House Republicans Push To Make Drug Price Legislation Bipartisan

House Republicans push to make drug price legislation bipartisan |  FierceHealthcare

Source: Fierce Healthcare, by Robert King

House Republicans want their Democratic counterparts to endorse more bipartisan-friendly reforms to drug pricing as the chances of a bill to give Medicare negotiating power look dim.

Republicans on the House Energy and Commerce Committee endorsed during a hearing on Tuesday legislation that includes a series of reforms including an out-of-pocket cost cap for seniors on Medicare Part D. The comments come as Democrats are pressing for the inclusion of legislation to grant Medicare power to negotiate for lower drug prices in a massive infrastructure package.

Republicans say the legislation will likely pass the Democratic-controlled House but will stall in the Senate as Democrats likely can’t get enough Republicans in the Senate to pass it.

“Why aren’t we working together on something that can be signed into law,” said Rep. David McKinley, D-West Virginia, during the hearing. “Unless we change the course, the projection of this legislation, we know how this story is going to pan out.”

Republicans endorsed the “Lower Costs, More Cures Act” introduced last month that includes several provisions aimed at lowering costs on Medicare and Medicaid.

The legislation would create a $3,100 out-of-pocket cap on Medicare Part D costs for seniors and give incentives for providing a share of Part D rebates to be delivered at the point of sale.

Another provision would call for increased price transparency by expanding a Medicare online tool to enable “beneficiaries to compare costs across three settings: hospital outpatient department, ambulatory surgical centers, and the outpatient prospective payment system,” according to a fact sheet on the legislation.

It would also demand a site-neutral payment to providers for the administration of drugs reimbursed under Part B, which are drugs such as chemotherapy that are administered in a doctor’s office. It would require a payment at the lower “physician fee schedule rate rather than the rate paid to hospitals, lowering federal spending and beneficiary cost-sharing,” the fact sheet said.

The legislation is far different from the “Elijah E. Cummings Lower Drug Costs Now Act” that gives Medicare the power to negotiate for lower prices and requires commercial plans to adopt the prices that Medicare negotiates.

The bill passed the House in 2019 and languished in the GOP-controlled Senate.

But now Democrats are trying again as they have control of the White House and Senate, albeit by a 50-50 margin in the Senate with Vice President Kamala Harris breaking any ties.

“For too long, Americans have been forced to ration their medications, go without, or exhaust their life savings in order to afford the drugs they need, all while large pharmaceutical companies continue to make record profits,” said Rep. Frank Pallone, D-New Jersey, the chairman of the full committee, during the hearing.

Experts also testified that the provisions in the legislation, including the Part D cap, will not be enough to lower costs.

“Capping out-of-pocket costs doesn’t lower spending,” said Rachel Sachs, an associate law professor at Washington University. “It just moves money around in the system.”

She said the cap could increase Part D premiums overall and increase Medicare spending as a subsidy for those premiums.

“The restructuring of the Part D benefit is critical to help seniors afford the cost of prescription drugs, but because it moves money around the other items are important,” she added.

Employers, Insurers Push To Make Virtual Visits Regular Care

The Associated Press
Source: Associated Press, by Tom Murphy

Make telemedicine your first choice for most doctor visits. That’s the message some U.S. employers and insurers are sending with a new wave of care options.

Amazon and several insurers have started or expanded virtual-first care plans to get people to use telemedicine routinely, even for planned visits like annual checkups. They’re trying to make it easier for patients to connect with regular help by using remote care that grew explosively during the COVID-19 pandemic.

Advocates say this can keep patients healthy and out of expensive hospitals, which makes insurers and employers that pay most of the bill happy.

But some doctors worry that it might create an over-reliance on virtual visits.

“There is a lot lost when there is no personal touch, at least once in a while,” said Dr. Andrew Carroll, an Arizona-based family doctor and board member of the American Academy of Family Physicians.

Telemedicine involves seeing a doctor or nurse from afar, often through a secure video connection. It has been around for years and was growing even before the pandemic. But patients often had a tough time connecting with a regular doctor who knew them.

Virtual-first primary care attempts to smooth that complication.

The particulars of these programs can vary, but the basic idea is to give people regular access to a care team that knows them. That team may include a doctor, nurse or physician assistant, who may not be in the same state as the patient. Patients can also message or email the caregivers with a quick question in addition to connecting on a video call.

People who choose this option may have to give up a doctor they’ve been seeing in person. They also will need a smartphone, tablet or computer paired with a fast internet hookup.

The goal of the virtual-first approach is to make patients feel more connected to their health and less reliant on Google searches for advice or the nearest urgent care center to treat something minor.

“We have a large portion of the population that is avoiding going to a primary care doctor because they don’t have time or they think they can’t afford it, even though its generally covered under their benefits,” said Arielle Trzcinski, a health care analyst with Forrester who works with insurers.

Amazon Care pairs patients with a regular care team and in some markets also sends providers like nurses to them if they need in-person care. The retailer developed the program for its employees but said in March that it would expand it to other employers nationwide.

Insurers like Oscar Health, UnitedHealthcare and Kaiser Permanente also have started or expanded virtual-first care plans this year. Priority Health in Michigan began selling a plan for people without employer-sponsored coverage after the insurer noticed that customers weren’t visiting doctors as much as they expected.

A vice president, Carrie Kincaid, said Priority Health found that some customers didn’t have time to leave work for appointments. Another group, early retirees, travels frequently and isn’t able to make it back to Michigan for in-person visits.

She said the new plan, run with virtual care provider Doctor on Demand, blew past enrollment projections and had more than 5,000 people signed up on the first day.

“When members get exposed to virtual care in general, they really, really like it,” she said.

Wendy Katje signed up for a Priority Health virtual-first primary care plan by accident online, but she plans to stick with it.

The 60-year-old multiple sclerosis patient said the doctor she got through the program has helped adjust her cholesterol medications and made sure she stays connected with a neurologist she usually sees in person.

Katje said the virtual-first approach makes sense during the pandemic, when she wants to avoid waiting rooms.

“It’s not quite as personal as sitting in an office with someone, but for what I’ve needed to have done it was perfectly adequate,” the Otsego, Michigan, resident said.

Walter Woodberry, of Albuquerque, New Mexico, signed up for a virtual-first plan through his employer, ABF Freight, after he tried telehealth and grew used to its convenience.

He said he doesn’t have to leave work early for an appointment, and he feels more comfortable giving medical information to someone who knows him.

“I’m not trying to schedule my life around a doctor’s appointment,” he said.

Consumers have grown used to shopping for clothes, gifts or groceries online. But Carroll, the family physician, noted that patients sometimes need an in-person visit.

He said he once had a patient diagnosed virtually with pink eye. In person, Carroll could see that the patient actually had a form of glaucoma and was in danger of blindness.

Doctors are still sorting out what can be treated virtually and what demands in-person care. These new plans generally reserve those visits for emergencies or if the doctor or patient requests them.

Virtual-first proponents say they aren’t trying to eliminate in-person visits. They are focused on improving health.

Patients are more likely to follow a doctor’s orders, get laboratory tests or take prescribed medicine when they receive care from someone they’ve gotten to know and trust, said Doctor on Demand CEO Hill Ferguson.

“That’s what we need to get back to in this country,” he said.

Stanford University’s Dr. Megan Mahoney estimates that about half of primary care visits can be done virtually, depending on whether insurers and other payers reimburse for the care.

The family physician says her practice still does 30% to 40% of its visits virtually, months after reopening its offices. The pandemic has changed how patients view care, she said.

“We had made assumptions about consumers’ willingness to adopt telehealth, yet we see 89-year-olds who are on video visits with their providers every other week with no problem now,” she said.

Biden Says He Wants to Go Big On Health Care. But He Left Major Reforms Out of His Latest Plan

U.S. President Joe Biden speaks during a joint session of Congress at the U.S. Capitol in Washington, D.C., U.S., on Wednesday, April 28, 2021.

Source: Time, by Abigail Abrams

During President Joe Biden’s speech to Congress on Wednesday, he called for an ambitious health agenda that would allow the federal government to negotiate prescription drug prices, expand Medicare coverage, build on the Affordable Care Act and lower deductibles. All of these ideas would transform the way Americans pay for health care—but most of them are not actually in the legislative plan the President has put forward.

“Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices. And, by the way, that won’t just help people on Medicare. It will lower prescription drug costs for everyone,” Biden said. “We’ve talked about it long enough. Democrats and Republicans, let’s get it done this year.”

Despite his strong rhetoric, Biden’s American Families Plan, also unveiled on Wednesday, does not include the proposals to cut prescription drug costs or lower the Medicare eligibility age, which congressional Democrats had pressured him to include in recent weeks. His $4 trillion package comprised of the American Families Plan and the American Jobs Plan has been praised by progressives as a huge investment in the country’s economy and social safety net. But the omission of these larger health care policies has raised questions for progressives about the President’s commitment to the ideas in the face of opposition from Republicans, moderate Democrats and pharmaceutical companies.

“While [lowering drug prices and expanding Medicare] is a focused priority of Congress, it’s clear it’s not as much so for the White House,” says Alex Lawson, executive director of Social Security Works, which supports the drug pricing and Medicare reforms.

Biden’s plan does include $200 billion to make permanent the increased premium subsidies for people who buy health coverage on the Affordable Care Act (ACA) marketplace, which were passed in the American Rescue Plan earlier this year. The expanded subsidies mean that millions of Americans are eligible for cheaper or free health coverage. But the Congressional Budget Office has estimated that the subsidies will get just 1.3 million uninsured people to buy coverage over two years, a small portion of the total uninsured. “In terms of federal dollars, subsidizing private insurance is the most expensive way you can go about getting people covered. Whereas doing it through a public option or Medicaid or Medicare is much lower cost on a per person basis,” says Cynthia Cox, a vice president at the nonpartisan Kaiser Family Foundation.

That is a main reason why many congressional Democrats have been pushing Biden to do more than shore up the ACA. Vermont Sen. Bernie Sanders and 16 other Senators sent a letter to Biden on April 25 calling for the President to address drug pricing, lower the Medicare eligibility age, cap out-of-pocket expenses for Medicare and expand Medicare benefits to cover hearing, dental and vision care. Another group of more than 80 House members, including progressives like Washington Rep. Pramila Jayapal and moderates like Rep. Conor Lamb of Pennsylvania and Rep. Jared Golden of Maine, wrote a similar letter advocating for the government to negotiate drug prices and expand Medicare.

A new set of analyses from the Kaiser Family Foundation this week indicate that lowering the Medicare eligibility age from 65 to 60 or even lower could bring down U.S. health spending overall. The foundation’s first analysis showed that when people turn 65, their health care spending drops significantly from the period between age 60 to 64 despite the fact that most people use more health care as they age. The reason? Medicare pays lower prices for health care services than private insurers. Employers also benefit. The foundation’s second analysis showed that if people ages 60-64 were no longer enrolled in employer-sponsored insurance, the cost for employer plans could drop by 15%. Even if Medicare expanded to include dental, vision and hearing coverage as Sanders and some Democrats want, Kaiser Family Foundation’s Cox says health spending could still drop.

Polling has shown that both of these policies are popular, even among Republican voters. And congressional Democrats say that is especially true after the COVID-19 pandemic disproportionately affected older Americans. But by far the most popular item that Democrats are pushing is the proposal to allow the U.S. government to negotiate with manufacturers over drug prices—something that most other developed countries already do. A new government study commissioned by Sanders and released this week shows that the U.S. pays two to four times more for prescription drugs than other wealthy countries, adding to the evidence supporting the Democrats’ position.

Even though these policies are popular among voters, the political reality for Biden is more difficult. Republicans oppose most of Biden’s spending on the social safety net, so the legislation will likely need to pass through the budget reconciliation process, which would allow Democrats to push it through along party lines. But with an evenly-divided Senate, they can’t afford to lose any votes. The ACA subsidies that Biden has included in his plan face no opposition from Democrats or the health insurance industry, but both the drug pricing reform and Medicare changes will face intense pushback from pharmaceutical companies, hospitals and medical providers, as well as more moderate Democrats.

Health care has been a winning topic for Democrats in recent election cycles and bringing down drug prices could be particularly helpful ahead of the next midterms, says Robert Blendon, a Harvard professor of health policy and political analysis who studies public opinion about health care. If Biden isn’t prioritizing that, “it must be because there’s one or two votes in the Senate who have an interest that’s more worried about the pharmaceutical industry than what it’s going to look like in the 2022 election,” he says.

Democrats can still fight to add the drug pricing proposal and Medicare changes into the spending package once it gets to Congress. Sanders told reporters on Tuesday that the provisions would be in the legislation “if I have anything to say about it,” while Senate Finance Committee Chair Ron Wyden of Oregon said he would “look at every possible vehicle” to get drug pricing done. House Energy and Commerce Committee Chair Frank Pallone of New Jersey said drug pricing would be one of his top priorities as the plan makes its way through the House.

House Democrats passed their signature drug pricing legislation, known as H.R. 3, back in 2019, and the bill was recently reintroduced and has a hearing scheduled in Pallone’s committee. Advocates believe that lawmakers can negotiate to put measures like this into the American Families Plan. “We have a container that can fit what we want in there,” said Lawson of Social Security Works.

Still, Biden’s speech Wednesday hinted at how difficult these big health care changes can be. “We know how to do this. The last president had that as an objective,” he said, referencing former President Donald Trump’s failed push to lower prescription drug prices.

Now Biden has left it up to Democratic lawmakers to get their own colleagues on board and make the changes happen.

Dem Senators Urge Biden To Expand Medicare In American Families Plan

Dem senators urge Biden to expand Medicare in next big spending bill | Fox  BusinessSource: Fox Business, by Megan Henney

A coalition of 17 senators is calling on President Biden to expand Medicare as part of his next massive economic spending bill.

In a Sunday letter addressed to the White House, the group of mostly Democrats – led by Sen. Bernie Sanders, I-Vt. – urged Biden to lower the Medicare eligibility age, expand Medicare benefits to include vision, dental and hearing coverage, allow the program to negotiate lower drug prices and establish a limit on out-of-pocket expenses under traditional Medicare.

“We have an historic opportunity to make the most significant expansion of Medicare since it was signed into law,” the lawmakers wrote. “We look forward to working with you to make this a reality and, in the process, substantially improve the lives of millions of older Americans and persons with disabilities.”

In addition to Sanders, letter signatories included: Sens. Debbie Stabenow of Michigan, Ben Cardin of Maryland, Elizabeth Warren of Massachusetts, Tammy Baldwin of Wisconsin, Dick Durbin of Illinois, Chris Van Hollen of Maryland, Ed Markey of Massachusetts, Cory Booker of New Jersey, Kirsten Gillibrand of New York, Jeff Merkley of Oregon, Richard Blumenthal of Connecticut, Tina Smith of Minnesota, Sherrod Brown of Ohio, Tammy Duckworth of Illinois, Sheldon Whitehouse of Rhode Island and Alex Padilla of California.

Biden is expected to release details of the second part of his Build Back Better agenda, dubbed the American Families Plan, ahead of his address to a joint session of Congress on Wednesday.

The proposal could cost as much as $1.5 trillion and will focus on child care, paid family leave and other domestic priorities. It’s unclear whether the administration plans to address health care in the tax and spending plan.

Biden is also facing pressure from Democrats in the House who want the White House to use the American Families Plan to include three Medicare-related provisions: allow Medicare to negotiate drug prices, expand Medicare by lowering the eligibility age from 65 to 60 and extend Medicare to include dental, vision and hearing care.

Over 20 Democrats sent a letter to Biden on Monday asking the White House to include those provisions in the forthcoming plan. Signatories included representatives from across the party’s ideological spectrum, including Reps. Conor Lamb, D-Pa., and Jared Golden, D-Maine, as well as Pramila Jayapal, D-Wash.

“Now is a historic opportunity to also make an important expansion of Medicare that will guarantee health care for millions of older adults and people with disabilities struggling with the health and economic realities of the COVID-19 pandemic,” the lawmakers wrote, in a letter first obtained by Politico. “Therefore, we are asking for you to prioritize the expansion and improvement of Medicare in the American Families Plan.”

Although details remain in flux, the measure will likely be fully paid for with new tax increases aimed at wealthy Americans and and investors. Some tax increases currently under consideration include restoring the top marginal tax rate to 39.6%, where it sat before Republicans’ 2017 tax overhaul, taxing capital gains as ordinary income above a certain threshold and eliminating the stepped-up basis at death.

Lyft Pass For Healthcare Lets Patients Book Their Own Rides To The Doctor

Source: Fierce Healthcare, by Dave Muoio

Ride-sharing company Lyft is letting patients schedule nonemergency medical transport (NEMT) on health organization’s dime with the launch of Lyft Pass for Healthcare.

The latest healthcare offering falls in line with the initial Lyft Pass service launched in July 2020, which allows business organizations to monitor and cover the cost of employees’ transportation. Now, the company is extending those capabilities to healthcare organizations—commercial health plans as well as Medicare or Medicaid—and their members.

Through the app, users who need a ride to their medical appointments, vaccinations, prescription pickups or other destinations request a ride. This process is similar to ordering a pickup as a consumer, except that patients will need to select an in-app branded Lyft Pass provided via phone number, access code or a direct link.

Healthcare organizations sponsoring the pass, meanwhile, are able to customize the program’s budgets, approved locations and scheduling windows. The organizations are able to monitor usage and manage spend while allowing members to be more autonomous with their NEMT scheduling.

“By leveraging our superpower in consumer tech, we’ve automated an important piece of health access that allows patients to be self-sufficient and in control, while allowing our partners to focus on the services they provide, rather than on administrative processes,” Megan Callahan, vice president of Lyft Healthcare, said in a statement.

Inadequate transportation is a persistent roadblock to care for low income, elderly and other underserved patients.

A study published in 2019, for instance, found that a program that provided unlimited Lyft rides to older patients with transportation barriers helped these individuals reach their medical appointments and improved their self-reported quality of life.

Organizations also weather the cost of patient transportation issues. Millions of patients in the U.S. don’t receiving medical care due to transportation issues, with no-shows contributing to more than $150 billion in annual costs across the entire U.S. health system.

Lyft said in the announcement that the product is compliant with healthcare regulations. It’s the latest healthcare-focused effort from the company, which over the last couple of years has partnered with health organizations and coordination servicesintegrated with Epic’s electronic health record system and launched a campaign to provide rides to and from COVID-19 vaccination sites.

Uber, its primary rival in the ride-sharing space, has also had its eye on healthcare for some time.

Its Uber Health service launched in 2018, and it has since partnered with more than 1,000 healthcare organizations to provide NEMT. The service recently cut deals with NimbleRx and ScriptDrop to enable home prescription deliveries, but it also lost its leader, Dan Trigub, to home health startup MedArrive late last year.

Can You Add Your Parents to Your Health Plan? California Considers It

CA Considering Letting Kids Add Parents to Their Insurance Plans

Source: The National Law Review, by Katherine Anne Sullivan Morgan and Hannah R. Demsien

12% of parents in the United States with children under age 18 are also caring for another adult. The number of caregivers who provide unpaid care for a family member over the age of 50 has increased in the past five years, as has the percentage of caregivers who live in the same household as the individual who is receiving care. Children who care for a parent or parent-in-law are commonly involved in the management of their parent’s health, handling responsibilities such as communicating with health care providers and monitoring their parent’s health conditions.

Last week, the California Department of Insurance sponsored California State Assembly Member Miguel Santiago in introducing Assembly Bill 570 (the “Bill”), which would mandate that individual or group health care service plan contracts or health insurance policies cover dependent parents. Though the Bill does not limit the age of the dependent parent, Assembly Member Santiago noted an existing issue with seniors’ access to health care that has been exacerbated by COVID-19, and the Commissioner added that in the face of the high health risks to older adults due to the pandemic, the Bill could help reduce health insurance costs for California families by expanding health coverage. Additionally, the Bill would offer relief to immigrant families with younger working adults caring for older undocumented family members.

If passed, the Bill would require health coverage issued, amended, or renewed on or after January 1, 2022 that provides dependent coverage to make that coverage available to a qualified dependent parent or stepparent. The Bill would expand the definition of “dependent” under California law to include a parent or stepparent who meets the definition of a qualifying relative under 26 U.S.C. § 152(d). This connection to the federal definition of “qualifying relative” in the Internal Revenue Code means that in order to fall under the mandate, a parent or stepparent must have a gross annual income under a certain amount and must have more than one-half of their support for the year provided by the individual claiming them as a qualifying relative.

We will continue to monitor this bill and similar bills at the state and federal level.

Sanders Pushes Medicare Expansion In Dems’ Next Big Bill

Sanders pushes Medicare expansion in Dems' next big bill - POLITICOSource: Politico, by Burgess Everett

Bernie Sanders wants to make sweeping changes to Medicare and prescription drug policy — and evade the filibuster to do it.

The Vermont Independent is urging Democrats to force Medicare to enter into negotiations with drug companies and use that revenue to pay for a huge expansion of the entitlement program. Sanders, who chairs the Senate Budget Committee, is aiming to lower Medicare’s eligibility age from 65 to 55 or 60 years old and expand the program to cover dental work, glasses and eye surgeries as well as hearing aids.

Those major changes would be rolled into a massive infrastructure bill Democrats are starting to craft that’s likely to include to tax policy as well. Sanders said in an interview on Friday that Congress’ recent $1.9 trillion coronavirus relief measure was “an enormous step forward” on the immediate challenges facing the country, but that “now we have to look at the structural long-term problems facing our people.”

“We’re talking about physical infrastructure, affordable housing. We’re talking about transforming our energy system to deal with climate change. We’re talking about human infrastructure,” Sanders said. “In the rescue plan, we were able to take a major step forward in lowering child poverty — very important. Now I want to deal with issues facing seniors as well.”

Sanders’ emerging plans come amid a budding Washington battle over the filibuster rules and questions over whether Senate Majority Leader Chuck Schumer will try to will his caucus to kill the 60-vote threshold for most legislation. Sanders did not want to get into that on Friday, but his hope to craft huge changes to health care policy via the blunt legislative tool known as budget reconciliation is an acknowledgment that many liberals plan to move aggressively on their agenda before the midterms, regardless of what happens with the Senate rules.

The remarks from Sanders also jibe with growing support in the House for a “kitchen sink” approach to the next reconciliation bill, which can pass the Senate with a simple majority but has some limits to its use. House Democrats are discussing including drug pricing and climate legislation in their next big legislative package, which is expected to focus on infrastructure while hiking some taxes on corporations and high-income earners.

Earlier this year the House passed the Covid recovery bill and attached a measure raising the minimum wage to $15 hourly, but that was stripped out of the package after the Senate’s parliamentarian determined it would need 60 Senate votes. Sanders said that if he, Speaker Nancy Pelosi and Schumer can agree on including his Medicare and drug policy changes, they won’t run into that procedural blockade.

“This is easier. This is pretty straightforward,” Sanders said. Senior Democrats say they are confident that issues like health care would pass muster under the Senate budget rules, given that those policies would have a major budgetary impact.

“Right now what I want to focus on is the fact that there is an enormous crisis facing seniors who are unable to get the dental care, the hearing aids, and the optical care that they need,” Sanders added.

President Joe Biden is also considering proposing a massive $3 trillion infrastructure package, which Schumer said on Thursday he is just beginning to coordinate on with the administration. Biden and many Democrats would like to kill some of former President Donald Trump’s tax cuts and use that to pay for part of their progressive wish list, aligning with Sanders’ broader priorities though not yet endorsing his call for a Medicare expansion.

Sanders estimated that adding the drug pricing component to the bill would raise $450 billion over 10 years, and that money could go toward expanding Medicare coverage to dental, optical and hearing aids, which he believed would cost about $350 billion.

But as far as a total sum of how much new spending Sanders would like to see, the gruff Vermonter demurred on Friday. He said he doesn’t want to just pick a target; he wants to check off as much as can be done to help people across the country and then figure out just how much that would cost.

“You don’t start off by coming up with a sum and working down. You start out by looking at the needs that need to be addressed and adding them up,” he said.

Senate Passes Bill To Extend Medicare Sequester Fix Through 2021

AHA: Senate to vote this week to extend moratorium on Medicare sequester  cuts | FierceHealthcare

Source: Fierce Healthcare, by Robert King

The Senate overwhelmingly passed legislation Thursday to extend a pause on Medicare payment cuts through 2021, a major demand from providers still struggling financially during the pandemic.

The legislation passed the Senate by a 90-2 margin and now heads to the House for final passage. The House passed a similar bill earlier this month that extended the moratorium on the cuts, which were installed under the sequester, for nine months.

However, the House is unlikely to take up the legislation until next month as the chamber is in recess until the middle of April.

The American Hospital Association, which has pressed the Senate for the legislation, has said the Centers for Medicare & Medicaid Services (CMS) could hold back Medicare claims payments until the final legislation is signed into law.

CMS told Fierce Healthcare earlier this week that it doesn’t comment on pending legislation when asked about the possibility of holding the payments until final legislative approval.

The 2% cuts were originally paused by Congress as part of the CARES Act as providers started to struggle with the financial fallout of the COVID-19 pandemic.

The moratorium on the cuts has been extended several times since then, with the latest extension being included in a federal spending package approved by Congress in late December.

Hospital groups lauded the Senate vote as a key win for providers.

“Extending the 2% Medicare sequester moratorium is a key piece of the puzzle to ensure clinicians and hospitals have the critical resources to care for their patients and defeat this virus,” said Chip Kahn, president and CEO of the Federation of American Hospitals, in a statement.

The American Hospital Association also lauded passage of the legislation but stressed that more support will be needed in the future such as “more overall funding for the Provider Relief Fund, relief for hospitals and health systems with Medicare accelerated payments.”

AHA also called for Congress to eventually pass legislation to extend a mandatory 4% payment cut to Medicare reimbursements set to go into effect under the PAYGO law, which requires mandatory spending cuts if federal spending reaches a certain threshold.

The House legislation included a delay of the 4% additional cut, set to go into effect in 2022, but the Senate bill that passed Thursday does not.

Biden To Push Infrastructure Before Health And Family Care

Biden to push infrastructure before health and family care

Source: CNBC, by Tucker Higgins

President Joe Biden will separate his sprawling plan to upgrade the nation’s infrastructure into two separate pieces that he will unveil weeks apart, White House press secretary Jen Psaki said on Sunday.

Psaki said on Fox News Sunday that Biden will unveil the first part of his plan, focusing on items like rebuilding roads and railways, on Wednesday. The second part of Biden’s plan will include child-care and health-care reforms — aspects of what is sometimes called social infrastructure — and will be released in “in just a couple of weeks,” she said.

The New York Times reported on Monday that Biden’s advisors were recommending that Biden separate traditional infrastructure proposals from the other aspects of his plan geared at relieving burdens on families via social services. Taken as a whole, the legislation is expected to cost more than $3 trillion.

Some Biden advisors believe that dividing the package and pushing for the roads-and-bridges proposal first may make it easier to gain support from Republicans, the Times reported. Documents reviewed by the newspaper indicated that it could include $1 trillion devoted largely to building and repairing physical infrastructure, with a focus on fighting climate change.

The second part of Biden’s plan would include proposals like free community college and universal prekindergarten, the Times reported. Psaki said the second plan “will address a lot of issues that American people are struggling with,” and cited child care and the cost of health care.

Psaki suggested that Biden’s proposal may come with tax increases, but declined to provide details.

“The total package we’re still working out, but he’s going to introduce some ways to pay for that, and he’s eager to hear ideas from both parties as well,” she said.

Biden has said that he intends to raise taxes on wealthy individuals and corporations, though he has not yet provided a detailed plan to do so.

Republicans are broadly opposed to tax increases. Senate Minority Leader Mitch McConnell, R-Ky., has said that there will not be “any enthusiasm on our side for a tax increase” to fund infrastructure.

Talk of Biden’s next big push on the economy comes just weeks after the president signed a $1.9 trillion Covid-19 relief bill, which included funding for vaccine distribution as well as stimulus payments for most Americans.

The coronavirus legislation was passed without any Republican support via a special congressional mechanism known as budget reconciliation. The nearly-$2 trillion package was funded by federal borrowing.

The White House hasn’t said whether it will use reconciliation to pass legislation related to its infrastructure agenda, though it seems likely that separating the two parts of the plan is aimed at avoiding the streamlined process for at least one bill.

Republicans and Democrats have both been pressing for a bipartisan infrastructure deal for years.

“We’re not quite at the legislative strategy yet, Chris, but I will say that I don’t think Republicans in this country think we should be 13th in the world as it relates to infrastructure,” Psaki told host Chris Wallace.

“Roads, railways, rebuilding them, that’s not a partisan issue. That’s a lot of what the president will talk about this Wednesday,” she said.

Psaki did not say whether the plan would be limited to two pieces of legislation or if more discrete bills may be introduced.

House Votes to Avert Deep Medicare Cuts to Pay for $1.9 Trillion Stimulus Plan

House Votes to Avert Deep Medicare Cuts to Pay for $1.9 Trillion Stimulus  Plan - The New York Times

Source: The New York Times, by Emily Cochrane and Margot Sanger-Katz

The House voted on Friday to avert an estimated $36 billion in cuts to Medicare next year and tens of billions more from farm subsidies and other social safety net programs, moving to stave off deep spending reductions that would otherwise be made to pay for the $1.9 trillion stimulus bill enacted last week.

The action, opposed by the vast majority of Republicans, would effectively exempt President Biden’s pandemic aid package from a deficit-reduction law that requires that all spending be offset by automatic, across-the-board cuts to certain government programs. It passed by a vote of 246 to 175, with 29 Republicans joining Democrats to support it.

In passing the virus aid plan, Democrats used a fast-track budget process to push past Republican opposition, arguing that urgent needs brought on by the pandemic outweighed concerns about running up the national debt. But the maneuver meant that Congress had to act separately to prevent the automatic cuts, which would go into effect in January if lawmakers do not act.

Democrats remained confident that, even though they opposed the stimulus package, Republican senators would eventually support legislation to avoid cutting Medicare, farm subsidies and social services block grants to pay for it. But the debate was a chance for members of both parties to make their dueling cases about the government’s spending priorities after the enactment of one of the most expansive federal rescue packages in modern times.

In remarks on the House floor, Representative John Yarmuth of Kentucky, the chairman of the Budget Committee, described the bill as “a loose end we have to tie up before our work is finished.” He argued that the legislation would place the stimulus law on equal footing with previous pandemic relief bills passed during the Trump administration. All of those bills were approved with overwhelming bipartisan majorities and waived the requirement for corresponding spending cuts.

The vote margin signaled that the waiver legislation could become the subject of negotiations later in the year, as lawmakers approach a deadline to address the debt ceiling and the dozen spending bills needed to keep the government funded. It is unclear when the measure will be taken up in the Senate, where 10 Republicans would have to join Democrats for it to become law. Similar waivers have repeatedly been approved regardless of party.

The politically unpopular specter of drastic Medicare cuts during a pandemic is likely to prod lawmakers to a deal before the year is out.

“Very few of them would actually want the pay-go sequester to hit,” said Marc Goldwein, a senior vice president at the Committee for a Responsible Federal Budget, a group that urges fiscal restraint. Mr. Goldwein predicted that Republicans were likely to eventually vote for a waiver, as part of a larger deal. “They may try to get something in return for it.”

The debate over paying for the stimulus stems from a 2010 law called the Statutory Pay-as-You-Go Act that requires certain deficit spending to be automatically offset by cuts to federal programs. Typically, when Congress has wanted to spend big, it has also voted to ignore that rule. But because the recent pandemic relief bill was passed using a special budget process known as reconciliation, a waiver could not be included.

The Congressional Progressive Caucus has called for the law to be ended to avoid the automatic cuts.

The Congressional Budget Office, in a letter to Representative Kevin McCarthy of California, the minority leader, estimated that without the waiver enacted before the end of the calendar year, $36 billion would be cut from Medicare spending — 4 percentage points — in 2022 alone and billions more from dozens of other federal programs. Many mandatory spending programs could be completely defunded, including social services block grants, a Justice Department program that provides aid to crime victims, and the Black Lung Disability Trust Fund.

Waiver bills of this sort have typically been passed in time to avoid major cuts. In 2017, after Republicans passed their $1.5 trillion tax cut, also using the budget reconciliation process, many Democrats voted to prevent automatic spending reductions as part of a year-end funding bill.

“We need to be working together, as we did for you when you were giving tax cuts to the wealthiest Americans,” Representative Jan Schakowsky, Democrat of Illinois, said in a comment directed at Republicans.

Republican lawmakers criticized Democrats for having created their own problem, arguing that there would be no need for a separate vote to avert the cuts if the stimulus plan had been bipartisan.

“We are here today because Democrats want to ‘fix’ one of the many problems caused by President Biden’s $1.9 trillion bailout bill,” said Representative Jason Smith of Missouri, the top Republican on the Budget Committee. “They want to do so by just erasing $1.9 trillion in spending from the nation’s books — pretending $1.9 trillion in spending is not going to happen.”

Conservatives see the confrontation as an opportunity to criticize overspending by the Democrats.

“I do think it would be irresponsible to not do something to address the level of overspending,” said Matthew Dickerson, the director of the Grover M. Hermann Center for the Federal Budget at the Heritage Foundation. He said Republicans should use the looming cuts as leverage to pressure Democrats to agree to new measures to reduce federal spending.

Last Updated 05/12/2021

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