Congress' race to recess

Jul 10, 2024

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Driving The Day

A general view of the U.S. Capitol Building is shown.

Lawmakers in Congress have a hefty to-do list to tackle before their August recess. | Anna Moneymaker/Getty Images

THE WORK BEFORE THE BREAK — Even though lawmakers will likely tackle most of their health care policymaking after the November election, Congress has plenty on its agenda before its August recess.

Many eyes are on Democrats returning to the Capitol this week for the first time since President Joe Biden’s debate performance, and they’re facing reporters asking whether Biden should stay in the race. As one lobbyist quipped to us, health care is “whispering, hoping to be heard in a hurricane.”

But they’ll also deal with appropriations for health care agencies and the future of telehealth in the Medicare program among other issues.

Here’s what to expect in the coming weeks:

Appropriations: Lawmakers will likely have to pass a stopgap spending measure to avoid a government shutdown at the end of September, but they’re moving forward on a number of appropriations bills impacting health care agencies.

The House Appropriations Committee is set to mark up the Labor-HHS-Education package after it advanced through a subcommittee on party lines last week. That bill would cut HHS’ fiscal 2025 budget by 7 percent, but it isn’t likely to become law in its current form, given opposition from Senate Democrats. The full committee will also mark up the Agriculture-FDA measure that advanced last month on party lines.

In the upper chamber, the Senate Appropriations Committee is slated to mark up the Agriculture-FDA package and the Military Construction, Veterans Affairs, and Related Agencies package on Thursday.

Telehealth: Legislation that would extend loosened virtual care rules in Medicare for two years was supposed to get a full committee markup at the end of June, but it fell victim to tensions over an unrelated privacy bill that forced Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee, to cancel the markup.

The pandemic-era rules expire at the end of the year. Rodgers has said she hopes to advance a fully paid-for package before the August recess.

Pediatric rare disease priority review vouchers: Rodgers said last month that legislation to reauthorize the pediatric rare disease priority review voucher program remains a top priority. It was also supposed to be marked up late last month in the markup that was ultimately canceled.

The program intends to incentivize the development of treatments for rare pediatric diseases by speeding up the regulatory process and is set to expire at the end of September.

WELCOME TO WEDNESDAY PULSE. It’s NATO week in D.C., which means my bus route is detoured, streets are closed, and it’s too hot outside to walk anywhere, so I’m currently hiding at home for the foreseeable future. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.

A message from the PBM Accountability Project:

Patients, providers, and employers deserve to pay transparent, fair prices for prescription drugs, but pharmacy benefit managers (PBMs) are gaming the system while eating up profits and driving up costs. The Wall Street Journal recently uncovered that PBM middleman “mark up prices of generics for cancer, multiple sclerosis and other complicated diseases,” particularly medications from mail-order pharmacies that PBMs own. Congress must act now and protect patients from big PBMs pigging out on patient savings. Learn more at pbmaccountability.org.

In Congress

The seal for the U.S. Department of Health and Human Services is displayed.

House Republicans want to reduce HHS' budget in fiscal 2025 and restructure the NIH. | Jacqueline Larma/AP

INSIDE THE HHS FUNDING BILL — House Republicans want to cut the HHS fiscal 2025 budget by 7 percent, which includes eliminating programs related to health and climate change.

The Republican Party outlined its plans for the Labor-HHS-Education appropriations bill Tuesday in a House Appropriations Committee report ahead of a full markup today.

The report explains how the GOP intends to allocate $107 billion for HHS, which is $14 million less than what the White House requested for 2025.

The bill includes a number of controversial proposals likely to rile House Democrats, including:

— Slashing Title X family grants funding

— Eliminating certain CDC programs, including the agency’s injury prevention program, which focuses on reducing domestic violence, violence against children and overdoses and some climate change and health surveillance work “to restore public confidence and better focus CDC on controlling and preventing communicable diseases,” per the report

— Requiring the CDC to include in its data reporting on fertility clinics the number of fertilized eggs typically created during an in vitro fertilization cycle as well as how many of those embryos are destroyed, whether accidentally or intentionally, echoing an ask by Senate Republicans

— Barring federal dollars from being used to promote abortion or reproductive rights information and information on gender-affirming care

— Restructuring the NIH

The bill also includes a funding increase for provider training and loan repayment programs, emerging and zoonotic disease prevention and substance use disorder programs — though Republicans said they wouldn’t fund certain harm-reduction programs they say encourage illegal drug use.

Read more about what’s in the bill here.

WHERE THE FIGHTS MIGHT BE — House Democrats on an appropriations subcommittee have said they’ll push back on some proposals in the bill — including those that would limit reproductive health care access and shrink the NIH.

Here are the other appropriations matchups brewing:

— The appropriations bill seeks to block HHS from implementing a final rule requiring nursing homes to meet minimum staffing requirements. It’s the latest in a series of efforts by lawmakers to stop the rule that’s unpopular among the long-term care industry that argues it would exacerbate staffing shortages. Labor groups and patient advocates, however, have said opposition to the rule is antiworker and would harm patient safety. On Tuesday, a coalition of 50 labor organizations wrote to Congress, urging them to drop legislative attempts to block the rule.

— The bill also cuts funding for HIV/AIDs prevention and treatment programs, a measure that has alarmed more than 200 HIV/AIDS groups who’ve been pushing Congress to reconsider. Those groups opposed cuts to these same programs in last year’s budget process. Those cuts were later reversed, and funding remained level.

Understand 2024’s big impacts with Pro’s extensive Campaign Races Dashboard, exclusive insights, and key coverage of federal- and state-level debates. Focus on policy. Learn more.

BIRD FLU

BIRD FLU FEARS AS ANOTHER HERD INFECTED — A new bird flu case in a dairy herd in Michigan this week has inflamed fears that the longer the virus circulates, the greater the risk it could mutate and more easily spread among humans, POLITICO’s Meredith Lee Hill reports.

Some state agriculture and health officials say it’s likely the virus is widely circulating among dairy herds across the country, although as of July 3, it had only been confirmed in herds in 12 states.

Tim Boring, director of the Michigan Department of Agriculture and Rural Development, said in an interview that he wasn’t surprised to see the new case, which he said was detected as the result of the federal government’s interstate testing requirements for dairy cows mandated in late April.

The Biden administration, however, has struggled to persuade farmers to participate in its voluntary testing programs, as it works to better track and contain the virus’ spread.

Summer spread concerns: Many states nationwide are either banning or limiting lactating dairy cows from county and state fairs this summer, for fear that the gatherings will become superspreader events for the virus.

Catastrophic flooding in Iowa, Minnesota and South Dakota — all states with confirmed bird flu cases in dairy herds — is also triggering concerns that breached manure pits and other contamination could supercharge the virus’ spread.

A message from the PBM Accountability Project:

AROUND THE AGENCIES

NEW HIV GUIDANCE — New federal guidelines recommend that all adults with HIV be assessed annually for anal cancer.

Why it matters: While anal cancer is relatively rare in the general population, people living with HIV have higher rates of this type of cancer. Men who have sex with other men and transgender women with HIV who have sex with men are disproportionately affected, the NIH said.

This is the first time federal recommendations have been made on this topic.

The National Cancer Institute says that regular screening and the removal of precancerous growths reduce the risk of cancer.

According to the guidelines issued Tuesday by the NIH’s Office of AIDS Research, people with symptoms or signs of cancer during an initial screening should be examined with a high-resolution anoscopy.

Understand 2024’s big impacts with Pro’s extensive Campaign Races Dashboard, exclusive insights, and key coverage of federal- and state-level debates. Focus on policy. Learn more.

Names in the News

Michelle Sagan is now director of communications and marketing at the National Down Syndrome Society. She previously was senior manager of communications.

WHAT WE'RE READING

POLITICO’s Megan Messerly, Natalie Allison and Irie Sentner report that the RNC has dropped its national abortion limits platform.

The New York Times reports that the second patient to receive a genetically modified pig kidney has died.

NPR reports on the “fourth wave" of the opioid crisis: stimulants.

A message from the PBM Accountability Project:

PBMs are pigging out on employer and patient savings while Americans struggle to afford the medicines they need.

A groundbreaking new study in Washington state uncovered several ways that big PBMs are reaping record amounts of prescription drug profits, hurting local pharmacies, employers and ultimately the patients at the pharmacy counter:

· For a subset of matched claims between the plan sponsors and the pharmacies, the average plan sponsor (employer) costs were approximately $165,000 higher (roughly 80% more) than the reimbursement provided to pharmacies (approximately $8 more per prescription).
· Plan sponsor (employer) costs increased by 30% while pharmacy reimbursement decreased by 3% between 2020-2023.
· PBM-owned mail-order pharmacies had drug markups that were more than three times higher than the markups at retail pharmacies.
· In one example, as reported by the Wall Street Journal, PBMs charged more than $6,000 for a cancer drug that costs $55.

We need Congress to put an end to the great PBM pig-out. Learn more at pbmaccountability.org.