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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.

Emergency visits for opioid overdose are up during pandemic

July 31, 2021 9:28 pm

During the pandemic, we’ve seen access to health care decrease and various health problems deepen as a result. A study published in Annals of Emergency Medicine shows that hospital visits for opioid overdose increased by about 28 percent in the U.S. in 2020 compared to 2018 and 2019. Emergency department (ED) visits overall decreased in 2020 by about 14 percent. Health experts are concerned that the actual rate of opioid overdoses could be higher.

“COVID-19, and the disruptions in every part of our social and work lives, made this situation even harder by increasing the risk of opioid misuse and relapse because people were separated from their social support and normal routines,” said Molly Jeffery, a researcher in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and senior author of the paper, in a press release.

For the paper, Jeffery and collaborators looked at 25 EDs in six states — Alabama, Colorado, Connecticut, North Carolina, Massachusetts and Rhode Island — from January 2018 through December 2020. Opioid-related overdose visits were at 3,285 and 3,020 in 2019 and 2018, respectively, and in 2020 it increased to 3,486.

There was a dip in ED visits early in the pandemic, and experts think there may be a percentage of people who experienced overdoses but didn’t choose to visit the ED. This suggests the overdose rate may be higher than the data suggests.

“In the absence of comprehensive, real-time national surveillance data, our results offer evidence that the increases in nonfatal opioid overdose rates are not isolated to specific communities,” the authors said.

The team recommends wider access to treatments for opioid misuse. For example, buprenorphine and methadone are synthetic derivatives of opioids approved for medication-assisted treatment of opioid misuse. These produce similar effects to opioids at low dosages and help to diminish the physical dependency. There’s also naloxone, which is an opioid overdose reversal drug.

“While institutions across the U.S. are keenly aware that opioid misuse is a major health concern, this shows that there is more work to be done, and it provides an opportunity for institutions and policymakers to expand evidence-based treatments and resources,” said Jeffery.

Behavioral Health

07/31/21 9:28 PM EDT

Emergency visits for opioid overdose are up during pandemic

The Hill

Health experts are concerned that many who experienced overdoses are not choosing to visit the emergency department.

Lawmakers Introduce Bill To Extend Provider Relief Spending Deadline

July 30, 2021 9:34 pm

A bipartisan group of lawmakers want to extend the provider relief spending deadline for certain providers until at least the end of 2021, introducing legislation in both houses about a month after HHS stopped short of the complete extension for which providers, lawmakers and hospitals had asked. While the American Hospital Association and Medical Group Management Association support the bill, the measure would only affect providers who received relief in the initial distributions.

After weeks of pressure, HHS announced on June 11 it would tie spending deadlines to when providers received their relief instead of allow for a blanket extension until the end of 2021 like some providers advocated for. The department created four relief payments periods that give providers one year to spend their funds.

Those who received more than $10,000 in relief between April 10, 2020 to June 30, 2020 are in the process of reporting to HHS how they used that funding. They have until Sept. 30 to submit all their financial information, and recipients have 30 days beyond that to return any unused provider relief.

If passed, the bicameral bill would extend the spending deadline for this first group of recipients through Dec. 31 or the end of the public health emergency, whichever is later. Reps. Cindy Axne (D-IA) and Mariannette Miller-Meeks (R-IA) said in a joint statement Thursday (July 29) an extension is necessary because some providers postponed spending their relief due to HHS’ inconsistent, confusing guidance.

Sens. Michael Bennet (D-CO) and Kevin Cramer (R-ND) introduced the same bill in the senate.

Claire Ernst, MGMA government affairs director, said many of her organization’s members are subject to first spending deadline and an extension would give them the flexibility to address rising COVID-19 cases and use the funds to pay for new protection requirements laid out in the Occupational Safety and Health Administration emergency temporary standards.

She added MGMA’s goal is for lawmakers to pass the bill before the first reporting period is over in about two months so providers don’t have to report again or, if applicable, try to get returned, unused funds back from HHS.

As the bills only apply to the first provider relief reporting group, it’s not yet clear how it might affect other spending deadlines. The next provider relief spending deadline is Dec. 31 for providers who received relief anytime from July 1, 2020 to Dec. 31, 2020.

COVID Legislation

07/30/21 9:34 PM EDT

Lawmakers Introduce Bill To Extend Provider Relief Spending Deadline

Inside Health Policy

Telehealth

07/30/21 9:33 PM EDT

Bill Would Require HHS Study On Telehealth During COVID-19 PHE

Inside Health Policy

Rep. Robin Kelly (D-IL) reintroduced a bill Wednesday (July 28) that would direct HHS to study telehealth’s impact on Medicare and Medicaid during the COVID-19 public health emergency and eventually submit a report to Congress. One telehealth advocate says this bill would be a positive step forward — so long as it’s paired with an extension of telehealth flexibilities.

Insurance Industry Split On Key Biden Exchange Proposals

July 30, 2021 9:31 pm

Two of the nation’s key health insurance lobbies — AHIP and the Blue Cross Blue Shield Association — strongly oppose CMS’ plans to create a new monthly enrollment period for subsidy-eligible people earning 150% or below of poverty and to extend the open enrollment period for a month. But the lobbies representing community health plans that offer Medicaid managed care and exchange products back the SEP, and while they have differing opinions on the final deadline, they also support extending open enrollment for 30 days.

The agency had proposed these and numerous other policies, including upping exchange user fees, expanding navigator responsibilities and more in a draft rule out June 28 that CMS refers to as the third installation of the 2022 Notice of Benefit and Payment Parameters rule.

AHIP, BCBSA, Association for Community Affiliated Plans (ACAP) and Alliance of Community Health Plans (ACHP) responded to the proposals in comments due July 28.

Monthly SEP

CMS proposed a new, monthly special enrollment period (SEP) that would be limited to people earning up to 150% of poverty who generally have access to no or low-cost ACA coverage due to the increased tax credits in the American Rescue Plan. CMS says the SEP will help make sure that individuals able to stay on Medicaid due to a ban on redeterminations can easily transition into an exchange plan once the public health emergency ends.

In their comments on the rule, AHIP warns the policy could destabilize the market and urges HHS to reconsider the proposal. “Despite guardrails, like metal level restrictions, we have significant concerns this would create a revolving door of enrollment, result in adverse selection, and lead to higher premiums and fewer plan options,” AHIP says.

The health insurance industry has already dealt with significant churn as enrollees switch plans to access certain providers and the SEP would exacerbate the problem, AHIP say. The lobby also says the SEP would impact premiums more than the 0.5% to 2% increases that HHS assumes in the draft rule. Allowing consumers to switch plans could also result in their deductibles resetting, and disrupt plan efforts to help patients manage care, AHIP says. The lobby also worries that some providers might try to steer patients to certain plans at the point of service.

AHIP says federal and state officials and other stakeholders should instead increase outreach to ensure people disenrolled from Medicaid know about other coverage and help then sign up through existing SEPs. The loss of minimum essential coverage (MEC) already triggers a 60-day SEP, the lobby points out. Instead of monthly enrollment, HHS could extend that window for 30 days.

The Blue Cross Blue Shield Association (BCBSA) similarly asks HHS not to finalize the proposal, and instead focus on ensuring consumers are aware of existing enrollment opportunities. BCBSA also says CMS potentially could extend the existing MEC enrollment window.

AHIP and BCBSA both say if CMS does choose to finalize the proposal, it should include several additional guardrails to prevent destabilization. BCSA says consumers should not be allowed to switch plans once enrolled, or drop coverage and reenroll, and CMS should limit the SEP to the first few months of the year. AHIP says enrollment should be limited to those who are uninsured, and consumers should be required to enroll in silver-level coverage with the most generous cost-sharing reductions. Both lobbies say the SEP should not be effective prior to Jan. 1, 2023, because that would be too late for the 2022 plan year. BCBSA and AHIP also say that if the increased premium tax credits under the American Rescue Plan are not extended or made permanent, the SEP should also expire.

AHIP-member Centene also raised concerns about the policy during its second quarter earnings call this week, saying a SEP could create adverse selection.

But ACAP and ACHP say the SEP should move forward.

ACAP says the SEP will be useful for the potentially large numbers of Medicaid beneficiaries that will be disenrolled after the public health emergency and might need additional time to sign up. ACAP believes risk of adverse selections is low since most people have $0 premiums and no incentive to drop coverage. However, CMS should closely monitor implementation, ACAP says.

ACHP also backs the SEP but asks that the administration consider potential risk pool implications.

Open enrollment

CMS proposes to keep the Nov. 1 start date for open enrollment but extend the deadline for an additional month — from Dec. 15 to Jan. 15. The extension would bring the enrollment period closer to the Nov. 1– Jan. 31 timeframe in effect during the last three years of the Obama administration. The later deadline was also meant to help people who might have been automatically reenrolled in a plan with higher premiums and currently have no chance to find another option. HHS also asked stakeholders to comment on whether a special SEP should be created for that population as an alternative to the deadline extension.

AHIP and BCBSA both say CMS should maintain the current dates. “A single enrollment deadline creates a consistent message and allows issuers, agents and brokers, and other enrollment assisters to reinforce the deadline through streamlined messaging,” AHIP writes. The lobby also worries that many consumers may wait until after Dec. 15 to enroll, which means their plan would not be effective until February, which could create gaps.

AHIP supports CMS’ alternative proposal of a SEP for people auto reenrolled into a higher cost plan.

BCBSA also says that a broad extension of the open enrollment period is not needed to solve the problem that CMS is attempting to address.

“Instead of lengthening the annual open enrollment period for all enrollees in all exchanges, we recommend, starting in 2023, allowing auto-renewed enrollees who face premium increases to change their coverage up until Jan. 31,” BCBSA writes. The lobby also urges CMS to increase targeted outreach to that population and to ensure that consumers are getting accurate information on subsidy-levels as early as possible.

But ACAP supports the open enrollment extension. In addition to issues CMS discussed in the rule, ACAP says its plan have noticed some consumers are not reenrolled because they have been in a grace period for non-payment, and these enrollees may not realize their coverage been terminated until after Dec. 15. The extra 30-day enrollment period would give these consumers a chance to find a new plan and enroll in coverage for at least 11 months of the year, ACAP says.

ACA also urges CMS to draft rules that require any non-ACA compliant health plans to have a coverage term ending Dec. 31 and to ban sales of such plans during open enrollment.

ACHP supports giving consumers another 30 days to enroll in ACA coverage, but suggests CMS consider moving the start date from Nov. 1 back to Oct. 15, and setting a Dec. 31 deadline for coverage effective Jan. 1.

“The current proposal would push the enrollee coverage start date to Feb. 1, resulting in a consumer having just 11 months of coverage, “ACHP writes.

The Jan. 1 start date would have fewer operational burdens, help with marketplace stability, and ensure Americans are offered a full 12-month coverage period, which is the basis of plan benefit actuarial design and pricing, ACHP says. — Amy Lotven (alotven@iwpnews.com)

Affordable Care Act

07/30/21 9:31 PM EDT

Insurance Industry Split On Key Biden Exchange Proposals

Inside Health Policy

Proposal Would Allow States to Pay Home Health Worker Benefits

July 30, 2021 9:30 pm

States would be able to use Medicaid money to pay for home health workers’ health and training benefits or union dues under a proposed rule issued Friday by the Centers for Medicare & Medicaid Services.

The proposed rule, if finalized, would re-establish states’ flexibility to allow home care workers and personal care assistants to enroll in—and use Medicaid to pay for—”typical employee benefits” like health insurance or employee training. It would apply to individual health practitioners who rely on Medicaid for their livelihood, generally by taking care of some of the “most vulnerable” beneficiaries in their own homes, the CMS said in a statement. These workers are paid directly by the people for whom they care using Medicaid.

The proposal also is intended to resolve problems that the U.S. District Court for the Northern District of California found with a 2019 rule that barred payments to third parties on behalf of states to home health workers. Several states, led by California, sued the Department of Health and Human Services over that rule, saying it was “in service of anti-union objectives that bear no relationship to the purpose” of the law governing Medicaid. Previously, states could opt to allow Medicaid to pay for union dues for home health workers.

The plaintiffs claimed the 2019 rule harmed individual Medicaid beneficiaries—many of them with disabilities—by upending careful arrangements “relating to the financial logistics of paying care providers.”

The district court vacated that rule and remanded it to the HHS for a rewrite. Alex Azar, then the HHS secretary, appealed to the U.S. Court of Appeals for the Ninth Circuit on Jan 15, five days before President Joe Biden took office. The court docket for that case is temporarily closed until February 2022, but any party to the suit can request that it be reopened before then.

In a footnote, the proposed rule address the question of union dues, saying “to the extent state agencies utilize this option to deduct union dues, union dues may only be deducted from Medicaid payments with the affirmative consent of the practitioner.”

Home Health

07/30/21 9:30 PM EDT

Proposal Would Allow States to Pay Home Health Worker Benefits

Bloomberg

2019 rule covering same issue vacated
Proposal covers aides who work for Medicaid recipients

Medicare

07/30/21 10:41 AM EDT

White House OKs Final Medicare 2022 Hospital Pay for Release

Bloomberg

Proposed rule published in May
Acute- and long-term facilities could get bump

Infrastructure

07/30/21 9:01 AM EDT

Breaking down the Senate infrastructure agreement’s $550B in new spending

Politico

Biden Looks to Corral Democrats on $3.5 Trillion Senate Plan

July 29, 2021 9:14 am

President Joe Biden urged Senate Democrats to act boldly on his sweeping social and economic agenda Wednesday, as they began hashing out details of an $3.5 trillion tax and spending agreement that marks a crucial step forward for his plan.

Biden himself hasn’t yet said whether he supports the proposal unveiled by Democrats on the Senate Budget Committee Tuesday night, though top aides have expressed enthusiasm.

“We’re going to get this done,” Biden told reporters as he arrived at the Capitol.

If it holds, the budget agreement will be a victory for the president, bridging divisions among party factions over the size and scope of the package. But it’s a crucial moment for Biden, who must persuade Democratic progressives to agree to lower spending than they wanted while keeping moderates from balking at the price tag.

The budget measure would accompany a separate, $579 billion bipartisan infrastructure plan that Biden has endorsed, raising the total spending of his economic agenda beyond $4 trillion.

The draft budget proposal does not yet have the firm support of all 50 members of the Democratic caucus in the Senate, which it would need in the face of united Republican opposition. Democratic leaders also have only a thin margin in the House and are trying to head off dissent from progressives, who want even higher spending levels.

Earlier: Biden Agenda Gets Boost on Democrats’ $3.5 Trillion Proposal

A senior Democratic official said the $3.5 trillion in proposed spending would be offset by health care savings, tax hikes on companies and the wealthiest Americans, and economic growth. An expansion of Medicare would be funded by cuts to drug prices, while higher emission standards and carbon tariffs would be used to combat climate change.

At a Democratic lunch, Biden told Democrats that they have to do a better job connecting with working class voters on kitchen table issues and that both the bipartisan infrastructure plan and wider tax and spending bill can do that, according to a person familiar with the event. The president said that polls show majorities of Americans support changing the tax code to make it less favorable for the wealthy.

Senator Joe Manchin of West Virginia, a key moderate Democrat, didn’t speak at the meeting but said earlier Wednesday the price tag would have to be fully offset with spending cuts, tax increases or other measures and that the tax increases should not hamper U.S. competitiveness on the global stage.

“We are going to have to pay for all this,” Manchin told reporters at the Capitol.

Senator Mark Warner of Virginia, another moderate, said Tuesday the bill would be “fully paid for.”

Montana Senator Jon Tester, also a moderate, said he, too, was waiting to see more details before committing to support the plan. “The issue is $3.5 trillion is a lot of money,” Tester said. “It doesn’t scare me if it is spent appropriately and over the right amount of time. We will analyze that.”

Narrow Margins

In the House, Representative Pramila Jayapal, head of the Congressional Progressive Caucus, said the group’s support isn’t guaranteed without knowing details about how their priorities are dealt with. House Speaker Nancy Pelosi praised the Senate Budget Committee agreement as “a victory for the American people.”

The White House must also keep Senate Republicans on board with the separate, bipartisan infrastructure deal. Some Republicans have expressed concern that by supporting the smaller bill, they are paving the way for Democrats to pass their sweeping agenda through Congress. They’ve urged the White House to disconnect the two measures.

Under special rules known as budget reconciliation, only a simple majority is needed to pass the $3.5 trillion Democratic economic plan through the Senate. But with the upper chamber split 50-50, Democrats can’t afford any defections because Republicans are expected to unanimously oppose the budget resolution.

“There are bumps along the way,” Senate Majority Leader Chuck Schumer said Wednesday. “But we are going to get this done.”

Senate Minority Leader Mitch McConnell, a Kentucky Republican, raised the specter of rising inflation in castigating the Democratic plan, calling it “wildly out of proportion to what the country needs right now.”

The agreement nonetheless marks an achievement for Democratic leaders. Budget Committee Democrats had been divided over the cost of the plan and which policies to include. Chairman Bernie Sanders initially pushed for a $6 trillion measure that added an expansion of Medicare, the health program for the elderly and disabled, an immigration overhaul and more generous childcare benefits, along with other items, to Biden’s initial proposal.

Senator Richard Blumenthal, a Connecticut Democrat, said Biden’s message to the caucus was “very, very friendly.”

“It was do it big, do it bold. This is an historic opportunity,” Blumenthal said. “He emphasized the importance of the moment.”

The Budget Committee agreement includes Medicare expansion and provisions on immigration and prescription drugs, marking a significant win for Sanders.

“It’s a work in progress, but all I can tell you is that every issue that I have been talking about is in this proposal. Everything,” he said Wednesday.

Infrastructure

07/29/21 9:14 AM EDT

Biden Looks to Corral Democrats on $3.5 Trillion Senate Plan

Bloomberg

President meets with Senate Democrats after budget deal
Budget plan would carry much of Biden’s economic agenda

Behavioral Health

07/29/21 8:52 AM EDT

SAMHSA Awards $250 Million to 100 Certified Community Behavioral Health Centers to Improve Community Substance Use Disorder and Mental Health Treatment Services

Substance Abuse and Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded 100 grants to increase access to facilities throughout the nation that provide community-based support for Americans in need of substance use disorder and mental health treatment services. Totaling $250 million, including $77 million from the American Rescue Plan (ARP), the grants support the Biden-Harris Administration’s priority of addressing the behavioral health needs of Americans—particularly those impacted by the COVID-19 pandemic.

Hospitals and Doctors Win, Pharma Loses in Infrastructure Deal

July 28, 2021 9:16 am

Hospital and doctors’ groups successfully lobbied to save Covid relief money earmarked for their members, while pharmaceutical companies are expected to lose billions of dollars as part of a bipartisan infrastructure deal struck Wednesday.

The $550 billion infrastructure package negotiated by a bipartisan group of senators would be paid in part by delaying a Trump-era regulation to end some pharmaceutical rebates and refunds from drugmakers for some kinds of physician-administered single-use medicines.

Senators Reach Infrastructure Deal; Schumer Preps First Vote

Not included in the deal: a clawback of $43.7 billion in unspent Covid relief funds marked for health-care providers, which lawmakers had considered taking back. Sen. Ron Wyden (D-Ore.) confirmed the relief funds were untouched.

Leaning on cost offsets that affect the revenue of drugmakers, rather than those of health-care providers, highlights which sector has a bigger constituency in Congress.

“Cases are going up,” Wyden said of Covid-19 prevalence in the U.S. “I want to make sure this doesn’t impact our nursing homes and hospitals that are getting hit.”

He added that he doesn’t support how the Trump administration designed the rebate rule, and plans to put together a drug pricing bill later this year.

The Trump rule aims to end Medicare rebates to pharmaceutical middlemen and make drugmakers pass any discounts to consumers. That could balloon Medicare drug benefit premiums, which are subsidized by the government.

Hospital Lobby

Hospital groups such as the American Hospital Association lobbied against rescinding the relief funds.

The infrastructure package includes a provision that seeks refunds from drugmakers for some kinds of physician-administered single-use medicines, a move that lawmakers estimate would save the government $3 billion, according to a summary of the provision shared with Bloomberg Government.

The Pharmaceutical Research and Manufacturers of America, the drugmakers’ lobby, supported the rebate rule from the Trump administration and sought to keep it in place.

Sen. Bill Cassidy (R-La.) said he supported the rebate rule but Democrats signaled they were planning to block it, so it became a pay-for.

“I actually agree with the policy but it was 186 billion in costs of the Treasury,” he said, referring to the cost of fully implementing the rule over a decade.

Infrastructure Gang Targets Pharma to Pay for Roads, Bridges

One area providers didn’t win: The package will delay the Medicare sequester by less than a year, saving the government almost $9 billion.

The sequester, or planned cuts to hospital and doctor reimbursements, is set to run from fiscal 2022 to 2030. These cuts were originally slated to run from fiscal 2013 to 2021 but have repeatedly been delayed and extended.

Infrastructure

07/28/21 9:16 AM EDT

Hospitals and Doctors Win, Pharma Loses in Infrastructure Deal

Bloomberg

Deal delays rebate rule, adds new drugmaker rebate
Provider relief fund untouched after hospital lobbying

What’s in the $550 Billion Bipartisan Infrastructure Deal

July 28, 2021 9:13 am

A group of lawmakers and the White House struck a $550 billion deal to revitalize the nation’s transportation and utility infrastructure after weeks of negotiations, meeting a key goal of President Joe Biden: a large, bipartisan bill.

The Senate plans to vote to begin consideration of the legislation, which has yet to be completed, as soon as Wednesday night. The release of the bill text, as well as additional debate and votes could occur in the coming days.

Here’s what’s in the deal:

Roads, Bridges

The deal calls for spending $110 billion on roads, bridges and other major projects. This includes $40 billion for bridge repairs and replacement, as well as $17.5 billion for major projects. It also would reauthorize the surface transportation program for the next five years.

Public Transit

The plan includes $39 billion to modernize transit and improve accessibility. In addition, the deal would continue existing transit programs for five years as part of the surface transportation reauthorization.

Railways

The deal would allocate $66 billion to Amtrak for maintenance, to upgrade tracks in the Northeast Corridor and bring rail service — including high-speed rail — to other areas of the country.

Power Grids

The deal includes $73 billion for power grid upgrades, including building thousands of miles of new transmission lines for renewable energy and research for new technologies like nuclear reactors and carbon capture.

Electric Vehicles

The bill would spend $7.5 billion to build a nationwide network of charging stations for electric vehicles to help accelerate the adoption of non-fossil fuel cars.

Electric Buses

The plan includes $5 billion for new school buses, although the program would allow half of that to go toward buses that run on natural gas or diesel. The plan also includes $2.5 billion for ferries.

Airports, Waterways

The plan would provide $25 billion for airport repairs and efforts to reduce congestion and emissions. That includes encouraging the use of electric and other low-carbon technologies. It would also invest $17 billion in port infrastructure.

Resilience, Climate Change

The deal includes $50 billion to help communities ward off cyber attacks and the effects of climate change. The funds include money to protect against droughts and floods.

Drinking Water

The package spends $55 billion to improve drinking water, including dedicated funding to replace lead pipes and dangerous chemicals.

Broadband Internet

The plan would invest $65 billion in high-speed internet to ensure that every household can access reliable broadband service.

Environmental Spending

The package has $21 billion dedicated for environmental remediation to address past pollution that harms public health.

The plan also includes $1 billion to reconnect communities that have been divided by past infrastructure projects, such as highways splicing through established areas.

Transportation Safety

The plan would spend $11 billion on transportation safety, including programs to reduce crashes and fatalities, especially for cyclists and pedestrians.

Revenue Raisers

Here are some of the major ways that lawmakers have agreed to offset the cost of the spending:

$205 billion from using unspent pandemic relief funds appropriated in earlier legislation;
$56 billion in additional tax revenue from the extra economic growth generated from the infrastructure improvements;
$50 billion from recouping unemployment benefits claimed by fraudsters;
$49 billion for delaying the Medicare rebate rule enacted under former President Donald Trump;
$53 billion from unspent unemployment benefits from states that ended the enhanced payments early;
$28 billion from increasing tax reporting rules for cryptocurrency investors;
$21 billion from fees on government-sponsored enterprise;
$20 billion from spectrum auction sales; and
$13 billion from a Superfund fee on corporations that pollute.

Telehealth

07/28/21 9:13 AM EDT

What’s in the $550 Billion Bipartisan Infrastructure Deal

Bloomberg

Virtual doctors brace for Covid’s new wave

July 28, 2021 8:54 am

Telemedicine didn’t just provide a pandemic lifeline for patients and their doctors. It’s linking rural hospitals with offsite clinicians who consult on patient care and back up on-site doctors and nurses as Covid’s latest surge fills beds once again.

With the highly transmissible Delta variant of Covid-19 now overtaking areas with low vaccination rates, demand for tele-ICU and tele-ER services is on the rise as hospital administrators try to shorten the length of stays and avoid transferring medically frail patients over long distances to higher levels of care.

Matthew Lyon, service chief of virtual care operations at Augusta University Health, in Georgia, said most hospitals his facility collaborates with remotely monitor one or two Covid patients. A month ago, it was one in every 10 or 12 hospitals.

Kelly Rhone, medical director of outreach and innovation at Avera eCARE, a leading tele-ICU provider in Sioux Falls, S.D., has begun seeing sicker younger patients at facilities her company connects with in the upper Midwest and Great Plains states.

“We don’t know what the future holds with Delta or any other variants that are coming, but we know that this system works to help with that,” Rhone said.

The fiber optic–connected setup keeps cameras trained on patients. Nurses or board-certified doctors in a command center watch vital signs like heart rates or blood oxygen levels on monitors. A data point change prompts a real-time response, with the virtual care team able to jump in and assist with ordering tests, updating case notes or, in serious cases, putting patients on ventilators.

Providers say some patients gave the virtual experience high marks, while others’ experience was mixed. Marshall Lee, medical director of the virtual ICU at Oregon Health & Science University, said a number of those hospitalized “wonder what’s going on with the camera,” but have appreciated the attention when hospitals’ in-house staffs are stretched thin.

Hospitals benefit from keeping more patients in their communities and getting a more predictable revenue stream during a crisis that’s seen many elective procedures and routine care curtailed. Providers like Avera also charge by the cameras in operation, allowing facilities to scale up care without lots of abrupt staffing changes.

The consultations also reduce the need to shuttle patients to hospitals in big population centers, some of which are experiencing their own Covid crises. A report from Augusta University Health found its tele-ER program cut patient transfers from rural hospitals in Georgia by 81 percent last year.

With almost 30 million Americans living more than 60 minutes from a trauma center, demand for “teletrauma” could outlast the Delta variant and future Covid surges. Hospitals with limited critical care like KershawHealth Medical Center in Camden, S.C., use hookups with offsite doctors for every patient in the ICU, and had leaned on the tech before the pandemic. The arrangement proved invaluable during the health crisis, when patients were far sicker than normal, said Tallulah Holmstrom, KershawHealth’s chief medical officer.

Augusta University Health sees future growth in areas like pediatric care and in collaborations with skilled nursing and rehabilitation facilities once patients are discharged. “We think it really helps decrease this rural-urban disparity,” Lyon said.

Telehealth

07/28/21 8:54 AM EDT

Virtual doctors brace for Covid’s new wave

Politico

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Budgetary Effect

Worried Prices Will Increase

Tax Write-Offs

Narrow Margins

Hospital Lobby

Roads, Bridges

Public Transit

Railways

Power Grids

Electric Vehicles

Electric Buses

Airports, Waterways

Resilience, Climate Change

Drinking Water

Broadband Internet

Environmental Spending

Transportation Safety

Revenue Raisers

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