CLIENT PORTAL

Nursing Home Overhaul Bill Would Boost Staffing, Oversight

August 10, 2021 9:35 am

Responding to the ravages of COVID-19 in nursing homes, senior Democratic senators Tuesday introduced legislation to increase nurse staffing, improve infection control and bolster inspections.

The bill, from a group led by Sens. Ron Wyden of Oregon and Bob Casey of Pennsylvania, is part of a broader overhaul of long-term care just getting started. Separately, President Joe Biden is seeking $400 billion to expand home and community based care as an alternative to nursing homes in the giant domestic agenda bill Democrats are pushing in Congress. His COVID relief law already provided a down payment.

Nursing homes and long-term care facilities house a tiny proportion of the U.S. population but they’re estimated to account for about 3 in 10 deaths from COVID-19. Vaccines have finally brought relief, dramatically reducing cases and deaths, but concerns remain.

Some of the main provisions of the Senate bill would:

— Raise salaries and benefits for nursing home staff by giving states the option of an increase in federal Medicaid matching funds, available over six years. Low wages in the nursing home industry make for constant turnover, a critical problem even before the pandemic. The bill also starts a process for setting minimum staffing thresholds.

— Require nursing homes to have an infection prevention and control specialist.

— Require nursing homes to have a registered nurse available 24 hours a day, instead of the current eight hours.

— Bolster state inspections of nursing homes, and add more low-performing facilities to a “special focus” program that helps them improve quality.

— Forbid nursing homes from requiring residents and families to agree in advance to arbitration, thereby waiving their rights to go to court over disputes involving care.

The Congressional Budget Office has not put a price tag on the bill, but it could reach tens of billions of dollars.

“Families must have faith that loved ones receiving long-term care or care after a hospital stay will be safe and receive good-quality care,” Wyden said in a statement. “The pandemic, myriad reports of abuse, and critical failures during natural disasters have shattered that foundation of trust and safety.”

Nursing homes receive most of their financing through Medicaid and Medicare, and Wyden oversees both programs as chair of the Senate Finance Committee. Casey leads the Aging Committee. In the House, Ways and Means Chairman Richard Neal, D-Mass., and Energy and Commerce Chairman Frank Pallone, D-N.J., are also working on a nursing home overhaul. The four lawmakers wield clout, but prospects for the legislation are uncertain.

“These proposed measures would help improve staffing and increase accountability on the part of nursing homes,” Harvard health policy professor David Grabowski said of the legislation. “Historically, we have often underfunded nursing homes but some facilities have also not spent public dollars on direct resident care as intended. Under this legislation, more funding will go to nursing homes for staffing, but more will be expected of them as well.”

The bill would also launch an experiment to see if downsized nursing homes lead to better care and quality of life for residents. Those facilities would have between five and 14 residents, make private rooms available, feature accessible outdoors areas, and involve residents and families in decision-making.

Nursing home industry groups have been clamoring for more money from the federal government, but they also complain about the cost of added requirements and the burden of more rules. They’re likely to oppose banning arbitration clauses.

Nursing Homes

08/10/21 9:35 AM EDT

Nursing Home Overhaul Bill Would Boost Staffing, Oversight

Responding to the ravages of COVID-19 in nursing homes, senior Democratic senators Tuesday introduced legislation to increase nurse staffing, improve infection control and bolster inspections.

Bill Summary: S. Con. Res. 14, FY22 Budget Resolution

August 10, 2021 9:33 am

House and Senate committees would be directed to produce legislation providing $3.5 trillion of spending to enact the bulk of President Joe Biden’s economic agenda under S. Con. Res. 14, the Senate’s fiscal 2022 budget resolution.

The resolution would tee up the budget reconciliation process that would allow Democrats to pass Biden’s plan without Republican support, including provisions to address climate change, expand health-care coverage, and increase taxes on business and high-income individuals.

“The $3.5 trillion Budget Resolution that I am introducing today will allow the Senate to move forward on a reconciliation bill that will be the most consequential piece of legislation for working people, the elderly, the children, the sick and the poor since FDR and the New Deal of the 1930s,” said Senate Budget Committee Chair Bernie Sanders (I-Vt.), the sponsor of the resolution, in an Aug. 9 news release.

Committee ranking member Lindsey Graham (R-S.C.) said in a July 14 news release after the framework was first announced that the “$3.5 trillion tax and spend package being proposed by Senator Schumer and other Democrats is using infrastructure as an excuse to raise taxes and expand government.”

The $3.5 trillion topline would be in addition to the Senate’s infrastructure package (H.R. 3684; see BGOV Bill Summary) that its supporters said would increase spending by $550 billion over five years.

Reconciliation Instructions

The resolution would direct 12 Senate committees to report legislation by Sept. 15 that would make the following changes to the deficit:

It would direct 13 House committees to report legislation by the same date with the following deficit effects:

The Senate and House Budget panels would then package the reconciliation legislation and send it to the full chambers without substantive revision.

The instructions for the Senate Finance and House Ways and Means committees would be a “nominal” $1 billion over ten years to give the panels flexibility to draft various tax and health-care changes, including offsets for the reconciliation package, according to a document from Senate Democrats.

While lawmakers have discussed offsetting the entire $3.5 trillion cost of their upcoming bill with revenue increases, the instructions give the House and Senate tax-writing committees more flexibility by only requiring a partial offset. In total, the instructions would allow the Senate committees to advance measures that would add nearly $1.75 trillion to the debt and the House committees to advance measures that would add nearly $2 trillion. Those numbers reflect differences in committee juris diction.

Though the resolution doesn’t specify what the resulting reconciliation bill would contain, the document highlighted initiatives including:

Expanding Medicare coverage to include dental, vision, and hearing benefits, and lowering the program’s eligibility age.
Lowering the price of prescription drugs.
Extending child tax credits.
Providing paid family and medical leave.
Providing universal pre-kindergarten and tuition-free community college.
Expanding tax incentives for clean energy, manufacturing, and transportation.
Establishing a Civilian Climate Corps.
Providing lawful permanent status for qualified immigrants.
Providing pro-worker incentives and worker support.
Hiking taxes on corporations and high-income individuals.
Expanding the state and local tax (SALT) break.
Imposing tariffs on carbon-intensive imports.

The resolution includes reserve funds that would allow the Senate and House Budget chairs to adjust budgetary levels to accommodate subsequent action on reconciliation legislation, including legislation that doesn’t raise taxes on individuals making less than $400,000. A covered reconciliation bill would also be exempt from certain points of order—requiring 60 votes to waive in the Senate—against legislation with short-term or long-term deficit increases.

It would also allow allocations in the resolution to be adjusted to reflect changes from enacting an infrastructure bill.

Byrd Rule

Bills produced under reconciliation instructions can be passed in the Senate with a simple majority instead of 60 votes, though they’re subject to restrictions.

The Byrd rule, named after former Sen. Robert Byrd (D-W.Va.), limits what can be included in a reconciliation bill. For example, provisions must have actual, or non-incidental, budgetary effects and can’t affect Social Security. Provisions that don’t comply can be removed through points of order that take 60 votes to overcome in the Senate.

For more on the reconciliation process, see the BGOV OnPoint and Cheat Sheet.

Budget Targets

The nonbinding budget blueprint includes spending, revenue, and deficit targets for fiscal 2022 through fiscal 2031.

It would specify outlays of $4.7 trillion in fiscal 2022 and revenue of $3.4 trillion, for a net deficit of $1.3 trillion. It also projects deficits for the rest of the decade, including $1.82 trillion by fiscal 2031.

The budget panels could allocate additional funds to House and Senate appropriators for “program integrity” and other spending, including disability reviews, tax enforcement, programs to curb health-care abuse, reemployment services, wildfire suppression, disaster relief, and veterans’ medical care.

The measure would modify emergency provisions from the fiscal 2018 budget resolution (H. Con. Res. 71) and remove a point of order against emergency designations. It also would restore a point of order against advance discretionary appropriations, with exceptions for certain accounts such as Veterans Affairs Department medical programs.

The measure’s budgetary targets generally would be exempt from adjustments to discretionary spending limits.

Debt Limit

The resolution doesn’t include instructions to increase or suspend the debt limit, which went back into effect Aug. 1 following a two-year suspension (see BGOV OnPoint).

Republicans had called on Democrats to address the debt limit through budget reconciliation and many said they won’t support raising it in a continuing resolution to fund the government past Sept. 30, when the current fiscal year ends.

The Treasury Department is using “extraordinary measures” to juggle cash flow and stay below the renewed debt ceiling, but Treasury Secretary Janet Yellen warned of default risks soon after the August recess. She also called on lawmakers to address the debt limit on a bipartisan basis.

Group Positions

Groups that SUPPORT provisions in the budget resolution include the Center on Budget and Policy Priorities (CBPP), The Nature Conservancy, and OxFam America.

The resolution “takes an important first step toward enacting groundbreaking legislation with long overdue investments to address problems that have plagued the United States for generations,” CBPP President Sharon Parrott said in an Aug. 9 statement.

Groups that OPPOSE the measure include Americans for Tax Reform, the Committee for a Responsible Federal Budget, and the U.S. Chamber of Commerce.

The resolution “would enable a $3.5 trillion reconciliation bill that would dramatically expand the size and scope of government through record levels of inflationary spending, impose massive tax increases, and halt America’s economic recovery,” wrote Jack Howard, the U.S. Chamber of Commerce’s senior vice president of government affairs, in an Aug. 10 key vote alert.

Previous Action & Prospects

Sanders unveiled the resolution with Majority Leader Chuck Schumer (D-N.Y.) on Aug. 9.

The Senate voted 50-49 to proceed to the measure on Aug. 10, after passing its infrastructure package by a vote of 69-30. Debate on a budget resolution is limited to 50 hours in the Senate, and typically includes a vote-a-rama with multiple back-to-back votes on amendments.

House Democrats haven’t unveiled a budget resolution or announced plans to take up the Senate measure. Both chambers must agree to the same text under the same resolution number for the reconciliation process to move forward.

With assistance from Jack Fitzpatrick

To contact the analyst: Michael Smallberg in Washington at msmallberg@bgov.com

To contact the editors responsible: Danielle Parnass at dparnass@bgov.com; Heather Rothman at hrothman@bgov.com

Congress

08/10/21 9:33 AM EDT

Bill Summary: S. Con. Res. 14, FY22 Budget Resolution

Bloomberg

Senate Democrats Unveil $1 Trillion Health Care Agenda for Fall

August 10, 2021 7:09 am

By Alex Ruoff | August 9, 2021 2:48PM ET

Senate Democrats laid out an ambitious plan to expand public health insurance programs Monday, with a price tag that could hit more than $1 trillion.

Democratic leaders released text of their budget resolution, setting up President Joe Biden’s $3.5 trillion economic plan. Roughly a third of that plan will consist of expanding Medicare’s benefits and lowering the program’s eligibility age, extending the Obamacare expansion achieved earlier in the year, expanding home and community-based care programs, and preparing for the next pandemic, according to a memo released Monday.

The lofty costs for all these items will likely mean some will be temporary, and some could be dropped completely.

“This is all a jigsaw puzzle more complicated than you can ever imagine to design health care expansion policies, and then create revenues and budget savings to pay for them,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “The less revenues and savings you create, the less you can spend.”

Here’s how the costs break down, all over 10 years:

Expanding Medicare’s benefits to include dental ($238 billion), vision ($30 billion), and hearing ($89 billion), for a total of $358 billion;
Home and community-based care expansion of up to $400 billion;
Closing the Medicaid gap for $100 billion;
Preparing for the next pandemic, for $30 billion;
Addressing the provider shortage, for $50 billion; and
Lowering the Medicare eligibility age to 60, for a cost of $200 billion.

Democrats Release Budget Enabling Biden’s $3.5 Trillion Plan

Cost Trade-Offs

Democrats have vowed to offset about half of the $3.5 trillion economic package with other provisions, and have eyed offsetting much of the health-care spending by empowering the government to negotiate with drugmakers.

“We will save taxpayers hundreds of billions by requiring that Medicare negotiate prescription drug prices with the pharmaceutical industry, and we will use those savings to expand Medicare by covering the dental care, hearing aids and eyeglasses that seniors desperately need,” Sen. Bernie Sanders (I-Vt.), chairman of the Senate Budget Committee, said in a statement Monday.

Drugmakers to Pay Billions for Wasted Drugs Under Senate Deal

This also means that some of these health care priorities may squeeze out others. Sen. Bob Casey (D-Pa.), who has introduced sweeping legislation to expand Medicaid’s home-care offerings, said he’s negotiating with his colleagues over how much of the reconciliation package will be dedicated to home and community-based care.

“I want to make this as expansive as possible, but there’s going to be some compromises,” Casey said.

One senior Senate Democratic aide cautioned that the framework released Monday isn’t binding and lawmakers could exclude some of the provisions listed in it. Lowering the Medicare eligibility age is among those items likely to be cut to reduce spending levels, the aide said.

Ways to Save

Democrats have a laundry list of health-care items that can pay for their agenda:

Repealing a Trump-era rebate rule, saving roughly $130 billion;
Empowering the government to negotiate with drugmakers (similar to H.R. 3), which could save up to $456 billion; and
Medicare Advantage reforms, a savings of up to $150 billion.

Chris Meekins, a health-care policy research analyst at Raymond James, noted that Democrats could also expand the budget window in their reconciliation package from 10 years to 15 years to reap savings from further expanding the Medicare sequester, which are planned cuts to federal spending.

Meekins said Democrats might also offset the home and community-based care provisions with tax reforms, putting the final cost of Democrats’ health agenda closer to $450 billion—if lowering the Medicare eligibility age is also excluded.

Hospitals and Doctors Win, Pharma Loses in Infrastructure Deal

Estimates for the cost of expanding Medicare’s benefits and the savings from H.R. 3 come from the Congressional Budget Office.

President Joe Biden pledged to spend $400 billion on home and community-based care. Meekins of Raymond James provided an estimate for closing the Medicaid gap and addressing the provider shortage. The Committee for a Responsible Federal Budget provided the estimate for lowering the Medicare eligibility age.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Anna Yukhananov at ayukhananov@bloombergindustry.com; Alexis Kramer at akramer@bloomberglaw.com

Congress

08/10/21 7:09 AM EDT

Senate Democrats Unveil $1 Trillion Health Care Agenda for Fall

Bloomberg Government

Senate Democrats laid out an ambitious plan to expand public health insurance programs Monday, with a price tag that could hit more than $1 trillion. Democratic leaders released text of their budget resolution, setting up President Joe Biden’s $3.5 trillion economic plan. Roughly a third of that plan will consist of expanding Medicare’s benefits and lowering the program’s eligibility age, extending the Obamacare expansion achieved earlier in the year, expanding home and community-based care programs, and preparing for the next pandemic, according to a memo released Monday.

GAO: Trump-Era Hospital Reporting Program Incomplete, Burdensome

August 6, 2021 9:26 pm

Public health officials and epidemiological associations are often not using COVID-19 data gathered through the Trump-era controversial HHS hospital reporting program, opting instead for state and local datasets that are more detailed, the Government Accountability Office found in a report ordered by Democratic lawmakers who worried the Trump administration set up the HHS program to bypass the Centers for Disease Control and Prevention in order to manipulate the data.

But HHS officials say at least five states rely on the HHS data and the program has helped the government identify which hospitals have personal protective equipment and other supply shortages.

Hospitals were reporting COVID-19 cases through CDC’s National Healthcare Safety Network until July 10, when HHS officials told them to report only through its new program HHS Protect. The move prompted immediate outcry from several Democrats, including Rep. Rosa DeLauro (D-CT) who accused HHS as “operating as a dangerous, political apparatus.”

House Energy & Commerce Chairman Frank Pallone (D-NJ), along with two colleagues, asked the GAO on Aug. 19, 2020 to determine the timeline, effect on the pandemic response and data quality control measures since hospitals stopped reporting to the CDC.

Shortly after the letter, the Trump administration introduced an interim final rule that made reporting to HHS Protect a requirement to participate in Medicare and Medicaid. The move signaled hospitals would be removed from the programs if they didn’t report the number of confirmed or suspected COVID-19 positive patients, occupied ICU beds and the availability of essential supplies.

Then-HHS Secretary Alex Azar painted his department’s hospital COVID-19 data reporting program as a model for the future of data collection before he left office on Jan. 20.

The GAO released its findings Thursday (Aug. 5) and found constantly evolving, incomplete guidance that made it hard for hospitals to comply. One such challenge was the lack of an initial data dictionary for how to report hospital capacity, prompting questions about the definition of an intensive care unit bed and whether to include nursery beds in their reports.

The report also found HHS Protect increased administrative burden on hospitals more than HHS’ estimate of 1.5 hours each day. Stakeholders reported the department’s estimate didn’t take into account that reporting can involve multiple staff and require pulling data from multiple sources.

The GAO also found epidemiological associations and state and local health officials often preferred to use their own data, which are more tailored to their needs.

“HHS Protect requires hospitals to report on the number of beds in use, and officials from one state told us they asked instead for the number of beds available, which provided more pertinent information for their purposes,” the GAO report says. “They also told us that the state had implemented an automated feed from hospitals to provide bed utilization data every 10 minutes, giving the state more timely information on hospital capacity.”

But HHS says a handful of states use their data and the program enabled the department to alert states to 2,600 supply and staff shortages, of which about 1,500 were resolved. Another 100 instances required federal support and the remaining were validated, but no further action was needed.

HHS told the GAO it plans to use HHS Protect to create a long-term all-hazards system that quickly adapts to gather data for future public health emergencies. Meanwhile, the CDC emphasized the need for HHS to include CDC staff to ensure the program’s data are complete and useful.

HHS says it’s addressing part of the GAO’s recommendation that it provide on-going discussions with hospitals and public health officials, but it has yet to establish an expert committee due to COVID-19 and resource constraints.

Hospitals

08/06/21 9:26 PM EDT

GAO: Trump-Era Hospital Reporting Program Incomplete, Burdensome

Inside Health Policy

Health Insurers, Advocates Clash Over Proposed Obamacare Updates

August 6, 2021 9:09 pm

Insurers and consumer advocates are facing off over a Department of Health and Human Services proposal to extend the Affordable Care Act’s annual enrollment period and allow year-round sign-ups for those with low incomes.

In public comment letters on the proposed update (RIN 0938–AU60) of Obamacare benefits and payment parameters, major marketplace insurers like Anthem, Centene Corp., and UnitedHealthcare, all opposed a plan to lengthen the federal open enrollment period from 45 days to 75 days.

The longer enrollment would allow people who “were automatically re-enrolled into a plan to reevaluate their options after receiving updated plan cost information in the new year and select a new plan that is more affordable,” Fred Riccardi, president of the Medicare Rights Center, said in a comment letter.

But insurer Molina Healthcare said the proposal “creates the potential of adverse selection as healthier members could defer enrollment until the last minute and unhealthier members would enroll earlier, which would increase costs and premiums,” Carolyn Ingram, Molina’s executive vice president for external affairs, said.

If finalized by the Centers for Medicare & Medicaid Services, the annual sign-up period would run from Nov. 1 to Jan. 15. It now ends Dec. 15.

Instead of a longer enrollment period, America’s Health Insurance Plans recommends that the CMS establish a targeted special enrollment period for those “who automatically reenroll and experience an increase in premium. The end of the open enrollment period, December 15, should be the triggering event for a 30-day special enrollment period with prospective effective dates,” AHIP’s comment letter said.

Special Enrollment

The industry also opposes a CMS plan for a new monthly special enrollment period for adults and dependents who are eligible for advance premium tax credits—and whose household income is less than 150% of the federal poverty level. It would allow them to enroll in marketplace coverage whenever their income or eligibility permits. They now must experience a qualifying life event or wait for the annual open enrollment period to get coverage.

Riccardi and Pennsylvania Insurance Commissioner Jessica Altman both support the CMS’s special enrollment proposal. It’s designed to help people who lose Medicaid coverage, a population that’s sure to increase when the pandemic health emergency is lifted.

The special sign-up period would allow “Pennsylvanians to ensure that those losing Medicaid coverage have access to quality, affordable health coverage and care throughout the marketplace,” Altman wrote in her comment letter.

AHIP says that can be done through enhanced noticing and special outreach that encourages people to maintain continuous coverage.

If people could enroll at any time, or change plan selections each month, “we anticipate consumers would enroll in coverage at the point of care and or change plans mid-year. Constant enrollments and disenrollments would undermine stability of the individual market and could result in higher premiums, narrower networks, and limit consumer choice,” Jeanette Thornton, AHIP’s senior vice president for product, employer, and commercial policy, said in her letter.

Standardized Plans

Anthem, which covers nearly 700,000 people in the individual market, said in its comment letter that the current 45-day enrollment period should continue. But if the CMS does make changes, it would prefer a longer annual enrollment period over the proposed special enrollment period.

If the CMS does extend the enrollment period, Anthem recommends that applications submitted by Dec. 15 have a Jan. 1 effective date. And those submitted between Dec. 16 and Jan. 15 take effect Feb. 1. As written, the current proposal doesn’t provide effective dates.

Insurers also don’t want the CMS to require them to offer standardized plan options thatare designed to make it easier for consumers to compare and shop for coverage. The CMS plans to resume standardized plan options in 2023 after a federal court overturned a Trump administration rule that scrapped the practice of designating some plans as “standardized options.” The agency will also propose standardized plan designs for 2023.

UnitedHealthCare recommended that CMS permit, rather than require standardized plan options to give issuers “the latitude to continue pursuing innovative offerings.”

Roughly 40 organizations representing patients with complex conditions like autoimmune diseases, HIV, and hepatitis, want the CMS to require federal marketplace insurers to offer some standardized plans that either cap cost-sharing for prescription drugs and require no co-pay or deductible. In a joint comment letter, the groups say the federal government should follow states like California, Delaware, Louisiana, and Maryland, as well as the District of Columbia “that cap the amount a patient must pay out-of-pocket for a one-month supply of a single prescription medication.”

AHIP says insurers shouldn’t be required to offer the plans and that the CMS should not “implement differential display of standardized plan options on Healthcare.gov” nor “give special preference to these plans.”

“We are concerned that a differential display would increase consumer confusion and may appear to favor some plans over others and inadvertently steer consumers or otherwise influence the shopping experience,” AHIP’s comment letter said.

To contact the reporter on this story: Tony Pugh in Washington at tpugh@bloomberglaw.com

Affordable Care Act

08/06/21 9:09 PM EDT

Health Insurers, Advocates Clash Over Proposed Obamacare Updates

Bloomberg

Proposal would extend annual enrollment period
Anthem, UnitedHealthcare among opponents of rule change

Hospitals Must Track, Report Staff Covid-19 Vaccination Rate

August 5, 2021 9:23 pm

Hospitals will be required to track and report Covid-19 vaccination status for their health-care personnel to comply with a rule from the Biden administration.

The requirement, contained in a wide-ranging hospital payment rule (RIN 0938-AU44, 0938-AU56), is an effort to “support public health tracking and provide patients, beneficiaries, and their caregivers important information to support informed decision making,” according to the Centers for Medicare & Medicaid Services.

Hospitals are required to report certain quality measures to the CMS or they risk losing funding. The rule, finalized Aug. 2, asks hospitals to report data each quarter to the Centers for Disease Control and Prevention’s National Healthcare Safety Network’s surveillance system beginning with the period that starts Oct. 1, 2021.

Health-care groups have mounted pressure on the industry to require vaccination of medical staff as the delta variant sparks more Covid-19 deaths and infections. While the CMS’s reporting requirement is not a vaccine mandate, it seeks “to incentivize and track” vaccination to reduce Covid-19 transmission and protect staff, patients, and caregivers.

Increased vaccination among hospital staff could lead to an increase in patient uptake, the CMS said. The measure will also give patients, including those in high-risk groups, a more complete picture of hospital vaccination rates as they decide where to receive care.

‘Needs Further Refinement’

Hospitals will report the vaccination rate of their staff at least one week each month to comply with the new quality measure. The agency requires this reporting for anyone who gets a direct paycheck from a hospital, even if they don’t see patients.

The CMS asks for just one week of data—”a reliable snapshot”—in recognition of “the time and resources that hospitals would need to report the data,” the agency said.

Before the rule was released, some commenters expressed concern with the tracking requirement given that the vaccines haven’t been fully approved by the Food and Drug Administration. Commenters also opposed a vaccine requirement.

The CMS responded that hospitals wouldn’t be “held directly accountable for a particular outcome.” The agency doesn’t expect the quality measure to lead to universal vaccination among hospital staff. The tracking requirement is meant to help hospitals see whether their approaches to increasing vaccination rates are working.

The new quality measure “needs further refinement to ensure it accurately reflects hospitals’ progress in vaccinating their workforce,” Stacey Hughes, executive vice president of the American Hospital Association, said in a statement.

The measure “was adopted on an unusually accelerated pace,” and the AHA expects it will need to be tweaked as hospitals start to report data, AHA Director of Policy Akin Demehin said in a separate statement for Bloomberg Law. Information about the vaccine’s efficacy—including length of immunity and the potential need for booster shots—continues to evolve, which “could significantly change how hospitals collect and report measure data,” Demehin said.

“We are concerned about the potential for confusion and inconsistent reporting among hospitals if CMS needs to make sudden shifts in measure specifications,” Demehin said.

Hospitals

08/05/21 9:23 PM EDT

Hospitals Must Track, Report Staff Covid-19 Vaccination Rate

Bloomberg

Health agency requires quarterly reports from Oct. 1
Measure seeks to incentivize staff, patients to get jabbed

CBO Sees Infrastructure Bill Widening Budget Gap by $256 Billion

August 5, 2021 9:22 pm

The bipartisan U.S. infrastructure bill would add $256 billion to the federal budget deficit over a decade, the Congressional Budget Office said Thursday, differing from lawmakers’ contention that the spending would be fully paid for by a smorgasbord of funding measures.

The CBO’s release of its so-called score of the $550 billion infrastructure bill is a much-anticipated milestone as senators seek to advance the legislation ahead of Congress’s August recess. The infrastructure spending forms a key part of President Joe Biden’s economic policy and is expected to be followed by a $3.5 trillion, Democrats-only economic package that includes climate and health care initiatives.

The nonpartisan arm of the legislature estimated that the revenue provisions in the bill would generate close to $50 billion in funds over the decade through 2031.

The CBO’s scoring could cost some support among Republicans opposing deficit spending, although it isn’t expected to lose enough votes to bring down the bill. Senators have been anticipating that the CBO would not give them credit for perhaps as much as half of their so-called pay-fors.

For example, the bipartisan group said their plan would redirect $53 billion in savings from governors who had nixed supplemental $300-a-week unemployment benefits early. The CBO said that it had already included those savings in its budget baseline, so they weren’t included in the infrastructure bill’s score.

The lawmakers also had argued the infrastructure plan would yield substantial revenue by boosting the economy, but the CBO said it did not estimate the macroeconomic impact of the package.

Negotiators have said that, in their own minds, they feel the package is paid for, even if CBO won’t give them full credit.

A summary of the infrastructure legislation from the office of Democratic Senator Kyrsten Sinema of Arizona — who led negotiations along with Republican Senator Rob Portman of Ohio — showed an assumption of about $210 billion in funding from leftover Covid-19 relief funds. It also saw $56 billion in economic growth from a 33% return on investment in long-term projects.

Infrastructure

08/05/21 9:22 PM EDT

CBO Sees Infrastructure Bill Widening Budget Gap by $256 Billion

Bloomberg

Senators have contended that spending is fully paid for
Revenue provisions seen generating close to $50 billion

Pharma Could Face Billions in Waste Fines

August 5, 2021 9:20 pm

Drugmakers Takeda Pharmaceutical Co. and Roche Holding AG could each be forced to repay the government $100 million annually for wasted medicines under the Senate infrastructure deal.

The $550 billion measure, which the Senate is debating this week, would require companies to refund Medicare when doctors throw away drugs, a move meant to push some drugmakers to stop overpacking single-use containers. The funds would offset part of the bill’s spending on roads and bridges.

Medicare paid $752.9 million for drugs that were discarded in 2019, according to government data. More than a third, or $286 million, of that spending came from just four drugs, and one — Takeda’s Velcade — accounted for more than $114 million of that spending alone.

Researchers and health-care industry executives say drug waste is a major hidden cost for U.S. insurers, including Medicare, that contributes to rising insurance premiums. The waste also obscures what’s actually being spent on some of the most expensive medicines, in some cases raising the cost of pricey cancer drugs by 20% or more.

“When we talk about the cost of a drug, we’re often not talking about this waste,” said Peter Bach, chief medical officer for Delfi Diagnostics Inc. and a researcher with Memorial Sloan Kettering Cancer Center. “This is a lot of money the drug industry has been capturing for years.”

The infrastructure package would require drugmakers to refund Medicare for discarded physician-administered drugs starting in 2023. Drugs that have been covered by Medicare for fewer than 18 months would be exempt, as would some drugs that require a special filtration process.

The top five most-discarded drugs by cost in 2019 were Takeda’s Velcade, Roche’s Herceptin, Amgen Inc.‘s Nplate, Bristol-Myers Squibb Co.‘s Abraxane, and Roche’s Rituxan. Velcade topped the list for all three years Medicare has collected this data, most recently in 2019. Most of these are cancer drugs.

Nicolette Baker, a senior manager for corporate relations at Genentech, part of Roche, said the company’s medicines are packaged according to Food and Drug Administration requirements, which call on companies to ensure that waste is reduced but that a vial typically contains enough for a single dose.

Hospitals and Doctors Win, Pharma Loses in Infrastructure Deal

Why It’s Wasted

Some drug waste is typical for medicines that come in single-use containers where the dose is based on the patient’s weight, said Chris Marcum, vice president of enterprise pharmacy at Cancer Treatment Centers of America Inc., a network of cancer care and research centers. Physicians can either use whatever is left in the container for another patient—or discard it and bill it as waste, he said.

Often these medicines don’t contain preservatives, giving them a shelf life of a few hours, he said.

Velcade, for example, comes to hospitals in a 3.5-milligram vial but the typical dose is around 2.5 milligrams, said Jimmie Deibert, director of clinical pharmacy programs at Cancer Treatment Centers of America.

More than a quarter of what Medicare paid for this chemotherapy drug in 2019—nearly $426 million—was discarded, according to Medicare data. This waste and drugmakers’ list prices hide the true cost of some of the most expensive medicines on the market, Bach said.

For example, Biogen Inc.‘s recently approved Alzheimer’s medicine, Aduhelm, premiered with a price tag of about $56,000 per year. Bach said that’s based on dosing for a person who weighs about 163 pounds, which is below average for U.S. adults. The true annual cost for Aduhelm could be more than $60,000, he said.

Biogen Alzheimer’s Drug Approval to Get Inspector’s Probe

“They’re actively in the business of signaling a price average that is inaccurate,” Bach said of drugmakers.

Some drugmakers say they’re actively working to reduce waste. Amgen in 2019 introduced a smaller vial for Nplate to compliment the larger vials already available, said Kelley Davenport, a spokeswoman.

‘Right-Sizing’ for Cost

Lawmakers who want drugmakers to repay Medicare for wasted drugs say manufacturers intentionally over-package containers to reap more revenue from the government. Without a profit motive, these companies are likely to find ways to reduce waste, said Stacie Dusetzina, a professor of health policy at Vanderbilt University Medical Center.

“If the industry knows that every bit of waste comes out their bottom line, you can imagine they’d do a better job of right-sizing the vial,” she said.

Dusetzina noted that nothing would stop these companies from raising the cost of their drugs to offset what they must refund the government, putting into question whether Medicare would save any money with the refunds over time.

A Senate aide familiar with the provision said the Congressional Budget Office estimated it would save the government $3 billion over 10 years.

In addition to funding part of the infrastructure bill, Bach pointed out that taxpayers would no longer have to foot the bill for overpacked containers. “We’ll get our money back,” he said.

Pharma

08/05/21 9:20 PM EDT

Pharma Could Face Billions in Waste Fines

Medicare paid $753 million in 2019 for drugs that weren’t used
Refunds could reveal how drug packaging sizes drive up cost

Dems plot to squeeze health care promises into social spending bill

August 5, 2021 9:17 pm

Democrats’ $3.5 trillion social spending package marks the party’s last chance before the midterm elections to make good on health care promises they’re counting on to keep control of Congress. All they need is several trillion more dollars.

To squeeze as many of their priorities as possible in a budget resolution that’s expected right after the bipartisaninfrastructure package, lawmakers are discussing making some of the new healthspending temporary, similar to the two-year boost to Obamacare subsidies they wrapped into Democrats’ coronavirus relief package in March.

The move could allow them to claim credit for steps such as extending Medicaid coverage to millions of low-income people in red states and extending the two years of Obamacare subsidies they enacted in March without running afoul of congressional scorekeepers.

But a drug pricing plan that lawmakers are counting on to pay for a big chunk of the health investments is nowhere close to ready. That leaves Democrats uncertain of how much money they’ll have to invest in new programs.

“We’re not going to be able to do everything we want,” said Sen. Chris Murphy (D-Conn). “There’s not a simple answer. We’re going to have limited resources, and we’ll have to make different decisions on whether we do programs at lower levels for longer periods of time or higher levels for short periods of time. It’s important to get it right.”

The debate could test solidarity within the caucus as progressives push for ambitious and costly initiatives such as expanding Medicare to cover dental, vision and hearing care, while moderates raise concerns about the cost. The overlapping priorities also raise the prospect of another grinding debate over health spending this fall.

Already, some ambitious promises that played well on the campaign trail are being shelved. A senior Democratic aide told POLITICO that the package will not lower the eligibility age for Medicare — a top progressive demand.

The forthcoming budget resolution text won’t allocate specific funding levels for each health initiative, but instead broadly give different committees pots of money to work with. The $3.5 trillion reconciliation plan is being brought up under an expedited process so that it can pass without any GOP votes, but Democratic aides acknowledge they’ll have to make decisions in order to fit what they can into the budget resolution’s topline number.

A second senior Democratic aide said last month thatthere are five new health policies the budget resolution framework hones in on— creating Medicare dental, vision and hearing benefits; extending Obamacare subsidies; expanding Medicaid coverage to millions in states that have refused to expand their programs; bolstering Medicaid’s in-home care and reducing patient spending on prescription drugs.

Chris Meekins, an analyst for Raymond James, wrote in a note to clients Thursday that while the budget currently plans to spend $600 billion to $750 billion on health investments, he estimates the actual total will be closer to $400 billion to $450 billion. He cautioned that”significant savings will be required either way, with payfors for this bill in flux.”

Progressives say they’re pushing Democratic leadership and the White House to favor two- or three-year authorizations instead of cutting some health items altogether or making the programs skimpier.

“If the choice is between fewer people covered, less benefits or a shorter time frame, we would obviously choose a shorter time frame,” said Progressive Caucus Chair Rep. Pramila Jayapal (D-Wash.). “What we’re trying to do on all these programs is provide as universal a benefit as possible — include the most people who need that benefit and make it as comprehensive as possible — but look at reducing the number of years.”

But some Democrats say they plan to fight to ensurelong-term, if not permanent, funding for President Joe Biden’s $400 billion plan to allow millions more older adults and people with disabilities to get Medicaid-covered in-home services, saying the initiative needs a long runway in order to reach fruition.

“We’re creating something that’s rather new, and therefore it requires a time duration which is sufficient,” said Sen. Bob Casey (D-Pa.), who is leading work on the home care piece of the bill. “This can’t be a two or three-year commitment. I want it to be a 10-year commitment, because that’s the kind of duration that makes the most sense to me.”

Key Senate Democrats are also pushing hard to ensure the package extends health insurance to 2.2 million low-income Americans in states that have refused Obamacare’s Medicaid expansion, worried it could be left out because the population doesn’t have the same political clout as seniors or middle-class Obamacare enrollees.

Georgia Sen. Raphael Warnock said the expansion would fulfill a promise Congress made when it enacted Obamacare and expanded Medicaid to more poor adults. A 2012 Supreme Court decision made that expansion optional for states, and a dozen have refused to take up the program. “We’re in the middle of the process, and I know that this is a priority, and I’ll keep making the case,” he said.

While Democrats also hope to tap multiple sources of funding to pay for the initiatives, they’re leaning most heavily on a plan that would allow Medicare to directly negotiate the cost of prescription drugs, potentially saving the government hundreds of billions of dollars. But there isn’t yet agreement on how best to go about it.The Senate Finance Committee is currently working on an alternative to House Democrats’ prescription drug bill, which pegs what Medicare should pay for medicines to the lower prices paid in other developed nations.

Tying Medicare drug price negotiations to an international reference price has faced push back from moderates. Senate Finance Chair Ron Wyden (D-Ore.) recently acknowledged that “a lot of members have concerns” about the policy and he is still “trying to find common ground.”

Wyden is exploring tying price negotiations to a different benchmarkbased on domestic prices instead, according to two sources with knowledge, but has not yet shopped the plan around to members of his caucus.

Progressive Democrats see a political advantage to short-term authorizations of generous health programs, in the belief that new subsidies and programs will help them maintain control of Congress and give them the power to renew the spending a few years from now.

“Once people are able to see and experience these benefits, they’ll be harder to roll back,” Jayapal said. “They aren’t just the right thing to do but they’re incredibly popular.”

Congress

08/05/21 9:17 PM EDT

Dems plot to squeeze health care promises into social spending bill

Politico Pro

AHA names new trustees to the board

August 5, 2021 9:10 pm

The American Hospital Association has elected six new members to its Board of Trustees for three-year terms beginning Jan. 1, 2022. The Board of Trustees is the highest policymaking body of the AHA and has ultimate authority for the governance and management of its directions and finances.

Dennis W. Pullin, FACHE, president and CEO of Virtua Health, a not-for-profit integrated health system in New Jersey, with five hospitals, 300 care sites and 15,000 colleagues offering a full continuum of primary, preventive, wellness, acute, and long-term care.

Pullin came to Virtua in 2017 from the Washington, D.C./Baltimore, MD area where he was president of MedStar Harbor Hospital and senior vice president of MedStar Health. Prior to leading MedStar Harbor, he was senior vice president and chief operating officer at MedStar Washington Hospital Center in Washington, D.C.

Pullin’s extensive background includes many executive leadership positions in hospitals, academic medical centers, physician group practices and private industry. He was vice president of operations and business development at St. Luke’s Episcopal Health System in Houston and vice president of acquisitions and development at Symbion Healthcare, Inc.

A fellow and past regent of the American College of Healthcare Executives, Pullin serves on the New Jersey Hospital Association Board of Trustees. He is a past chair of the American Hospital Association’s Governance Council for Metropolitan Hospitals and a past member of the Maryland Hospital Association’s Council on Legislative and Regulatory Policy. He is a current member of the Chamber of Commerce Southern New Jersey Board of Directors and the United Way of Greater Philadelphia and Southern New Jersey Regional Board of Directors. In 2020 and 2018, Modern Healthcare recognized him as one of the nation’s Top 25 Minority Executives in Healthcare.

Pullin earned a Bachelor of Arts at Texas Lutheran University and a Master of Science at Texas A&M University.

Hospitals

08/05/21 9:10 PM EDT

AHA names new trustees to the board

AHA Press Release

Medicare Expansion Proposals

August 5, 2021 9:56 am

Congressional Democrats and the Biden administration are looking to expand Medicare

Senate Democrats are crafting a $3.5 trillion budget proposal that could add dental, vision, and hearing coverage to Medicare or lower the eligibility age

Broader proposals, such as “Medicare for All” or a public option, may be on the backburner

Medicare Covers Different Services Under Several Parts

PARTS	COVERAGE	BENEFICIARY COSTS	FINANCING
Part A: Hospital Insurance	Inpatient hospital, SNFs, hospice, some home health, Coverage	Premium-free for most; out-of-pocket costs vary, no annual catastrophic cap on out-of-pocket costs	Payroll tax revenue, goes into Hospital Insurance Trust fund
Part B: Medical Insurance	Physician services, outpatient hospital, equipment, drugs furnished by physicians, some home health & preventive services	Premiums vary by income; deductible $203 in 2021, 20% coinsurance, no annual catastrophic cap	Beneficiary premiums, general revenue into Supplementary Medical Insurance Trust Fund
Part C: Medicare Advantage	Private plans similar to Part A & B, may include additional benefit options or drug coverage	Premiums and out-of-pocket costs vary by plan; catastrophic cap and generally smaller out-of-pocket costs than Part A or B	Funded through both trust funds
Part D: Prescription drugs	Outpatient prescriptions drugs through private plans	Income-based premiums; standard coverage includes 25% coinsurance, 5% above catastrophic limit	Premiums, revenue go into separate SMI fund account

Medicare Covers Roughly 63 Million People

Serves adults 65 and older and those of any age who receive disability benefits

-Parts A and B are considered “original” or “traditional” Medicare; government pays for services directly

-About 60% of beneficiaries are enrolled in Parts A & B

-40% in Medicare Advantage

-Medicare Advantage and Part D are optional; government pays private insurers to provide benefits

88% of beneficiaries had additional coverage in 2016 to cover other services, help offset costs

-Eyeglasses, contact lenses, hearing aids, dentures, aren’t included in traditional Medicare coverage—though Medicare Advantage plans may offer these services at additional cost

-Most long-term care services aren’t covered

-Medigap policies cover Medicare’s out-of-pocket costs

-Some beneficiaries may qualify for Medicaid or have access to employer-based coverage

Democrats Eyeing Medicare Expansion

Progressives want to expand benefits, lower eligibility age in budget reconciliation

-Proposal to add vision, dental, and hearing benefits to Part B could cost $358 billion over a decade, according to CBO estimate of a previous proposal (H.R. 3 in the 116th Congress)

-Lowering eligibility age to 60 could cost $200 billion, according to document on Senate Budget Chairman Bernie Sanders’ (I-Vt.) budget plan

Centrist Democrats pushing for other health-care policies

-Some moderate Democrats prefer encouraging states to expand their Medicaid programs and making Affordable Care Act subsidies permanent

-House Budget Chair John Yarmuth (D-Ky.) said lowering eligibility age “has about 75% support in the caucus”

Medicare Costs Projected to Reach Nearly $1.5T by 2031

Bills Offer Variety of Approaches to Medicare, Health Coverage

President’s budget proposal indicated support for Medicare proposals but didn’t including funding for them

-Said access to dental, vision, and hearing through Medicare should be improved

-Supports option to enroll in Medicare at 60, with financing outside the Medicare trust fund

Democrats reintroduced ‘Medicare for All,’ public option, and buy-in plans

-Rep. Pramila Jayapal (D-Wash.) introduced the “Medicare for All Act” (H.R. 1976) to create a single-payer system that offers universal coverage and no cost-sharing

-Several bills, including “Medicare-X Choice Act” (S. 386, H.R. 1227), would create a public insurance option that individuals could purchase through the ACA health exchanges

-Other measures (S. 1279, H.R. 2881) would allow those ages 50 to 64 to purchase Medicare with separate premiums and financing

Medicare is Third-Largest Source of Health Coverage

Budget Reconciliation Is Key Path Forward for Democrats

Democrats eyeing $3.5 trillion reconciliation bill without support from Republicans

-Senate crafting a budget resolution that would set up reconciliation process

Aim to adopt resolution before August recess; unclear when House would take up measure

Reconciliation bill with proposals from several committees will likely come later in the year

Only a simple majority needed for passage of measure, though provisions must comply with budget rules

-Leaders must chart a path between progressive proposals and moderates in closely divided chambers

Lawmakers have floated Medicare drug price negotiations as a way to offset some of the costs of proposals to expand benefits and coverage

Republicans oppose expanding Medicare, point to trust fund’s approaching insolvency

-Lowering Medicare eligibility “would likely crowd out private coverage without moving the needle on access or affordability,” Finance Committee ranking member Mike Crapo (R-Idaho) wrote June 10

-“Medicare is five short years from going effectively broke,” and Biden’s budget proposal didn’t address the problem, wrote Ways and Means ranking member Kevin Brady (R-Texas) in a June 8 letter

Medicare

08/05/21 9:56 AM EDT

Medicare Expansion Proposals

Bloomberg

Congressional Democrats and the Biden administration are looking to expand Medicare

Senate Democrats are crafting a $3.5 trillion budget proposal that could add dental, vision, and hearing coverage to Medicare or lower the eligibility age

Broader proposals, such as “Medicare for All” or a public option, may be on the backburner

Sens. Urge Action On Medicaid Coverage Gap In Reconciliation Bill

August 4, 2021 9:15 pm

Sens. Raphael Warnock (D-GA), Jon Ossoff (D-GA) and Tammy Baldwin (D-WI) sent a letter to congressional leadership, President Joe Biden and HHS Secretary Xavier Becerra Tuesday (Aug. 3) asking them to close the Medicaid coverage gap in the reconciliation package expected later this year, as the Senate finishes up work on the bipartisan infrastructure bill and Democrats turn to figuring out how to pay for their solo so-called social infrastructure plan.

The three senators last month introduced the Medicaid Saves Lives Act, which would create a federally administered Medicaid-like program available to adults earning up to 138% of the federal poverty level in the 12 states that have not yet expanded Medicaid under the Affordable Care Act. A companion bill has been introduced in the House.

More than 2 million Americans, mostly people of color and those living in southern states, stand to gain coverage through a federal Medicaid-like program.

The senators Tuesday said Congress should use the Medicaid Saves Lives Act to close the gap.

“Unlike other paths to close the coverage gap, a federally administered Medicaid-like program would provide more robust benefits with lower out-of-pocket cost expectations not found in other plans. Therefore we urge you to include provisions closing the coverage gap that result in the creation of a Medicaid-like program administered by the federal government,” the letter reads.

Senate Majority Leader Chuck Schumer (D-NY) and House Speaker Nancy Pelosi (D-CA) have both said there is space for a Medicaid gap fix in the $3.5 trillion budget resolution that will lay the foundation for Democrats’ reconciliation package.

The extent to which Medicaid coverage gap fixes — and other health care reforms — can be included in the reconciliation bill likely depends on how much savings Democrats can glean from drug-pricing reforms. Cuts to Medicare Advantage may also be on the table to pay for health priorities in the reconciliation package.

Cost estimates for the Medicaid Saves Lives Act aren’t yet available.

The Urban Institute put out a report on June 30 estimating that it would cost between $181 billion and $335 billion over 10 years to expand premium tax credit eligibility for exchange plans to people making below 100% of the federal poverty level. Closing the gap through a public option that reimburses at Medicare rates would cost less, the Urban Institute found.

House Ways & Means health subcommittee Chair Lloyd Doggett (D-TX) said last month that his committee is looking to solve the problem by expanding premium tax subsidies to help those in the coverage gap purchase exchange plans. The House Energy & Commerce Committee is said to be examining federal Medicaid-like options.

An Energy & Commerce spokesperson said there were no updates to share as of Monday (Aug. 2) and a Ways & Means spokesperson did not respond to inquiries about how the committee’s proposal is coming along.

Doggett has also introduced a bill that would allow local governments in non-expansion states to expand Medicaid eligibility for their own residents. This plan is likely to be less expensive than expanding premium subsidies or a federal Medicaid-like program but would ultimately provide less coverage.

Medicaid

08/04/21 9:15 PM EDT

Sens. Urge Action On Medicaid Coverage Gap In Reconciliation Bill

Inside Health Policy

House Democrats Expect Drug Price Cap to Cover Employer Plans

August 3, 2021 9:18 pm

House Democrats agree with employer, labor, and consumer groups that commercial health plans should be included in legislation designed to curb drug prices, according to sources.

Whether plans sponsored by employers or insurers can be covered under H.R. 3‘s proposed cap on drug price inflation depends on whether the addition is allowed under a budget procedure that Congress will use to advance expanded Medicare benefits in the fall.

“We’re trying to see if we can make that work this year,” said a House Democratic aide who spoke on condition of anonymity. “We haven’t resolved it completely, but we’re trying.”

The House drug pricing bill is designed to offset the cost of the expanded benefits by lowering what Medicare pays for prescription drugs. The bill’s chief driver of the lower prices is a provision that allows the federal government to negotiate directly with drugmakers on how much it pays for high-priced products. Commercial plans—those run by employers, insurers, or labor unions—would pay the same amount for those drugs.

The bill also would require pharmaceutical companies to rebate to the Treasury Department the amount that they raise prices for certain drugs above inflation.

Employers and labor unions want those rebates in commercial plans as well. Without that protection, they argue, they are susceptible to large price increases in prescriptions. They’ve been discussing the issue with House leaders for months, according to a source involved in the talks.

“We want to make sure that any changes that happen will affect people in the commercial market as well as people in the Medicare program,” Amy Herr, director of health policy for the West Health Policy Center, said in a July 28 webinar.

She estimates that negotiating drug prices in the commercial market could save employers about $200 billion and employees another $60 billion between 2023 and 2029.

West Health Policy Center does research and education on slowing rising health-care costs while investigating ways to improve access to and the quality of care, particularly for seniors.

Budgetary Effect

Republicans don’t support the legislation, so the only path to passage is a budget process called reconciliation that bypasses the need for 60 votes in the Senate. Only policies that change spending or revenues can be included in budget reconciliation bills, so lawmakers would need to write the commercial insurance provision such that it affects the budget.

If the Senate parliamentarian doesn’t rule that the provision is primarily budgetary, “that provision which applies the inflation rebate to the commercial sector would have to be dropped,” the House aide said.

“We haven’t made a final determination of the language,” the House aide said. “I think we’re going to put it in there.”

Drug pricing legislation passed by the House in 2019 would have allowed commercial health plans to benefit from prices negotiated by Medicare for new drugs coming onto the market. But the bill didn’t include a provision allowing commercial plans to benefit from the inflation rebate.

Worried Prices Will Increase

“If they don’t include us, we’re worried that basically we’ll continue to see price increases well above the rate of inflation, and potentially even higher increases because drug companies are trying to profit maximize, and they’re making up for their inability to raise prices on Medicare by raising prices on us even higher,” Shawn Gremminger, director of health policy for the Purchaser Business Group on Health, said in an interview.

The PBGH, one of the employer groups working to get the price cap provision included in the drug price legislation, represents about 40 companies that spend about $100 billion a year covering 15 million people, Gremminger said.

Consumer advocates concur. “If we really want to address prescription drug pricing abuses, it’s critical that these employer-sponsored plans have access to the savings, to a fair price,” Frederick Isasi, executive director of Families USA, said in an interview.

“We want this problem solved for everyone, not just Medicare,” Isasi said. About 150 million Americans receive health-care coverage through employer-sponsored plans, he said.

Tax Write-Offs

Employers receive large write-offs for the coverage they provide their employees, Isasi said. “When you think about something as important as the price you’re paying for prescription drugs, it has a very direct impact on the taxes that can be collected,” he said.

“There’s a pretty clear argument that this definitely has a budgetary impact,” and it should be included in a budget reconciliation bill, he added.

Senate Democrats are on board for including commercial plans in provisions that would lower drug prices for Medicare, assuming the language passes parliamentary muster.

Senate Finance Committee Chairman Ron Wyden (D-Ore.) released a set of principles in June for lowering drug prices. One of the principles says, “Drug pricing reforms that keep prices and patient costs in check should extend beyond Medicare to all Americans, including those covered by employer and commercial health plans.”

The Pharmaceutical Research and Manufacturers of America (PhRMA) didn’t respond to a request for comment.

Pharma

08/03/21 9:18 PM EDT

House Democrats Expect Drug Price Cap to Cover Employer Plans

Bloomberg

Needs to impact federal budget to qualify
Employers worry about drug price inflation

Medicare

08/02/21 9:07 PM EDT

CMS Final Rule Improves Health Equity, Access to Treatment, Hospital Readiness, and COVID-19 Vaccination Data Reporting of Hospital Workers

CMS Press Release

Hospital Inpatient Prospective Payment System Final Rule Increases Payments to Treat COVID-19 and Improves Quality of Data Collection.

Missed debt ceiling deadline kicks off high-stakes fight

August 1, 2021 9:35 pm

The legal limit on how much debt the U.S. government can owe was reimposed Sunday, kicking off a high-stakes battle over federal spending with dire implications for global financial markets.

A two-year deal to suspend the debt ceiling lapsed at midnight following inaction from Congress and President Biden to give the U.S. more borrowing authority. The Treasury Department will now begin taking what it refers to as “extraordinary measures” to prevent the U.S. from defaulting on its debt.

Those steps are likely to avert a default until October or even November before Biden will need to sign a bill to raise or suspend the limit again.

The expiration of the debt limit has triggered numerous partisan standoffs over the past decade, most recently in 2019. Each time, Congress has raised or suspended the debt limit. But the weeks before a potential default have often been the most tense, both for financial markets and administration officials.

“I respectfully urge Congress to protect the full faith and credit of the United States by acting as soon as possible,” Treasury Secretary Janet Yellen wrote in a letter to congressional leaders last week, warning that they risked “irreparable harm to the U.S. economy and the livelihoods of all Americans” by delaying action.

There is no clear path to a bipartisan agreement as Republicans hold out for spending cuts that Democrats refuse to consider.

While Democrats have slim majorities in both the House and Senate, they will still need the support of 10 GOP senators to avoid a filibuster on legislation to raise or suspend the debt ceiling.

Republican leaders have told Democrats that there can be no bipartisan debt ceiling agreement without a slate of debt reduction measures targeting the roughly $28 trillion national debt. Several GOP lawmakers have floated a deal similar to the 2011 Budget Control Act, which ended a debt ceiling standoff shortly before the U.S. suffered its first ever credit downgrade.

Democrats, however, argue that tying a debt ceiling increase to any controversial legislation is akin to holding the financial system hostage.

Without help from Republicans, Democrats would have to approve a debt ceiling hike through a budget reconciliation measure, which only needs a simple majority to pass in each chamber but would require support from all 50 Senate Democrats.

The Congressional Budget Office (CBO) estimated in June that Congress likely has until October or November before the Treasury Department exhausts its extraordinary measures and the ability to pay government bills on time. But both CBO and Treasury have warned that the U.S. could be on the verge of default soon after lawmakers return from a planned summer recess in September, when they will face a time crunch on passing legislation to avoid a government shutdown on Oct. 1.

Yellen has also said uncertainty driven by the coronavirus pandemic and the federal government’s fiscal response has made it harder to pin down exactly how long the U.S. to avoid a default.

The debt ceiling does not directly prevent the government from spending money, nor can it void any bills the U.S. has to pay. The limit simply prevents the Treasury from taking on any more debt to pay expenditures already authorized by the president and Congress.

Defaulting would likely cause a massive disruption to markets and the economy. Trillions of dollars in Treasury bonds held by foreign governments and investors are underpinned by faith in the federal government’s ability to pay its bills. A default on the national debt could shatter that confidence and trigger a catastrophic financial crisis.

Nonpartisan experts have urged lawmakers for years to consider alternatives to the debt ceiling, warning that even the prospect of a default hinders the financial system in dangerous ways.

A 2015 report from the Government Accountability Office analyzing the 2013 debt ceiling standoff found that “investors reported taking the unprecedented action of systematically avoiding certain Treasury securities,” which are considered almost as safe as cash, causing widespread issues across credit markets.

“Industry groups emphasized that even a temporary delay in payment could undermine confidence in the full faith and credit of the United States and therefore cause significant damage to markets for Treasury securities and other assets,” the report said.

Congress

08/01/21 9:35 PM EDT

Missed debt ceiling deadline kicks off high-stakes fight

The Hill

The legal limit on how much debt the U.S. government can owe was reimposed Sunday, kicking off a high-stakes battle over federal spending with dire implications for global financial markets.

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Reconciliation Instructions

Byrd Rule

Budget Targets

Debt Limit

Group Positions

Previous Action & Prospects

Cost Trade-Offs

Ways to Save

Special Enrollment

Standardized Plans

‘Needs Further Refinement’

Why It’s Wasted

‘Right-Sizing’ for Cost

Budgetary Effect

Worried Prices Will Increase

Tax Write-Offs

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