Here’s Congress’s health-care to-do list

On tap for Congress: Raising the debt ceiling, crafting a bipartisan health package and extending key health programs

Congress is back after a two-week recess, and this spring will test what lawmakers can get done amid a divided government. 

There’s a brewing debt limit battle. An effort to clinch a bipartisan health deal in the Senate. And looming reauthorizations over key programs expiring at the end of September, such as funding for community health centers.

This morning, we’re taking a look at what’s to come on Capitol Hill over the next few months. 

Republicans are finalizing a proposal to raise the debt ceiling for roughly one year and avert a potential financial crisis that could come as soon as in seven weeks.

In a speech at the New York Stock Exchange yesterday, House Speaker Kevin McCarthy (R-Calif.) confirmed Republicans’ plan to seize on the upcoming deadline to raise the country’s borrowing cap to extract spending cuts and other concessions from President Biden, our colleague Tony Romm reports. 

• “Our proposal will also include restoring work requirements that ensure able-bodied adults without dependents earn a paycheck and learn new skills,” McCarthy said. (We reported last week with Tony that the GOP was eyeing new work rules for millions on Medicaid and food stamps.)
• House Republican leaders are aiming to cap agencies’ future budgets, claw back unspent coronavirus aid and more, Tony writes, setting up a showdown with the White House. 

A bipartisan health bill?

Key Senate leaders are working to ready health legislation for a potential bipartisan package, according to multiple people familiar with the matter who spoke on the condition of anonymity to be candid. 

The possible package — which Senate Majority Leader Chuck Schumer (D-N.Y.) could put on the floor as soon as this spring — may consist of legislation related to generic drugs, pharmacy benefit managers and policies to tackle the cost of insulin. Axios first reported the emerging package. 

The Senate HELP Committee was originally eyeing a markup of legislation related to generics and prescription drug middlemen this week, but one hasn’t been scheduled. The discussions are fluid about what policies would be on the docket, but some ideas could be drawn from bills introduced in previous years, according to several sources. One person familiar with negotiations said they are ongoing, there’s been good progress made, and that “hopes are high for a bipartisan agreement soon.”

On insulin: Sens. Raphael Warnock (D-Ga.) and John Kennedy (R-La.) joined forces to reignite the effort this year on Capitol Hill to lower insulin costs. The legislation would cap out-of-pocket costs for the lifesaving medication at $35 per month for Americans with private insurance as well as the uninsured, as the three major insulin makers have recently moved to cut the drug’s costs. Kennedy told The Health 202 last night that he was searching for ways to pay for the bill. 

Meanwhile, Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) are planning to soon reintroduce their bipartisan bill targeting the medication those with diabetes use to manage their blood sugar levels. There will be some changes from last year, and the pair are working to include the measures as part of a larger package for floor consideration, per Sarah Weinstein, a spokesperson for Shaheen.

Congress is running up against a Sept. 30 deadline to get some health care work done. (Though lawmakers have been known to blow past deadlines before.)

Committees in both chambers have been making moves toward reauthorizing a slew of programs set to expire at the end of September. That includes a fund comprising of roughly 70 percent of community health centers’ federal funding, a noncontroversial provision originally included in the Affordable Care Act.

• The House Energy and Commerce health subcommittee is holding a hearing Wednesday to discuss legislation, which includes a proposal to maintain level funding for five more years for health centers and the National Health Service Corps. Another bill would reauthorize payments for three years to teaching health centers operating graduate medical education programs. 
• The Senate HELP Committee held a hearing on health center funding in early March. The panel’s chair, Sen. Bernie Sanders (I-Vt.), has been a longtime champion of community health centers and pushed for the inclusion of more funding in the ACA. 

Also of note: Both panels have also put out requests for information on the reauthorization of the Pandemic and All-Hazards Preparedness Act. The bill was first signed into law in 2006 and has broad implications for the federal health department’s preparedness and response activities. 

On tap today: President Biden is releasing an executive order aimed at lowering the cost of family care, which includes a focus on long-term care jobs. The order will direct the federal health department to consider issuing regulations and guidance to improve the quality of home care jobs, such as by leveraging Medicaid funding, and to condition a portion of Medicare payments on how well a nursing home retains workers, according to a fact sheet out this morning.

Supreme Court to consider whether Medicare, Medicaid were overcharged in false claims case

Also on tap today: The Supreme Court will hear arguments in a pair of cases that could weaken an important weapon in the government’s arsenal for fighting fraud in federal contracts and programs.

It will be up to the justices to determine whether hundreds of major retail pharmacies across the country “knowingly” overcharged Medicare and Medicaid by overstating what their usual and customary prices were. If found guilty of violating the False Claims Act, they could be liable for triple damages, NPR’s Nina Totenberg reports.

Key context: The plaintiffs in the two consolidated cases are whistleblowers who allege that the retail pharmacy giant’s SuperValu and Safeway overbilled the government when they started offering prescription drugs at discounted prices to customers but didn’t adjust the fees that they charge the federal entitlement programs for the medications. 

In August 2021, the U.S. Court of Appeals for the 7th Circuit ruled that the companies aren’t liable for damages because they hadn’t knowingly violated the act, even if they “might suspect, believe, or intend to file a false claim.” 

Why it matters: If the justices agree with the appellate court’s ruling, legal experts warn it could make enforcing the False Claims Act more difficult by affording defendants an opportunity to come up with alternate explanations to rationalize their alleged misconduct post hoc, the whistleblowers’ brief said.

The new rules of the road for Obamacare are here

The Biden administration finalized new rules yesterday aimed at making it easier for consumers to sign up for Affordable Care Act plans, particularly for those losing their coverage through Medicaid or the Children’s Health Insurance Program.

Under the final rule, which will govern the health insurance marketplaces for 2024, insurers will only be able to offer four nonstandard ACA plans. The goal of the limit is to reduce the overload of plan choices on the marketplaces while continuing to offer consumers several options that could fit their needs.

The Centers for Medicare and Medicaid Services will also give state marketplaces the option to hold a special enrollment period for people who lose their Medicaid or CHIP coverage. The federal government will also have a special enrollment period. Shoppers will have 60 days before, or 90 days after, losing coverage to choose an Obamacare plan, which is aimed at making a more seamless transition into the marketplace. This comes after states began redetermining their enrollee’s eligibility for the social safety net programs earlier this month.

The federal health department issued guidance yesterday encouraging states to apply for permission for Medicaid to cover care for incarcerated individuals in the months leading up to their release.

The Medicaid Reentry Section 1115 Demonstration Opportunity allows state Medicaid programs to cover certain services for those in prisons and jails three months before they’re released. Treatments for substance use disorders or chronic health conditions would be among those covered by the waiver, CMS said.

The idea is to enroll those eligible in Medicaid early in an effort to provide an easier transition as they exit the criminal justice system. In January, California became the first state to get federal sign-off to offer prerelease services through its Medicaid program, jump-starting a new model that experts say could soon become more prevalent across the country.

Health and Human Services Secretary Xavier Becerra:

Abortion pill rulings undermine U.S. drug approval process, companies say

Pharmaceutical companies are mobilizing against a pair of lower-court rulings restricting access to a key abortion pill, contending that they go far beyond issues of reproductive health and pose a threat to the regulatory foundations of the U.S. drug industry, our colleague Christopher Rowland writes in a story out this morning.  

The industry is arguing that by nullifying years of evidence-based regulations by the Food and Drug Administration, the two rulings would weaken the agency’s authority more broadly and threaten the legal underpinnings of pharmaceutical research and development, according to friend-of-the-court advisory briefs filed Friday with the Supreme Court.

Pharmacy executives are warning that investments in cutting-edge biotechnology fields aimed at cancer and other serious diseases could be subject to legal attacks if the agency’s rulemaking is thrown open to court challenges — potentially putting tens of billions of dollars of investments in jeopardy.

Catch up quick: Earlier this month, U.S. District Judge Matthew Kacsmaryk in Texas blocked the federal government’s decades-old approval of mifepristone — the first time a judge suspended the approval of a medication over the objections of the FDA and the drug’s manufacturer. Last week, the right-leaning U.S. Court of Appeals for the 5th Circuit temporarily blocked Kacsmaryk’s decision to suspend the drug’s approval, but reimposed prior restrictions that could limit access to the medication. The Supreme Court is expected to decide by late tomorrow if it will put a temporary stay on the case while it winds its way through the courts.

Pharmaceutical Research and Manufacturers of America, a lobbying group: 

As Migrant Children Were Put to Work, U.S. Ignored Warnings (By Hannah Dreier l New York Times)

Lawsuit seeking to revoke West Virginia abortion ban dropped (By John Raby l Associated Press)

Robert F. Kennedy Jr., Soon to Announce White House Run, Sows Doubts About Vaccines (By Sheryl Gay Stolberg | The New York Times)

Washington used to abhor talking about mental health. No more. (By Myah Ward | Politico)

Thanks for reading! See y’all tomorrow.