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 | | By Chelsea Cirruzzo and
Ben Leonard | Presented by the Coalition to Strengthen America’s Healthcare | |
With Erin Schumaker
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The GOP could dismantle President Joe Biden's final health care rules by using the Congressional Review Act. | Saul Loeb/AFP via Getty Images
| HEALTH RULES IN THE CROSSHAIRS — Certain health care rules that the Biden administration finalized in its waning days could be targeted and killed
by a Republican-controlled Congress and White House, Chelsea reports. Under a law called the Congressional Review Act, lawmakers would have a fast-track option that bars Senate filibusters when they seek to overturn rules adopted in the final 60 legislative days of a congressional session. Republicans in both chambers have already introduced CRA resolutions to yank back a final Biden administration nursing home rule that requires facilities to maintain minimum staffing levels.
Here are some Biden rules likely to be in the crosshairs this year: — Preventive services under the ACA: Under this October proposal from HHS and the Departments of Labor and Treasury, Affordable Care Act
plans would be required to cover certain preventive services, such as over-the-counter contraceptives, without cost-sharing. However, President-elect Donald Trump has said he plans to overhaul the ACA, and House Speaker Mike Johnson recently said the law would undergo “massive” changes in the Trump administration. —
Organ transplant model: Last month, CMS delayed a Medicare pilot program aimed at improving access to kidney transplants from its initial January start date. Last year, the Biden administration began an overhaul of the 40-year-old network, which has been criticized for long wait times and access inequities.
The delay left some transplant advocates worried about impediments to kidney transplants, while the American Hospital Association has urged CMS to rethink the model, arguing it would incentivize “sub-par” organ matches. — Mental health parity:
The rules HHS and the Labor and Treasury departments finalized in September aim to ensure insurers cover mental health care on the same terms as other types of care, as Congress required in a 2008 law. The regulations reinforce that insurers can’t impose more restrictive standards on mental health care by requiring doctors to more often seek their approval before providing care or by maintaining limited numbers of in-network providers.
Republicans and insurers oppose the rule, with the latter saying they’re hamstrung by clinician shortages. However, whether the rule is subject to the CRA depends on when this Congress concludes its session. Rep. Virginia Foxx (R-N.C.), who chairs the House Education and Workforce Committee, has railed against the rules. Her office didn’t respond to questions about whether she would seek to have it rescinded using a CRA resolution.
WELCOME TO TUESDAY PULSE. The number of kindergartners receiving vaccine exemptions has risen slightly, according to the latest CDC data. It’s part of a trend of increased vaccine skepticism, Axios reports. Send your tips, scoops and feedback to ccirruzzo@politico.com and
bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.
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A message from the Coalition to Strengthen America’s Healthcare:
Hospitals are there for you and your family every hour of every day, ensuring you receive the appropriate level of care. Nearly half of all hospitals offer a trauma center that includes a multi-disciplinary team of surgeons, physicians and caregivers ready to help patients facing life-threatening injuries such as falls, motor vehicle collisions or gunshot wounds. GET THE FACTS. | | |
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A new survey claims high employer satisfaction with PBMs, though critics argue that lack of transparency have driven up drug costs. | Sue Ogrocki/AP |
FIRST IN PULSE: PBM CLOSING SALVO — As lawmakers weigh pharmacy benefit manager reform, PBMs are making their closing case to Congress: Employers are satisfied with their services negotiating drug prices, Ben reports.
PCMA, the lobby for PBMs, funded a survey conducted by the polling group NORC of nearly 700 U.S. employers who use PBMs to negotiate drug costs. The survey, first obtained by POLITICO, shows broad satisfaction with PBMs. For example, 88 percent of respondents said they were satisfied with PBMs’ ability to allow employees to have the “lowest costs” at the pharmacy.
The pushback from PBMs comes as employer groups, pharmaceutical companies and a broad bipartisan group of lawmakers try to crack down on what they see as PBMs’ role in raising prescription drug costs for Americans. Numerous pending bills would require PBMs to be more transparent about their practices or to “delink” drugs’ list prices from the payment PBMs receive. PCMA’s findings are at odds with arguments made by employer groups like the ERISA Industry Committee and the Partnership for Employer-Sponsored Coverage that
employers aren’t satisfied with their PBMs. PBM critics have pointed to consolidation — the three biggest PBMs control more than three-quarters of the market, according to some estimates — as a reason PBMs can drive drug costs higher, meaning employers and patients are picking up the tab. In a report first obtained by POLITICO this fall
, the ERISA Industry Committee, which represents the benefit interests of large employers, said PBMs should be deemed fiduciaries under a 1974 law. That would hold PBMs to the same standards as employer-plan sponsors, which “have a duty to” control costs.
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RAND PAUL’S COVID PLANS — Sen. Rand Paul (R-Ky.), who will chair the Senate Homeland Security Committee next Congress, has his sights set on oversight related to Covid-19’s origins and expects the Trump administration will be more helpful than the Biden administration, Ben reports.
Paul said that the NIH has “refused” to reveal deliberations over why research at the Wuhan lab at the center of the lab leak theory wasn’t considered by a key safety committee. He will also get subpoena power as chair. “The NIH has steadfastly refused to give that to me,” Paul told Pulse. “With the new administration, I think we’re going to get that.” The NIH didn’t immediately respond to a request for comment.
On the Homeland Security Committee, Paul hopes to rein in so-called gain-of-function research — which can strengthen a virus — in light of the pandemic. The U.S. intelligence community is split over whether the virus originated from an animal spillover event or leaked from a lab in Wuhan, China. RFK JR. AND ABORTION —
President-elect Donald Trump’s pick to run HHS, Robert F. Kennedy Jr., can expect to face skepticism from GOP senators over his stance on abortion-related issues, Ben reports. The latest indication was Sen. James Lankford’s (R-Okla.) comments to Pulse on Monday, saying he has "a lot of life questions" for Kennedy. “I want to know if the second Trump administration will have the same life perspective at HHS that the first one did. ... They were very, very good about all the different issues,” Lankford said.
Lankford’s questions are likely a sign of more to come from Republicans, as Kennedy’s stance on abortion has been all over the map. He called for a national ban on the procedure after the first trimester before backing away from that stance. He has also said “every abortion is a tragedy,” he identifies as “pro-choice” and he believes “it is always the woman’s right to choose.” Anti-abortion groups have raised concerns
, and former Vice President Mike Pence warned that Kennedy would be “the most pro-abortion Republican appointed secretary of HHS in modern history.”
| | | | A message from the Coalition to Strengthen America’s Healthcare:
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SMOKE-FREE ZONE — The decline in tobacco-linked death and disease rates in the U.S. is among public health’s most well-known success stories. Smoking has declined more than 70 percent since 1965. Secondhand smoke deaths have fallen by half since 2006, Erin reports. A new report from Surgeon General Vivek Murthy today suggests there’s more to do.
Cigarette and secondhand smoke exposure still account for nearly 1 in 5 deaths, or 500,000 lives lost, yearly. And progress has been unequal: Black people, those living in poverty and people with lower education levels are disproportionately likely to use tobacco. Policy path forward:
In his report, Murthy laid out a series of public health strategies that have worked in the past, like increasing taxes on tobacco products, expanding tobacco-free public spaces and implementing aggressive counter-marketing and public education measures. Additionally, Murthy recommends new strategies, including banning menthol and reducing nicotine content in tobacco products. “These measures can literally save millions of lives,” Murthy told POLITICO. “That’s the goal here. The end game, ultimately, is to create a society where no lives are lost and no disease is caused by tobacco.”
What’s next: The FDA has dragged its feet on a national menthol cigarette ban, and it remains to be seen where the incoming Trump administration will stand on a ban or any of the other policies Murthy outlined. A hint at Donald Trump’s allegiances: The president-elect has promised to “save Vaping again!” during his second term.
When asked about retaining his post under Trump — who asked Murthy to resign during his first term — the surgeon general said, “I’ve got time to think about my future. I’m just focused on trying to get as much done as we can before the end of the year." DISCLOSURES: KENNEDY’S BIOTECH INVESTMENT —
President-elect Donald Trump’s choice to lead HHS listed investments in a biotech company focused on autoimmune disease in recent financial disclosure forms, Chelsea reports.
Robert F. Kennedy Jr., who filed the July disclosure during his independent presidential run, reported an investment — valued between $15,000 and $50,000 — in Dragonfly Therapeutics. It’s a clinical-stage biotech company based in a Boston suburb backing drugs for autoimmune diseases, oncology, fibrosis, neuroinflammation and neurology, according to its website. Kennedy has made his Make America Healthy Again movement key to his health policy
, with plans to nix corporate interests in regulation. He’s also said he wants to end what he sees as an “epidemic” of chronic disease, especially in children, for which he blames toxins in food and the environment and unhealthy foods. Kennedy will have to update his forms before facing Senate confirmation. That paperwork won’t become public until Trump officially nominates him to the Senate Finance Committee, which oversees HHS.
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Rebecca Heilig Lira has been promoted from vice president of government affairs to senior vice president of government affairs at the Federation of American Hospitals.
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STAT reports that hospitals and insurers are optimistic that ACA subsidies will be extended. The Washington Post
reports that one person has died and more than a dozen sickened by an E. coli outbreak linked to organic carrots. Reuters reports on how Medicaid fuels U.S. coverage of GLP-1 drugs.
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| | A message from the Coalition to Strengthen America’s Healthcare:
When tragedy strikes, you want to receive the best care possible for yourself and your loved ones. Nearly 85% of all trauma patients require the highest levels of complex, life-saving care that only hospitals are equipped to provide. It’s essential to protect these critical access points and the unique care they provide to patients in their communities 24 hours a day, 7 days a week, 365 days a year.
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