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Authored by District Policy Group

ACA Repeal and Replace Efforts Move to the Senate

A second try at passing a bill to repeal and replace the Affordable Care Act (ACA) in the House was successful on May 4. Prior to the House’s passage of the revised American Health Care Act (AHCA), a White House spokeswoman said President Trump had been “incredibly engaged” in negotiating the bill’s way forward, citing the one-hour meeting with former Energy and Commerce Committee chairman Rep. Fred Upton (R-MI-06) and Rep. Billy Long (R-MO-07) regarding their amendment to provide $8 billion to help offset the costs of covering individuals with pre-existing conditions in high-risk pools. The amendment was ultimately included and swayed the support of enough moderate Republicans to pass the bill. The final vote tally was 217 to 213. All Democrats and 20 Republicans voted against the measure.

Of interest, the AHCA would allow states to obtain waivers from the ACA requirement that marketplace plans include coverage for Essential Health Benefits (EHB), which include mental health services and substance abuse treatment. However, as part of its Patient and State Stability Fund, the bill provides $100 billion through 2026 to promote innovative solutions to lower costs and increase access to health care, including helping high-risk individuals gain coverage access in the individual market.

The response of Senate Republicans to the House bill was circumspect. Senators who have their own bills to repeal and replace the ACA responded most critically. Nevertheless, the majority of Republicans agreed that the House bill would serve as a starting point for their efforts, rather than a bill they would take up. Over the Memorial Day recess period, the Republican leadership of the relevant Senate committees began drafting their own bill to reform health care. As of mid-June, it appears that a compromise between conservative and moderate Senate Republicans on the phasing out the ACA’s Medicaid expansion, state waivers for EHB requirements, and coverage for pre-existing conditions may allow the chamber to move forward with a bill they can vote on before the July 4 recess, which has been a goal of Majority Leader Mitch McConnell. 

White House, Agencies Prioritize Efforts on Opioids

In late March, President Trump announced the establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which is tasked with “studying the scope and effectiveness of the federal response to this crisis and providing recommendations to the President for improving it.” New Jersey Governor Chris Christie was selected to chair the Commission and other members include Massachusetts Governor Charlie Baker, North Carolina Governor Roy Cooper, former Congressman and mental health and addiction advocate Patrick J. Kennedy, and addictions researcher and former Deputy Director of the Office of National Drug Control Policy, Bertha Madras.

Shortly thereafter, HHS Secretary Price announced the agency’s five point strategy to contribute to the federal response efforts outlining: (1) improving access to treatment and recovery services; (2) promoting use of overdose-reversing drugs; (3) strengthening our understanding of the epidemic through better public health surveillance; (4) providing support for cutting edge research on pain and addiction; and (5) advancing better practices for pain management. In April and May, Price participated in an opioids listening tour of the states, which included stops in Ohio, Michigan, West Virginia, Maine, and New Hampshire.

Additionally, in a letter to Governors, Secretary Price announced the availability of $485 million in grant funds for evidence-based prevention and treatment activities in the states through the 21st Century Cures Act. A second round of grants will be distributed next year.

Meanwhile, on May 9, the Food and Drug Administration (FDA) released proposed changes to the agency’s Blueprint for Prescriber Education for Extended-Release and Long-Acting (ER/LA) Opioid Analgesics, a 2012 curriculum document for use as part of its Risk Evaluation and Mitigation Strategy (REMS) for ER/LA opioids. The changes aim to broaden the curriculum’s modules on pain assessment and management and to include guidance on employing non-pharmacological treatments for pain. The FDA is accepting public comments on the proposed changes through July 10, 2017.

New FDA Commissioner Scott Gottlieb, M.D., said during his confirmation hearing that the opioid crisis would be his “highest immediate priority.” Since then, the agency has established a steering committee to evaluate efforts it can take “to reduce the number of new cases of addiction” and has planned a public workshop on July 10 and 11 on opioid formulations with abuse-deterrent properties.

Other Washington Happenings

On May 10, the Senate Health, Education, Labor, and Pensions (HELP) Committee approved its bill to reauthorize the FDA’s prescription drug, generic drug, medical device, and biosimilar user fee programs, which are set to expire on September 30. The bill is the result of agreements negotiated between industry and the FDA last year, as well as input gathered from stakeholders during several congressional hearings on the matter held this spring. The bill also includes additional provisions to improve regulatory processes for drugs and devices.

The House Energy and Commerce Committee approved its version of the bill on June 7. Both committees have been under pressure from the Administration to increase user fees more than had been agreed upon last year in order for those fees to fund more of the agency’s budget going forward. Neither committee incorporated this request into their bill, however, and next steps for the legislation were unclear as of mid-June. Changes can still be made to the bills before their full chamber votes, and then one bill, or the other, or a compromise bill, will need to be passed by both chambers before going to the president for signature.

The Trump Administration released its full fiscal year (FY) 2018 budget request for the federal government on May 23 totaling $4.1 trillion. It proposes a $3.6 trillion overall reduction in spending over the next ten years. For FY 2018, the budget proposed cutting $610 billion from Medicaid and assumes $250 billion in savings from repealing the ACA. The budget does not propose any cuts or policy changes to Medicare.

As has been the case with most President’s Budget requests, Congress was quick to remind the public that they hold the purse strings of the federal budget. As the House and Senate Appropriations Committees get to work on drafting their funding bills for FY 2018, they can be expected to consider the Administration’s requests, but it is unlikely that many of the proposal’s numbers will be adopted.

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