rule would make modifications to the Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). These modifications will improve cybersecurity in the health care sector by strengthening requirements for HIPAA regulated entities to safeguard electronic protected health information to prevent, detect, contain, mitigate, and recover from cybersecurity threats.