TRP Health Policy Report
November 3, 2014
Administration Officials to Testify on Ebola Funding
On November 12, HHS Secretary Sylvia Burwell and Homeland Security Secretary Jeh Johnson will appear before the Senate Appropriations Committee to testify on the government’s response to Ebola. Other witnesses expected to testify include CDC Director Dr. Thomas Frieden, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, as well as officials from the State Department, Defense Department, USAID and the Joint Chiefs of Staff. President Obama’s Ebola czar, Ron Klain, is not expected to testify.
The hearing is scheduled to take place a week before Congress returns to Washington for the lame-duck session. A continuing resolution (CR) bill will be at the top of their agenda before a short-term funding bill expires December 11. The hearing also comes after the White House ramped up its response to Ebola after a series of incidents and mistakes that resulted in several healthcare workers being infected. A number of other Congressional panels have held hearings examining the Administration’s response to the deadly virus over the last month.
In the House, Democrats on the Appropriations panel are pushing the Chairman of their health subcommittee, Rep. Jack Kingston (R-GA), to also hold a hearing on additional funding for the Ebola crisis. It remains unclear if the White House will ask for Congress to approve any additional funding for anti-Ebola efforts. Officials had suggested several weeks ago that could happen, but White House aides downplayed expectations last week. In September, Congress approved $88 million to fight Ebola in a stopgap CR. Lawmakers also approved an Administration request to shift $750 million in Pentagon funds to the Ebola response. Any additional funding would likely be included in an omnibus spending bill legislators are expected to negotiate over the next two months.
In related news, Senators Tom Harkin (D-IA) and Lamar Alexander (R-TN) are planning to introduce a bill that would fast-track the creation of Ebola treatments by offering incentives to drug companies. The respective bipartisan leaders of the Senate HELP Committee say their bill would speed through a company’s drug application for Ebola within about six months through a program called “priority review.” As an added incentive, companies would also earn a bonus voucher for another drug of their choice to receive priority review, even if it’s not meant to treat a neglected disease like Ebola. Harkin and Alexander plan to introduce their bill when Congress reconvenes for the post-election lame-duck session.
McConnell Reassures GOP on ACA Opposition
Last week, Senate Minority Leader Mitch McConnell (R-KY) reassured conservatives that his position on repealing the Affordable Care Act hasn’t wavered, as Republicans grow increasingly confident that they will seize control of the upper chamber in this week’s midterm elections. In a media appearance last Tuesday, McConnell said that a stand-alone repeal vote would require 60 votes and a Presidential signature. Some took the Kentucky Senator’s comments as a change in position from his frequent references to the goal of repealing the healthcare reform law “root and branch.” But McConnell’s office quickly stressed that the leader’s position is the same as it has been for years. Given the favorable climate for the GOP this fall, McConnell’s direction on the ACA has been closely watched as he both fights for reelection and as Republicans eye Senate control for the first time since 2006.
McConnell’s office said a Republican Senate could use several means to dismantle the ACA, including budget reconciliation – a parliamentary tactic that allows budget-related legislation to pass with a simple 51-vote majority. Democrats used the procedure to pass the ACA in 2010 after approving the underlying bill with 60 votes in 2009. It remains an open question as to how much of the law could be repealed through the reconciliation process. For example, the ACA’s spending provisions could probably be repealed through reconciliation, but regulations that aren’t directly related to the budget likely couldn’t be rescinded by the procedure.
Medicaid Directors Call for Federal Action on Specialty Drug Pricing
Last Tuesday, Medicaid directors told lawmakers on key Senate and House committees that the high cost of specialty drugs like the hepatitis C treatment Sovaldi “requires an immediate federal solution.” The National Association of Medicaid Directors, in a letter to the Democratic and Republican leaders of four Congressional committees with jurisdiction over healthcare issues, said that prescription drug spending for hepatitis C treatments has doubled or tripled in several states in the first quarter of 2014 compared to the amount the states spent during the entire year of 2013. Sovaldi, a treatment sold by Gilead Sciences, costs roughly $84,000 per treatment course.
The hearing came amid a national debate over the rising cost of prescription drugs. New hepatitis C treatments have raised particular cost concerns, because they promise cure rates exceeding 90% – which is prompting an increase in prescribing and qualms about the ensuing impact on insurance provider budgets. For the past several months, pharmacy benefit managers and state Medicaid programs have complained that the cost of Sovaldi may become unsustainable. Gilead Sciences maintains the treatment is a cheaper alternative to older forms of care that may be less successful and involve costly hospitalization. Last July, two members of the Senate Finance Committee asked the drugmaker to provide financial information about the $11 billion deal in which it acquired the treatment, research and development costs and subsequent pricing forecasts. Senior committee aides say the probe remains under way, but could not offer an update.
HHS Secretary Meets with Insurance Executives Ahead of ACA Enrollment
Last Wednesday, HHS Secretary Sylvia Mathews Burwell met with leading health insurance executives to discuss the Affordable Care Act’s second open enrollment period. Twelve executives met with Burwell, including two representatives of the industry's trade association, America's Health Insurance Plans (AHIP), the agency said. With the health law's exchanges scheduled to open for sign-ups in less than two weeks, the White House is intent on avoiding technical problems that marred the system’s rollout last year. In a statement, the insurance executives and the Administration hoped to convey a united front.
“HHS and issuers are focused on delivering a positive experience for both current and new consumers, including outreach and education so that consumers understand their options and the renewal process,” an HHS summary of the meeting stated. The Obama Administration and its industry partners are facing several new challenges this year, including a shorter enrollment period and consumer confusion about plan renewals. The sign-up period begins on November 15.
CMS Issues Final Rule on Sunshine Act Payment Data, Technically Eliminating “CME Exemption” Provision while Actually Creating a New CME Exemption by Re-Defining Reportable Payments
Last Friday, CMS issued a final rule that technically eliminates a reporting exemption it had earlier created under the Physician Payments Sunshine Act for indirect financial ties between industry and physicians. The move is causing considerable confusion, however, because while CMS deleted the previously-created exemption language, it also expanded the definition of non-reportable indirect payments to include most CME payments, so long as commercial supporters of CME do “not require, instruct, direct, or otherwise cause the continuing education event provider to provide the payment … to a covered recipient.” This limitation mirrors the limitations already proscribed by the leading national accreditors of CME, such as the Accreditation Council for CME (ACCME) and the American Medical Association, however, so as a practical matter, accredited CME support payments will now be considered outside the scope of the Sunshine Act reporting mandate.
CME stakeholders, such as the CME Coalition, applauded the CME clarification, which appears to have addressed the concerns of the 98% of commenters who called on CMS to prevent the Open Payment reporting requirements from including indirect CME support payments for both faculty and attendees.