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The chairman of the House panel that oversees most discretionary federal health spending wants ensure that the government is negotiating the good deals for medicines held in the national stockpile of treatments for potential terrorist attacks and severe flu pandemic
“Private industry needs to give the federal government, I think, a break” on sales to the Strategic National Stockpile, Rep. Tom Cole R-Okla, the chairman of the House Labor-Health and Human Services-Education Appropriations Subcommittee, said at a Wednesday hearing.
While examining the fiscal 2016 budget request for the Centers for Disease Control and Prevention, Cole urged the agency’s leader to considering enlisting Congress if the agency needs to improve the government’s bargaining position. The fiscal 2016 budget for HHS includes $571 million for the stockpile, an increase of $37 million from the current level. These extra funds would allow CDC to replace some expiring products as well as maintain countermeasures used to respond to emergencies.
“If you need some help on that, I hope you are very forthcoming with Congress because in many cases the federal government is not only the largest purchaser, but has done a great deal of the initial scientific work” on these medicines, Cole told CDC Director Thomas Frieden at a Wednesday hearing. “This is not an area to unduly profit from in my view.”
The CDC is only part of a network of federal agencies involved in encouraging development of treatments for potential disaster and attacks, Frieden said. An Institute of Medicine meeting Thursday on countermeasures, for example, will include speakers from the Biomedical Advanced Research and Development Authority, the Food and Drug Administration and Defense Department, as well as representatives of vaccine makers, including Merck & Co. and Novartis AG.
The stockpile now holds about $6 billion worth of products, held at sites throughout the nation so that countermeasures could be delivered to any community within hours, Frieden said. CDC is working with the FDA to try to determine which products may remain effective beyond their official expiration date, he said. In answer to Cole’s question on pricing, Frieden allowed that it can be difficult when there is little competition for a treatment.
“We’re able to negotiate with manufacturers but sometimes there is only one manufacturer and that makes the negotiations challenging,” he said.
Congress returns from a recess break and this week dives into an examination of fiscal 2016 spending bill requirements. Health and Human Services Secretary Sylvia Burwell will defend HHS agency funding at Wednesday and Thursday House committee hearings. However, Burwell will likely be quizzed mostly on other topics such as health exchange enrollment estimates plus exchange development and contingency planning. Burwell will also get an opportunity to explain a recently announced expanded enrollment period for people who didn’t comply with the health law’s individual mandate in 2014 and the release of erroneous subsidy data to 800,000 tax filers currently preparing their 2014 tax forms. A House hearing this week will focus on the tax implications of the exchange enrollment process. Also, a Senate hearing on Thursday reviews medical and public health preparedness.
The Senate Commerce, Science and Transportation Committee on Thursday is scheduled to mark up legislation (S 142) sponsored by Democratic Sen. Bill Nelson of Florida that would direct the Consumer Product Safety Commission to issue a childproof packaging rule for liquid nicotine, which is used to refill electronic cigarettes.
Today, the US Department of Agriculture and the Department of Health and Human Services formally published a notice seeking public feedback on the 2015 Dietary Guidelines Advisory Committee Scientific Report. The new guidelines seek to change public behavior on sugary drinks and continues an effort to reduce meat consumption.
Hospital groups are pressing the Department of Health and Human Services to steer much of the Ebola funding provided to the agency last year toward the medical centers most likely to confront the challenge of treating people infected with the often deadly virus.
Hospitals that handled Ebola cases and those already designated to do so “have not yet been compensated for the substantial costs that they have faced to achieve readiness, and additional delays may undermine their ability to sustain the heightened level of preparedness associated with designation,” wrote Rick Pollack, executive vice president of the American Hospital Association, in a Feb. 6 letter to Nicole Lurie, the assistant secretary for preparedness and response at HHS.
At issue is how Lurie’s unit, known as the ASPR, plans to use its share of about $2.7 billion for Ebola response provided in the fiscal 2015 spending package. Appropriators directed $576 million of this money for ASPR. In a report to the House and Senate Appropriations committees, HHS said it is weighing how to divvy up money between Ebola treatment centers and a broader effort to prepare the nation in case of further domestic cases.
The American Hospital Association said that in allocating the $576 million, ASPR needs to “prioritize the expenses that facilities have incurred to date,” even as it also pays other costs, such as transportation, for past and potential cases of Ebola. “We are concerned that ASPR may be planning to allocate only a small portion of these funds to health care facilities that stepped forward to raise their level of preparedness to care for suspected and confirmed Ebola cases,” Pollack wrote in his letter.
The Greater New York Hospital Association also has taken interest in how ASPR parcels out the money. Sen. Charles E. Schumer, D-N.Y., pressed this matter with HHS Secretary Burwell at a Feb. 4 Senate Finance Committee hearing. Schumer said that about half of the people who entered the United States from the three countries hit hardest by Ebola landed at John F. Kennedy Airport in New York.
City and state officials in New York worked with federal agencies and “made sure that we didn’t have the situation that we had initially in Dallas,” Schumer said. Two nurses became infected with Ebola while treating a patient in Texas. Preparing to better contain the virus involved “huge outlays” on the part of some hospitals for extra training and equipment to create anti-contamination rooms, which lawmakers want reimbursed through the recently appropriated Ebola money, Schumer said.
“Can you provide us with how you plan to ensure that the Ebola treatment centers — I care especially about the ones in New York– receive appropriate reimbursement?” Schumer asked at the hearing.
Burwell said HHS is working with a contractor to help it handle reimbursement on a “hospital by hospital” basis. “In addition, states and communities will receive other parts of funding that are part of the preventative work that they did,” she said. “So there are special funds for the treatment hospitals like Bellevue” and other hospitals that treated patients.
House Appropriations subcommittees today begin the early examination of the fiscal 2016 spending bills. First on the agenda today is the Indian Health Service. However, the head of the agency will be sitting at the witness table in an advisory role. Yvette Roubideaux, who has led the Indian Health Service as acting Director, now is serving as senior adviser on American Indians and Alaska Natives to the Secretary of Health and Human Services. The switch is entirely due to the sometimes-slow Senate confirmation process. Roubideaux’s initial four-year term ended in May 2013. She was then nominated for a second four-year term, and has been serving as acting director. An acting Director cannot serve forever without Senate ascent and the start of a new Congress and spending bill provisions forced Roubideaux to step aside pending a renewed effort at confirming her as IHS Director. Robert McSwain, IHS Deputy Director, is currently serving as acting director of the Indian Health Service
CQ Roll Call’s Kerry Young contributed to this report
Congressional committees this week engage a variety of health care topics. Leading-off is a Tuesday Senate hearing on the public health challenge of the re-emergence of vaccine preventable diseases, particularly measles.
Starting on Wednesday, the House Energy and Commerce Committee plans to conclude committee approval of a batch of health bills. The committee holds a two-day mark up session on measures regulating (HR 638) and managing (HR 471) controlled substances and renewing trauma systems programs (HR 647 and HR 648). Also, House Appropriations Committee panels begin the early examination of the fiscal 2016 spending bills. First on the agenda this week is the Indian Health Service and oversight of funding allocated to respond to the Ebola virus outbreak, plus an initial budget review session on veterans’ health programs.
Examining HHS Efforts on Mental Health and Disease Codes
Separately, two House committees on Wednesday review new Government Accountability Office reports critiquing the Department of Health and Human Services. An oversight committee examines a report on HHS leadership on mental health programs (view GAO report released on Feb. 5) and the health subcommittee examines HHS implementation of new health care disease codes (view GAO report released on Feb. 6).
Additionally, committees mull the GAO’s efforts to monitor high-risk programs in Senate morning and House afternoon sessions on Wednesday. House Science, Space and Technology panels on Thursday mull privacy expectations for information shared on the federal health insurance exchanges.
The House this week voted to repeal the 2010 Affordable Care Act. The action has been a regular occurrence since Republicans took control of the chamber in 2011. The current bill (HR 596) faces an uncertain and likely tumultuous fate in the Senate and a certain White House veto. However, the new repeal measure adds a requirement for committees to craft a replacement for the health law. Several committee chiefs quickly responded with a framework for a replacement plan. Senate Finance Chairman Orrin G. Hatch of Utah and House Energy and Commerce Chairman Fred Upton of Michigan adjusted an earlier proposal that now includes a tax on high-value employee medical coverage, new malpractice limits and a provision that would allow consumers to purchase insurance policies in different states.
Separately, the Senate completed action on bill (HR 203) that would require annual evaluations of the Veterans Affairs Department’s mental health and suicide prevention programs. The measure is ready for expected White House approval. Also, the White House on Monday submitted its fiscal 2016 budget request to Congress. Health and Human Services Secretary Sylvia Mathews Burwell later spent time before a Senate committee explaining the administration’s funding proposal, along with questions about the ongoing implementation of the health care overhaul law.
Congressional Committee: Vaccines: From Flu to Measles
The House today is scheduled to vote on a measure (HR 596) that repeals the 2010 Affordable Care Act. The measure has little chance for navigating past Senate consideration and faces a certain White House veto. However, the bill calls for House committees to develop health law replacement alternatives and is a politically necessary step toward possible development of any health care overhaul adjustments.
Meanwhile, the White House on Monday unveiled details of a fiscal 2016 budget proposal. Contentious elements of the plan are unlikely to gain support in Congress. However, the budget package is a necessary step in toward regular action on the fiscal 2016 spending bills. The budget offers a springboard for possible action on budding legislative efforts to streamline and support new medical research. Additionally, the budget offers some suggestions for legislative action, such as offsetting the cost of funding an extension for children’s health insurance coverage through an increase in tobacco taxes.
Separately, the House on Monday quietly approved a measure confirming emergency preparedness grants for medical supplies and pharmaceutical stockpiles (HR 361). The Senate deferred until today final legislative action on bill (HR 203) that would require annual evaluations of the Veterans Affairs Department’s mental health and suicide prevention programs.
The White House today will deliver to Congress the administration’s annual budget proposal. The bulk of the budget request is pegged toward entitlement and safety net programs, such as Social Security, Medicare and Medicaid. The budget plan will also call for exceeding caps on discretionary spending, which is enforced by a sequester mechanism that automatically cuts program spending. The Senate Finance Committee on Wednesday will the first congressional panel to quiz Department of Health and Human Services Secretary Sylvia Mathews Burwell on the HHS budget.
Meanwhile, the Senate today is poised to quickly complete action on a bill (HR 203) that would require annual evaluations of the Veterans Affairs Department’s mental health and suicide prevention programs. The House also plans a non-controversial vote on a measure (HR 361) confirming emergency preparedness grants for medical supplies and pharmaceutical stockpiles.
On Tuesday, the House is scheduled to vote on a measure (HR 596) that repeals the 2010 Affordable Care Act and calls for House committees to develop replacement alternatives. Also on Tuesday, a House panel holds a hearing to review preparedness and treatment efforts surrounding this year’s flu season.
The Congressional Budget Office on Monday set the stage for the start of the congressional budgeting season with its annual long-term economic outlook report. The budget analysis agency estimates that the long-term cost 2010 Affordable Care Act is about $101 billion lower than an earlier estimate. The total net cost of the law over the next 10 years is $1, 350 billion, which is a 7 percent reduction from previous estimates and substantially lower than original estimates. Aiding the reduced cost is a $68 billion reduction in the cost of subsidizing insurance purchased on state and federal insurance exchanges. However, the lower costs are partially offset by increased Medicaid spending. The CBO also reports that 42 million people in the United States were uninsured in 2014, a number that would have been 12 million larger without the health law. In 2015, the number of uninsured will be about 36 million.
Additionally, the report notes that federal spending on the Medicare program will grow by nearly 7 percent a year over the next 10 years. The CBO estimates that the number of people enrolled in Medicare will rise to about 73 million in 2025, from 54 million last year. Overall, the federal annual deficit is projected to fall to $468 billion in fiscal 2015, and again in fiscal 2016, before topping $1 trillion again in 2025.
More Americans support spending on global health needs instead of foreign aid in general, according to a new poll by the nonpartisan Kaiser Family Foundation – in part because the public thinks medical aid abroad protects them at home.
About 36 percent of 1,505 adults who were polled in early December said that the United States spends “the right amount” on health services overseas, 26 percent said “too much” and 27 percent saying it was “too little.” That’s compared to 24 percent who said the country spends the right amount on the broader category of foreign aid, 56 percent who said the nation spends too much on general foreign aid and 11 percent who said it was too little.
But people’s attitudes on overall foreign aid change when they learn how little the federal government actually spends on foreign assistance as measured by a percentage of the budget, the poll found. When told that all foreign aid spending is about 1 percent of the federal budget, the number of people saying it is too much fell from 56 percent of respondents to 28 percent of those polled. The number of people saying it was the right amount grew to 34 percent and the number saying it was too little grew to 26 percent of people surveyed.
People may more supportive of global health spending than foreign aid because they see a benefit for Americans. About 69 percent said that improving health in developing countries protects the health of Americans by preventing the spread of diseases like SARS, bird flu, swine flu, and Ebola.
Every January, the Congressional Budget Office provides congressional committee’s with a sort-of advance warning notice. The CBO report lists the various unauthorized appropriations and expiring authorizations which may need some legislative attention. Most legislation that streams through Congress largely updates, revises and renews various existing laws. Often, for budgetary reasons, program spending is given a discrete time frame and a specific expiration date. As a result programs are often face authorization renewals.
The CBO report, sorted by House committee jurisdictions, can be a useful guide on possible legislative action this year. Included in the mix of expired programs is a wide range of very prominent health programs and laws, including the National Institutes of Health and the Affordable Care Act. A Senate committee on Tuesday already scheduled early action on a re-authorization bill for senior citizen nutrition programs.
A bipartisan group of senators led by New Hampshire Democrat Jeanne Shaheen and Georgia Republican Johnny Isakson this week proposed a measure (S 150) seeking to overhaul the entire budget and appropriations process by shifting spending bills into a two-year cycle. Such a change, which has been suggested by lawmakers in the past, would significantly alter the legislative timetable. Currently lawmakers scramble each year in April and May to pass a budget resolution and often are deadlocked on spending priorities at the Oct. 1 start of the new fiscal year.
The chairman of the Senate Health, Education, Labor and Pensions Committee, Republican Lamar Alexander of Tennessee, also supports the idea, noting that the longer budget cycle also would give committees more time to review and consider ending unnecessary programs.
Separately, Alaska Republican Rep. Don Young and New Mexico Democrat Ben Ray Lujan this week introduced a measure (HR 395) that would authorize the Indian Health Service (HIS) through a 2-year appropriations process. The IHS doesn’t have automatically approved spending for health care services like the Medicare and Medicaid programs. The agency is regularly plagued by mid-year shortfalls and would likely benefit from a longer-term spending plan. The concept of two-year funding is already used for selected portions of the veterans’ health care program.
Week in Review
The Senate today is the last stop before final passage of an omnibus year-end spending bill. The House on Thursday — in contentious voting — approved the package, along with a stopgap spending resolution keeping federal agencies open over the next few days as senators deliberate on the larger spending bill.
The measure has been in negotiations for several weeks, but added spending is limited due to previously established budgetary caps, which left lawmakers little room to add money for discretionary health programs. Overall, funding for the agencies within the Department of Health and Human Services remain largely at last year’s levels or receive modest increases. However, separate mandatory spending for the Medicare and Medicaid programs jumps by more than $60 billion compared to 2014 levels, spurred by a huge increase in Medicaid funding to the states due to the Affordable Care Act.
Additional funding to respond to the Ebola crisis, particularly focused on assistance to West African countries and FDA and NIH drug and vaccine development, reduced any wiggle room for new spending. The original $6.2 billion White House Ebola response request was reduced in the spending package to $5.4 billion and is spread out between HHS agencies, the State Department and the Defense Department. Also, Republicans claimed no new health care overhaul law funding but omitted any major health law program cuts, except for a continued hold on money for a dormant health law provider payment advisory board. Separately, the measure continued a long-standing federal abortion ban and calls for administration action to clarify health plan abortion coverage requirements.
Congress this week completed action on a bill reauthorizing newborn screening programs (HR 1281), offering education, information tools and research on inheritable disorders in newborns and children. Also, the House passed bills updating veterans’ suicide prevention efforts (HR 5059) and renewing breast health education programs (HR 5185). The Senate could quickly complete action on the two measures today or this weekend prior to ending the term of the 113th Congress. The House has already retired for the year.
The Senate today is racing toward completing votes on a spending bill package that includes money for health care programs through the end of fiscal 2015. The 1600+ page bill details spending levels for most federal agencies, except for temporary stopgap funding provided for the Department of Homeland Security. However, the main bill text itself offers very dense reading material. A separate accompanying explanatory statement on the bulk of the bill’s health care agencies provides useful background and commentary on many health care issues that have recently attracted lawmaker attention. At 110 pages, the document — complete with copy-editor notations — describes congressional views and suggestions for health programs and regulatory activities.
CQ HealthBeat’s (@CQHealthTweet) KerryYoung reported (subscription) on several elements included in the explanatory statement. The Centers for Disease Control and Prevention is ordered to direct funding for fighting prescription drug overdoses to states hit hardest by the drug abuse (see explanatory statement page 30). The report also urges the Centers for Medicare and Medicaid Services to reconsider a decision on Medicare coverage for a high-tech heart pump, with an eye toward expanding eligibility for the device (see bottom of page 75).
Items noted in the explanatory statement may not be included in the actual bill text. Often a provision is too contentious for the bill, but a compromise can land some commentary in the accompanying report. Such a compromise in this year’s bill led to explanatory instructions clarifying coverage requirements for health plans purchased through health insurance exchanges, with an eye toward a dispute over plan coverage of abortion services. The report instructs HHS to take heed of a recent federal audit of health plan abortion coverage and orders quick responses to complaints on violations of “conscience protection” provisions on abortion services coverage (view health plan transparency and provider complaint comments beginning on page 81).
Congressional appropriators toil today to craft a year-end spending package. The objective is to assemble the full-year spending bills for most federal agencies, including contentious health care agency funding and policy riders, plus a stopgap temporary funding resolution for more controversial immigration provisions.
Meanwhile, the Senate is preparing for votes next week on a Pentagon re-authorization bill, which includes a hike in prescription co-payments for service members and blocks a ban on military sales of tobacco products. Senators are also seeking to avoid any amendments on a tax extension bill due to worries that someone will seek an amendment repealing a medical device excise tax.
Earlier this week, the House completed legislative action on bills calling for improved reporting on sudden infant deaths and adds Ebola drugs to an existing FDA rapid drug development program. Also, the House overwhelmingly approved a bill creating a tax-exempt accounts for persons with disabilities. The measure is largely funded through Medicare payment ban on vacuum systems to treat erectile dysfunction and other Medicare provider payment adjustments.
Meanwhile, the Centers for Disease Control staked out guidance on awkward health care provider conversations with patients on the benefits of male circumcision but a FDA panel avoided offering guidance on overturning a controversial ban on blood donations from gay men.