1 big thing: What's brewing on price transparency

2. Exclusive: Bipartisan bill would expand telehealth

3. What we're hearing: Biden and COVID origins law

Good morning ... Oh, HHS Secretary Xavier Becerra, how can the Hill miss you if you won't leave?

✅ Thank you for reading Axios Pro Policy, and thanks to editors David Nather and Mackenzie Weinger and copy editor Bryan McBournie.

Do you know someone who needs this newsletter? Have them sign up here.

Health Care Policy

1 big thing: Ways and Means chair hits Becerra on Medicare Advantage

Busy day! Here's the highlights from the HHS secretary's budget testimony at Ways and Means this afternoon.

✅ Thank you for reading Axios Pro Policy, and thanks to editors David Nather and Mackenzie Weinger.

Health Care Policy Thought Bubble

1 big thing: VALID's hazy future

Good morning ... Remember the VALID Act? One of the many things we were all tracking during the omnibus? It's back.

✅ Thank you for reading Axios Pro Policy, and thanks to editors David Nather and Chuck McCutcheon and copy editor Brad Bonhall.

1 big thing: Bipartisan bill targets Medicare Advantage overpayment

Illustration of a pair of scissors about to cut a manila folder with a red cross on it.

Back already! Did you miss us? Here's a new bill you might want to know about if you work on Medicare Advantage.

1 big thing: House GOP lowers its sights on health cuts

2. Hospitals go on the defensive

3. Member spotlight: Robin Kelly's maternal health fight

Congresswoman Robin Kelly speaks during a hearing

Good afternoon ... We have yet to find any Hill Democrats who are suggesting a specific legislative fix on the ACA and preventive health services, rather than just issuing statements, but we'll let you know if that changes. 

🎉 Happy recess! We'll be dialing down the newsletter schedule for the next two weeks, but we'll be back in your inboxes with deeply reported pieces and news you need to know.

✅ Thank you for reading Axios Pro Policy, and thanks to editors David Nather and Mackenzie Weinger and copy editor Brad Bonhall.

Rep. Robin Kelly is on a mission to improve maternal outcomes in the United States.

Where it stands: The Illinois Democrat has a big task at hand: According to the CDC's National Center for Health Statistics, 1,205 people died of pregnancy-related causes in the U.S. in 2021 — a nearly 60% increase since 2019.

The rate of maternal mortality for Black women in 2021 was nearly triple the rate for white women, according to the CDC.

Last year, Kelly helped secure a permanent option for state Medicaid programs to cover people for up to 12 months postpartum. “I consider that a big win, but I'm looking for more,” she told Axios.

So far, 3o states have gotten federal approval to extend their Medicaid postpartum coverage from 60 days to a full year. Kelly eventually wants all 50 states to be required to expand, she said.

What’s next: Kelly plans to reintroduce her signature maternal health legislation, the MOMMA’s Act, this Congress. Some of its policies have already passed, but she wants to get more provisions signed into law and add language about workforce diversity and postpartum mental health.

Kelly also became co-chair of the Bipartisan Maternity Care Caucus this month. She said she wants the group to work on issues such as increasing the maternal health care workforce, improving mental health and making more space for midwives and doulas in the birthing process.

Flashback: Kelly's interest in maternal mortality as a policy issue started around 2016, after talking about it with a close constituent.

“As a mom and a grandma myself, I just couldn't believe that the United States ranked like it did, and that women were dying like they were,” Kelly said. “It was safer for me to have my baby than for my two stepdaughters to have their babies.”

Don’t forget: Kelly’s health care portfolio stretches beyond pregnancy and early parenthood. She’s on the Energy and Commerce health care subcommittee and serves as chair of the Congressional Black Caucus health care brain trust.

She’s an advocate for clinical trial diversity. Her legislation requiring pharmaceutical companies to include a clinical trial diversity plan if they're submitting new drug, device and biologic applications to the FDA  passed in the December omnibus package.

Kelly also views gun violence as a public health issue and advocates for more prevention legislation. 

Member spotlight: Robin Kelly's maternal health fight

She's on a mission to improve maternal outcomes in the United States.

Congresswoman Robin Kelly speaks at a hearing

Kelly speaks during a hearing June 8, 2022. Photo: Andrew Harnik-Pool/Getty Images

Maternal deaths

Rep. Robin Kelly is on a mission to <a class="gtmContentClick" data-vars-link-text="improve maternal outcomes" data-vars-click-url="https://www.axios.com/local/houston/2023/03/22/maternal-death-rate-spikes" data-vars-content-id="10570fc0-e2ac-477a-899f-7bc4b460018b" data-vars-headline="Member spotlight: Robin Kelly&#x27;s maternal health fight" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/local/houston/2023/03/22/maternal-death-rate-spikes" target="_self">improve maternal outcomes</a> in the United States.Where it stands: The Illinois Democrat has a big task at hand: According to the CDC&#x27;s <a class="gtmContentClick" data-vars-link-text="National Center for Health Statistics" data-vars-click-url="https://data.cdc.gov/NCHS/VSRR-Provisional-Maternal-Death-Counts/e2d5-ggg7/explore/query/SELECT%0A%20%20%60data_as_of%60%2C%0A%20%20%60jurisdiction%60%2C%0A%20%20%60group%60%2C%0A%20%20%60subgroup%60%2C%0A%20%20%60year_of_death%60%2C%0A%20%20%60month_of_death%60%2C%0A%20%20%60time_period%60%2C%0A%20%20%60month_ending_date%60%2C%0A%20%20%60maternal_deaths%60%2C%0A%20%20%60footnote%60/page/filter" data-vars-content-id="10570fc0-e2ac-477a-899f-7bc4b460018b" data-vars-headline="Member spotlight: Robin Kelly&#x27;s maternal health fight" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://data.cdc.gov/NCHS/VSRR-Provisional-Maternal-Death-Counts/e2d5-ggg7/explore/query/SELECT%0A%20%20%60data_as_of%60%2C%0A%20%20%60jurisdiction%60%2C%0A%20%20%60group%60%2C%0A%20%20%60subgroup%60%2C%0A%20%20%60year_of_death%60%2C%0A%20%20%60month_of_death%60%2C%0A%20%20%60time_period%60%2C%0A%20%20%60month_ending_date%60%2C%0A%20%20%60maternal_deaths%60%2C%0A%20%20%60footnote%60/page/filter" target="_blank">National Center for Health Statistics</a>, 1,205 people died of pregnancy-related causes in the U.S. in 2021 — a nearly 60% increase since 2019.

National

A Medicare Advantage lobbying group that's emerged as the biggest political ad spender this year appears focused on prodding endangered Democratic incumbents in battleground states to turn back a package of Biden administration policy changes.

Better Medicare Alliance spent $13.5 million on media spots through March 31, according to data collected by AdImpact and shared with Axios. The group declined to comment.

Why it matters: The blitz comes as the Biden administration seeks to change elements of the way private Medicare plans get paid. 

The organization's ads portray the proposal as a cut Medicare that would hurt seniors. 

Yes, but: The Biden administration disputes the characterization and maintains the changes will make payments to insurers more accurate. 

What we're watching: The next turn comes on or before Monday afternoon, when CMS is due to release the final Medicare Advantage payment notice for 2024. 

Medicare Advantage group's advertising blitz

Better Medicare Alliance spent $13.5 million on media spots through March 31, according to data collected by AdImpact and shared with Axios.

Medicare Advantage

A Medicare Advantage lobbying group that&#x27;s emerged as the biggest political ad spender this year appears focused on prodding endangered Democratic incumbents in battleground states to turn back a <a class="gtmContentClick" data-vars-link-text="package" data-vars-click-url="https://www.axios.com/2023/02/02/medicare-advantage-plans-2-percent-rate-hike" data-vars-item="in_content_link" href="https://www.axios.com/2023/02/02/medicare-advantage-plans-2-percent-rate-hike" target="_self">package</a> of Biden administration policy changes.<ul><li>Better Medicare Alliance spent $13.5 million on media spots through March 31, according to data collected by AdImpact and shared with Axios. The group declined to comment.</li></ul>

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

Hospitals are paying attention to lawmakers’ growing interest in health care transparency and consumer costs — and they appear to be getting worried.

Driving the news: The American Hospital Association and the Federation of American Hospitals released an analysis this week that found physician-owned hospitals cherry-pick more profitable and less medically complex patients.

AHA also put out a study last week contending that site-neutral payments could put patients at risk, and a slew of hospital groups came out against a new 340B coalition earlier this month.

What they’re saying: “If there was ever any doubt, the evidence against POHs is as crystal clear today as it was when Congress passed the self-referral ban in 2010,” Chip Kahn, president of the FAH, said in a news release.

“Weakening or unwinding the current ban opens the door further to the very behaviors that Congress sought to prevent,” he added.

Our thought bubble: Policies expanding physician-owned hospitals, site-neutral payments and 340B reform face long odds in the current Congress, but they’re gathering more momentum and bipartisan support.

If hospitals are concerned enough to commission analyses backing their own positions, it's worth keeping an eye on how discussions about physician-owned hospitals, site-neutral payment and more develop.

Hospitals go on the defensive

A new analysis found that found physician-owned hospitals cherry-pick more profitable and less medically complex patients.

Illustration of a distressed hospital sign with the arrow portion detaching and swinging downwards

Hospitals

Hospitals are paying attention to lawmakers’ growing interest in health care transparency and consumer costs — and they appear to be getting worried.Driving the news: The American Hospital Association and the Federation of American Hospitals released an <a class="gtmContentClick" data-vars-link-text="analysis" data-vars-click-url="https://www.fah.org/wp-content/uploads/2023/03/2023-Fact-Sheet_20230323_wAppendixandCharts_POH-vs.-NonPOH-Only.pdf" data-vars-content-id="923fc86a-3a5a-416a-ab75-4d03e5ec19cf" data-vars-headline="Hospitals go on the defensive" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.fah.org/wp-content/uploads/2023/03/2023-Fact-Sheet_20230323_wAppendixandCharts_POH-vs.-NonPOH-Only.pdf" target="_blank">analysis</a> this week that found physician-owned hospitals cherry-pick more profitable and less medically complex patients.

Axios Pro Policy

Remember when we were going to have a vicious, economy-paralyzing partisan fight over Medicare and other big spending cuts to raise the debt ceiling this summer? 

Now, House Republicans are telling us that work requirements for Medicaid is probably as far as they'll go on cutting health care spending. And they're not necessarily clear on what those would look like.

Why it matters: When Republicans took back the House, they talked a big game of bringing back fiscal responsibility to Washington and reining in spending. But it turns out it's hard to find health care cuts that aren't politically toxic.

They already backed away from Medicare pretty quickly, but after a political scolding from President Biden and a GOP retreat to strategize on policy, they're really not talking major health care cuts or structural changes at all.

What they're saying: "Work requirements are going to be included. Republicans believe that we need to be adding work requirements. We're still working on the details," said Energy and Commerce Chair Cathy McMorris Rodgers.

Asked if that included Medicaid, she responded, "Oh, I think yes."

And what about per capita caps? "I would prefer other solutions to protecting Medicaid," she said.

Here's Rep. Brett Guthrie, health subcommittee chair for Energy and Commerce: "I want to see where it's something that helps people work themselves off of Medicaid. I think that would be helpful."

Asked for details on what that would look like, Guthrie said: "No, we just got more of a kind of a concept of it.... We have a lot of people on Medicaid for different reasons. We have the expansion population. To me, it would be the able-bodied and people able to work."

And here's House Budget Chairman Jodey Arrington, keeping it general: "Work requirements are being considered amongst all means-tested programs. What we can get 218 for, I'm for," he told reporters after a budget hearing this week, that discussed work requirements at length.

Some House Republicans aren't even specific about whether they want Medicaid work requirements or just work requirements generally.

"I don't know the specifics about Medicaid, but certainly work requirement as it relates to SNAP, 18- to 49-year-old able-bodied adults without dependents, no disabilities, no children at home," said Republican Study Committee Chair Kevin Hern.

The big picture: The shrinking ambitions were clear this week when Speaker Kevin McCarthy tweeted out a letter to President Biden listing his ideas for negotiation on the debt limit — including “strengthening work requirements for those without dependents who can work.”

Rep. Bob Good, a member of the House Freedom Caucus, said the caucus urged McCarthy to put work requirements in the letter. Asked if it included Medicaid, Good said: "Absolutely, all of it. Medicaid, SNAP or food stamps, welfare generally."

For now at least, that seems to be it for health care in the debt ceiling negotiations. 

Asked if there was any other health care spending being put on the table for either the debt limit or the budget, Guthrie said: "Right now Medicaid, and really just getting work requirements." 

"Medicare and Social Security have been taken off the table, so at this point yes, it's really only Medicaid," said Rep. Buddy Carter. 

McCarthy has consistently insisted that cuts to Medicare are "completely off the table" in debt ceiling negotiations. 

Yes, but: It's still possible Medicare changes could be brought up in the Republican Study Committee budget, Hern said.

He said the group's proposal will balance the budget in 10 years, though he insisted that "we are not going to cut benefits that have been earned by our seniors." 

"We've historically looked at Social Security reforms and Medicare reforms," Hern added, referring to the RSC budget and how he wants to ensure Medicare solvency. 

Reality check: The last time Republicans tried to implement Medicaid work requirements in the 2017 ACA repeal bill, the overall effort failed.

It's also possible that Republicans may not even end up voting on a budget resolution before the Treasury Department hits its default deadline, as Punchbowl News reported this week. Plus, budgets are largely symbolic anyway. 

The other side: "If they're looking to work requirements to actually reap savings, the history of the last 25 years shows that they really don't. So I would have to see the specifics. But in the grand scheme of things, we're talking about an incredibly small amount of money," said Rep. Brendan Boyle, ranking member of the House Budget Committee. 

House GOP lowers its sights on health cuts

They're down to Medicaid work requirements, rather than deeper cuts or structural changes.

Guthrie speaks at a February 2022 press conference. Photo: Bill Clark/CQ-Roll Call, Inc via Getty Images

House Republicans

Remember when we were going to have a vicious, economy-paralyzing partisan fight over Medicare and other big spending cuts to raise the debt ceiling this summer? <ul><li>Now, House Republicans are telling us that work requirements for Medicaid is probably as far as they&#x27;ll go on cutting health care spending. And they&#x27;re not necessarily clear on what those would look like.</li></ul>

The VALID Act is set to be reintroduced Wednesday — but its future is murky.

Why it matters: The bill is a priority for the diagnostic testing industry and for the FDA. But after it was cut twice from legislative packages last year and its main Senate champion retired, we're watching to see if the policy can actually pass in the 118th Congress.

Driving the news: Rep. Larry Bucshon plans to reintroduce the bill Wednesday afternoon with Rep. Diana DeGette, an aide said Tuesday.  

This year’s bill will resemble the version that came from Senate HELP last year, with some changes based on omnibus discussions, according to a source close to the matter.

The bill will not include a carve-out for academic medical centers.

Flashback: The VALID Act, as introduced last year, would create an oversight framework for diagnostic test review and approval under the FDA.

The bill would also allow developers to offer a suite of tests on the market after the FDA reviews and approves one representative test.

The overhaul is needed to help developers react more quickly to health emergencies, among other reasons, said Zach Rothstein, executive director of AdvaMedDx.

After VALID was cut from the FDA user fee reauthorization bill, advocates pushed to include it in the December omnibus. But the provision didn’t make the final version, in part because academic medical centers said it would hamper their ability to deliver and develop new tests.

What they’re saying: “There's a path forward” for VALID, Rothstein said. “If we're being honest, it's more complicated this year than it was last year.… But it doesn't mean that it's closed on us.”

Academic medical centers are still willing to work on a policy agreement — and having more time to do that is a benefit, said Heather Pierce, senior director for science policy and regulatory counsel at the Association of American Medical Colleges. 

“It’s not in a hasty emergency situation at the moment, which makes more nuanced, complicated discussions on a really, really hard issue much more likely to be successful,” she said.

The intrigue: VALID and diagnostic regulatory overhauls are not mentioned in the FDA’s 2024 budget document, which generally highlights an agency’s legislative agenda items for the fiscal year.

But a regulatory rewrite for diagnostic tests is still a priority for the agency, press officer James McKinney said in an email. McKinney said legislative proposals in the FDA’s 2024 budget all originated from the FDA, and VALID wasn’t included because it originated in Congress.

As it waits for Congress to take action, the agency is moving forward with rulemaking on diagnostic testing regulation, an FDA official said this month. 

But using the rulemaking process for this issue would open the FDA up to lawsuits, which could delay things and “cause a lot of havoc,” said James Boiani, a lawyer at Epstein Becker Green who specializes in FDA and clinical lab regulations. 

What’s next: Proponents say the most likely venue to pass a diagnostic testing overhaul is through the Pandemic and All-Hazards Preparedness Act, slated for this fall.

The VALID Act is one of the agency’s top legislative priorities for PAHPA reauthorization, McKinney said.

But DeGette wants to try to pass it as a standalone bill first.

“Congress has devolved to trying to find different places to put other bills,” DeGette told us in the hallway last week. “I see no reason why we couldn't pass this bill as a standalone bill. If we have to look at other options later, we will.” 

It's not clear that the Senate HELP Committee's new leaders have a lot of interest in the legislation, even though Richard Burr championed the VALID Act during his tenure.

“There’s a lot that we’re looking at,” Committee Chair Bernie Sanders told us. “I can’t give you an answer for that right now.”

 Said ranking member Bill Cassidy: “It’s an important issue that we have to address and I'm okay with addressing.… I had some concerns with the VALID Act, but I have not thought about it for a few months, so I can't give you chapter and verse.”

Sen. Michael Bennet, who co-sponsored the bill with Burr last year, is looking for a new Republican co-sponsor, his office said. 

VALID's hazy future

It could return in House, but it's unclear whether key senators have interest.

Illustration of a covid rapid test with a change symbol in the results panel

Diagnostic tests

The VALID Act is set to be reintroduced Wednesday — but its future is murky.Why it matters: The bill is a priority for the diagnostic testing industry and for the FDA. But after it was cut twice from legislative packages last year and its main Senate champion retired, we&#x27;re watching to see if the policy can actually pass in the 118th Congress.

Maya Goldman

Stories

Medicare Advantage group's advertising blitz

House GOP lowers its sights on health cuts

Hospitals go on the defensive

Member spotlight: Robin Kelly's maternal health fight

VALID's hazy future

Newsletter editions

🤔 Shrinking debt limit battles

👀 VALID second act

🔥 Tough talk on MA

🎉 Bipartisan MA idea

💵 Price transparency watch