Summary
A remarkably busy week lies ahead, and the stakes are high – possible government shutdown on Friday, potential debt default in October, and 2022 midterm elections.
- Government funding for fiscal year (FY) 2022 and the debt ceiling – Today, the Senate will vote on a procedural motion to move to a floor vote of the House-passed continuing resolution (R. 5305). The continuing resolution would extend FY 2021 funding levels through December 3, 2021 and suspend the debt limit through December 16, 2022. This procedural vote is expected to fail, since Republicans are lockstep in their opposition to helping Democrats address the looming debt crisis. Still, a government shutdown amid the twin crises of the COVID-19 pandemic and the economic recession seems unlikely. Senate Minority Leader Mitch McConnell (R-KY) has said “Senate Republicans would support a clean continuing resolution that includes appropriate disaster relief and targeted Afghan assistance. We will not support legislation that raises the debt limit.” We could see the Senate pass a clean continuing resolution to avert the government shutdown and deal with the debt limit at a later time.
- Traditional Infrastructure – Today, the House will begin debate on the Infrastructure Investment and Jobs Act (R. 3684) – the bipartisan traditional infrastructure package passed by the Senate in August. The floor vote is scheduled for Thursday, September 30 – the expiration date of surface transportation authorization, which funds federal highway and public transportation programs (Fixing America’s Surface Transportation Act (FAST Act; P.L. 114-94). With a razor-thin majority, House Speaker Nancy Pelosi (D-CA) can only lose three votes and needs progressives’ votes, whose support depends on reaching an agreement on the price tag and components of the budget reconciliation package.
- Budget Reconciliation – Over the weekend, the House Budget Committee advanced the $3.5 trillion Build Back Better Act. The legislation is composed of the legislative recommendations submitted by all 13 committees of jurisdiction. It includes provisions allowing Medicare drug price negotiation; expanding Medicare coverage to include dental, hearing, and vision benefits; closing the Medicaid expansion coverage gap; and making permanent the enhancements to ACA premium tax credits. The package that ultimately passes the House and Senate appears likely to have a smaller price tag, given concerns raised by moderates, though it is unclear how exactly the multi-trillion package will be scaled down.
COVID-19
On Thursday, the Senate Health, Education, Labor and Pensions Committee will question Health and Human Services Secretary Xavier Becerra and Education Secretary Miguel Cardona about reopening schools during COVID-19. On the vaccine front, Pfizer/BioNTech has reported it plans to seek authorization of its COVID-19 vaccination for children under 12 in the coming days. Pfizer says it will submit its data on children ages 5-11 to the Food and Drug Administration (FDA), who will then review the data to determine whether the vaccine is safe for children. The Centers for Disease Control and Prevention (CDC) Director Dr. Rochelle Walensky stated the full review process could occur “in the order of weeks.” Earlier this month, the FDA outlined how it will ensure the safety and efficacy of the vaccine for children here.
Regulatory Update
The October 1 deadline for the release of a second interim final rule on surprise medical billing (i.e., Surprise Billing Part II) continues to draw near. This rule will establish the specifics for the independent dispute resolution (IDR) process (i.e., arbitration) and the patient-provider dispute resolution process (for uninsured individuals to appeal a bill charged that is substantially greater than the good faith estimate). The rule, however, has not yet appeared at the Office of Management and Budget (OMB), meaning the White House has not received the rule for final approval. Given the impending due date, we may see the rule appear at OMB in the coming days before its release expected by the end of the month.
In addition, a final rule to rescind the Trump Administration’s “penny pricing” rule has just cleared OMB for review. We may see the final rule released in the Federal Register imminently. In brief, the Trump-era rule would require entities participating in the 340B Drug Pricing Program to offer insulin and injectable epinephrine to patients with low-incomes at the price at which the health center purchased the drugs through the 340B program. Additional details are available here.