Summary
Both sides of the Capitol are in session this week as attention remains focused on how to address the looming debt ceiling. President Biden hosted Democratic leaders at the White House last week and is expected to meet with Speaker of the House, Republican Kevin McCarthy, on Wednesday. Democrats largely remain unified that they will not negotiate on the debt ceiling and that Congress must pass a “clean” limit increase. Senator Majority leader Chuck Schumer reportedly left the White House meeting stating that House Republicans need to “put a plan on the table.” Senate Republican leader Mitch McConnell is largely staying out of the discussion at this time, leaving it to House Republicans to come up with a strategy.
Most agree that the issue will not be resolved any time soon. Notably, House Republicans are reportedly contemplating a clean short-term suspension to delay dealing with the matter until the end of September to align with the end of the fiscal year.
Last week, Senate Democrats made progress in organizing themselves for the 118th Congress by assigning full committee memberships. Senate Republicans are taking longer, which is preventing the Senate from passing an organizing resolution and starting official business.
The House is also making progress with Democrats announcing key Committee assignments and Republicans starting to name Subcommittee Chairs. Rep. Vern Buchanan (R-FL) was officially named as the Chairman of the Ways and Means Health Subcommittee and Congressman Brett Guthrie (R-KY) was officially named the Chairman of the Energy and Commerce Subcommittee on Health. Both served as the Ranking Members in the last Congress. Chairman Guthrie recently discussed with the press what his priorities for the year would be, including plans to focus on price transparency, oversight of the CDC, and keeping expanded telehealth flexibilities “sustainable.” Addressing the fentanyl crisis will be another priority. The full Committee held a Roundtable last Wednesday where Energy and Commerce Committee Republicans accused social media and technology firms of facilitating the deadly trafficking of fentanyl and not doing enough to prevent sales of the drug on their platforms. The issue will assuredly come up at the Subcommittee’s first legislative hearing of the year on Wednesday. The hearing will focus on legislation introduced to address the fentanyl crisis, the cybersecurity breach of suicide lifelines, and Quality Adjusted Life Year (QALY) measures.
Regulatory Update
Two regulations cleared review by the Office of Management and Budget (OMB) last week and are likely poised for release this week. The first is a proposed rule pertaining the coverage of certain preventive services under the Affordable Care Act (ACA). Under such requirements, most private health insurance plans must cover recommended preventive services without cost-sharing. The rule would specifically propose changes to previously finalized regulations regarding religious and moral exemptions and accommodations regarding coverage of certain preventive services. Notably, this rulemaking is occurring at the same time as ongoing litigation against the ACA’s preventive services requirements, specifically concerning the existing requirement for health insurers to cover preexposure prophylaxis (PrEP) – a medication used to prevent HIV.
In addition, OMB concluded its review of a final rule related to the calendar year 2020 policy and technical changes to Medicare Advantage (MA) and Part D. The final rule appears to address the unfinalized provisions related to the MA Risk Adjustment Data Validation (RADV) program and the use of extrapolation for audit recovery findings in calculating improper payments. Details on this provision – originally proposed in 2018 – are available here. The Centers for Medicare & Medicaid Services (CMS) chose not to finalize the proposed changes and instead extended the comment period for these particular provisions until August 2019 (details). The statutory deadline for finalizing these changes is February 1, 2023 (i.e., this Wednesday).