Axios Pro: Health Care Policy

November 29, 2022

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Situational awareness: The Republican Steering Committee will finalize its new regional representatives Tuesday, and votes for House committee chairs are now scheduled for next week, between Dec. 5 and Dec. 7, Victoria reports.

  • Depending on how the regional representation shakes out, it could influence who gets votes for committee chair (Florida getting another representative could help Rep. Vern Buchanan).

1 big thing: Lame duck health care forecast

Illustration: Brendan Lynch/Axios

We hope you had a good Thanksgiving break! Congress is heading back in with just three weeks until the government runs out of money.

  • Peter, Victoria and Maya caught up with senators, aides and lobbyists Monday to get an update on our lame duck preview. Here’s our sense of the outlook so far.

A newsy comment from Sen. Richard Burr: He told Peter on Monday that there is "no" chance of action on reforming FDA oversight of dietary supplements before the end of the year.

  • A senior Republican HELP Committee aide later added that there is a chance of reforming FDA oversight of cosmetics, and that it is "linked" to the VALID Act reforming diagnostic test oversight (a measure pushed by Burr), where changes are being discussed.
  • "If we reach consensus on VALID, then cosmetics can flow with it," the aide said.
  • Another candidate is the PREVENT Pandemics Act, which Burr introduced with Sen. Patty Murray.
  • "Everything's in conversations right now," Burr said. "Hopefully in the next week to 10 days we should get some read on that. I think VALID's currently on the table, so is the PREVENT Act."

The outlook is better for items with a firm deadline, like averting Medicare PAYGO cuts and at least partly averting a 4.5 percent cut to physician payments.

  • As Burr's comments suggest, dietary supplement reform is looking very unlikely, but there is some chance for other FDA items, like cosmetics, VALID, and accelerated-approval reform.
  • Public health policies (like the PREVENT Pandemics Act) will be easier to pass than policies that require extensive pay-fors, one former Democratic aide added.
  • An extension of the telehealth flexibilities seems very likely, though the specifics on how long the extension will be — and whether permanency is on the table — are still up in the air.
  • A House Republican aide said bipartisan negotiations on the FMAP rate and number of years to extend Medicaid funding for Puerto Rico are a lame duck priority. The starting point is a bipartisan 2021 Energy and Commerce bill that extended increased funding at the FMAP rate of 76% for five years.
  • Two health care proposals that Republicans oppose — vaccine mandates and paying for abortion travel — could also hold up the annual defense spending bill, which needs to pass in December.

What’s really looking tough: COVID-19 funding. The White House announced another request of about $10 billion for COVID needs, including development of next-generation vaccines that better target new variants.

  • But Republicans have been resisting new COVID-19 funds for months, and there’s no sign they are changing their minds.
  • We’re also hearing more and more that the $16 billion price-tag associated with Medicare Advantage prior-authorization reforms that passed the House earlier this year is likely to mean it won’t end up in an end-of-year package.

The big picture: There’s definitely uncertainty about what’s going to happen. Negotiations are not very intense yet, and a lot is still to be decided. One big unknown: How much money there even is to spend on the health-related items.

  • It’s always a safe bet to say Congress is going to kick the can down the road, at least a little bit, and we’re hearing the funding deadline could be extended from Dec. 16 to Dec. 23. (So don’t book your flights home for the holidays too soon).
  • "I don't know if we'll get [the package] done by the 16th. The 16th is the day I'd like to get it done, but we might be here 'til Christmas," Sen. Richard Shelby told reporters Monday evening.

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