This Week’s Dose

The House passes the Build Back Better Act, with the bill moving to the Senate for consideration following the Thanksgiving recess.

Congress

House Passes the Build Back Better Act. The House of Representatives approved the Build Back Better (BBB) Act, the third major piece of legislation supporting President Biden’s domestic agenda priorities. The 220-213 vote was largely along party lines, with all present Republicans voting against the measure, and just one Democrat voting no—Rep. Jared Golden (D-ME). This vote marks a significant step in what has been a months-long slow march toward passage of these social spending (or “soft infrastructure”) priorities. BBB now moves to the Senate, where it is expected to be taken up at some point after the Thanksgiving recess, but where the bill’s future is precarious.

The BBB is expected to change considerably before reaching the Senate floor as individual Senators exert their influence in the tightly divided 50-50 Senate, and Senate leadership has to contend the “Byrd Rule,” which dictates what types of provisions can advance in a budget reconciliation process. Stakeholders are closely watching the health care provisions, including the following: Medicare drug pricing reforms, that while less than originally envisioned, introduce price negotiation and redesign the drug benefit for Medicare beneficiaries including a cap on out-of-pocket expenses for medications; expanding Medicare by adding hearing benefits, including hearing aids; $150 billion in new Medicaid funding for Home and Community Based Services to states; extension of increased subsidies making ACA coverage much more affordable through 2025; provisions to give people in states that have not expanded Medicaid the opportunity to gain coverage through zero premium ACA plans; provisions extending coverage for 12-months for children and post-partum women on Medicaid, and a number of investments in the health care workforce.

Reps. DeGette and Upton Release Updated Cures 2.0 Proposal. This week, Reps. Diana DeGette (D-CO) and Fred Upton (R-MI) released an updated version of their Cures 2.0 Act—bipartisan legislation that builds upon the 21st Century Cures Act enacted in 2016. The bill addresses a number of key health care innovation priorities, including permanently removing Medicare geographic and originating site restrictions on telehealth services and creating the new Advanced Research Projects Agency for Health (ARPA-H) research agency—a priority for President Biden. A section-by-section of the draft legislation is available here.

While Reps. DeGette and Upton have expressed an interest in advancing Cures 2.0 quickly, action this year is unlikely. Congress has several other pending items to address before the fast-approaching end of 2021—including FY 2022 appropriations, the BBB, and health care payment issues with year-end deadlines.  

Administration

Biden-Harris Administration Issues New Reporting Requirements to Identify Prescription Drug and Medical Costs. This week, the Biden Administration implemented new requirements that require health insurers, employer-based health plans, and other group health plans to report on prescription drug and health coverage costs. The requirements, which were issued through an HHS, Labor and Treasury interim final rule, is the most recent attempt by President Biden to provide additional transparency and oversight to prescription drug and health coverage prices. Payors will be required to submit key data to the departments, which will publish a report on the prescription drug price trends and rebates, as well as their impact on out-of-pocket costs for patients. The new data submission requirements will apply starting with data from the 2020 calendar year, however enforcement of the new requirements won’t begin until December 2022.

Quick Hits

• The CMS vaccine mandate faces yet another legal challenge as twelve states filed a complaint in the U.S. District Court for the Western District of Louisiana challenging the Interim Final Rule (IFR) that put in place the COVID-19 vaccine requirement for healthcare facilities.

• CMS Administrator Chiquita Brooks-LaSure along with Center for Medicaid and CHIP Services (CMCS) Director Dan Tsai, outlined their strategic vision for Medicaid and CHIP, sharing a proactive policy agenda which included a focus on expanding coverage and access, increasing equity, and investing in innovation and “whole-person” care.

• CMS finalized their hospital co-location guidance outlining how hospitals may organize shared spaces, services, personnel, and emergency services to meet regulatory requirements.

• Ways and Means Ranking Member Kevin Brady (R-TX) sent a letter to Chairman Neal (D-MA) requesting a full committee hearing on looming cuts under the Medicare Physician Fee Schedule (PFS). Relatedly, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced legislation this week to mitigate the payment cuts, titled the “Supporting Medicare Providers Act” (H.R. 6020).

Next Week’s Diagnosis

The House and Senate will be in recess. The McDermott+ Check-Up will be on hiatus next week as we take time to celebrate the Thanksgiving holiday.