MONDAY MORNING (5/19) Update:
Late last night, the “One Big, Beautiful Bill” finally passed out of the Budget Committee, following the initial failure on Friday. Four conservatives changed their vote to "present", thereby allowing the bill to continue to the next stage of the process while still registering their disapproval. Their main demands center on accelerating work requirements, spending cuts, and Medicaid, although the negotiations will likely continue up till the bill actually passes. Despite clearing this hurdle, the bill will continue to be workshopped, and as mentioned below, faces strong headwinds in passing as currently constituted, both in the House this week, and certainly whenever it gets to the Senate.
WHITE HOUSE:
The White House focused this week on the President’s first visit to the Middle East of his second term, resulting in a new trade deal with the UAE, a $1.2 trillion commitment from Qatar, and $600 billion from Saudi Arabia. One item of note for us:
- Following up on a goal that was already a focus of his first Administration, the President issued an Executive Order that creates a “Most Favored Nation” status for drug pricing in America. The goal of the EO is to bring drug pricing in America in line with what other nations pay for drugs. The full text of the EO is here. While the goal is straight-forward, the mechanics will need to be worked out, and the tools available to the White House to make it happen are not simple.
CONGRESS:
As of the time of this writing (~6PM EST Sunday), the one “big, beautiful bill” of Reconciliation is stumbling to the finish line. The bill failed to advance out of the Budget committee on Friday following pushback from the conservative wing of the GOP, who are upset with the minimal spending cuts and delayed implementation of work requirements, along with other tactics they see as stalling on cutting the deficit. As of now, negotiations between Speaker Mike Johnson and the conservatives have continued through the weekend, and they are hoping to try again tonight, starting around 10 PM. Another major hangup, this time for moderates, is the SALT (State & Local Taxes) limit, which Republicans in high-tax states (like NY & CA) want to see raised significantly. All in all, it’s going to be a pressure-packed week for the House as they race to get the bill out of the House by the weeklong recess scheduled to begin this coming Friday, ahead of Memorial Day weekend. Elsewhere in the political world:
- With several Senators are already quite vocal about it, including Senator Ron Johnson (R – WI) arguing for more cuts and Senator Josh Hawley (R – MO) giving a full throated defense of Medicaid, It’s important to realize that many of these discussions in the House, and frankly whatever actually passes, is likely to be changed dramatically in the Senate.
- The last time a party struggled so heavily with Reconciliation? Democrats in the Biden Administration with the Build Back Better Act. While they eventually got something over the finish line, it was a shadow of the ambitious agenda they began with.
- The other major concern for the GOP? Medicaid cuts remain deeply unpopular. With Democrats planning on unifying their message around healthcare in the Midterm elections and the President back in town to garner support for the bill, GOP Congressional Members are in a political bind.
- While 2025 is an off year for elections, there’s one big one to keep an eye on: the race for NJ Governor that features a wide variety of Democratic candidates. Politico has a rundown of the likeliest candidates and where they stand in relation to the current Governor.
- Another election to keep an eye on? The Texas Senate primary for 2026, pitting incumbent Senator John Cornyn against Texas Attorney General Ken Paxton, and is shaping up to be one of the most expensive and complicated for the GOP.
- With Medicaid cuts such a hot topic on the Hill right now, the CRS released a guide for Congress on where to get data on Medicaid enrollment.
- Now that DOGE is running out of steam following Elon Musk’s departure from the agency, Congress may be stepping in.
- Might be of interest just to us political wonks, but a behind-the-scenes look from The Hill at the marathon 26 and half hours long Energy & Commerce hearing where they eventually passed the Medicaid components of Reconciliation.
AGENCIES:
Separate from the Congressional discussion on provider taxes, CMS issued a rule this week that effectively blocked the MCO provider tax in 4 states: CA, MA, MI, & NY. The fact sheet on the rule can be found here. The full text of the rule can be found at the Federal Register, where comments can be submitted through July 14th. Although specifically targeting MCO taxes, blocking these provider taxes will have detrimental effects on Medicaid funding for other healthcare providers in those states.
The White House’s Office of Management & Budget (OMB)’s request for areas where regulations should be trimmed closed earlier this week. Three of the leading healthcare organizations submitted extensive comments, including AHCA, Leading Age (PDF), and the American Hospital Association. All public comments can be found here.
CMS issued a RFI asking for public input on how technology can be modernized in the delivery of healthcare to patients. The full RFI is available at the Federal Register, where comments can be submitted through June 16th.
CMS released draft guidance for the third round of the Medicare Drug Pricing provisions of the Inflation Reduction Act. You can find a copy of the 221-page guidance here (PDF) and the fact sheet here (PDF). Here’s a good summary of the provisions.
HHS issued a call for input from the public on outdated regulations and what areas are ripe for deregulation. They’ve created a new central page where suggestions can be submitted here.
HHS & DARPA (the Defense Advanced Research Projects Agency) announced a new public-private partnership, called “Equip A Pharma” to utilize AI in the manufacturing and development of drug production. A good summary of the project is here.
CMMI, CMS’s division tasked with innovation and identifying new paths to improve American healthcare outcomes, released a blog post on their new priorities.
With work requirements a likely inclusion in any final reconciliation bill, CMS issued an op-ed in support. Of course, as we’ve discussed many times, it’s not clear that work requirements always help.
FROM THE NOTEBOOK:
- A new working paper from the National Bureau of Economic Research found that Medicaid saves lives. The NY Times has a good summary of the paper.
- We often quote research from the Kaiser Family Foundation here to highlight the impact that different policy proposals will have on Medicare and Medicaid. They created a central resource page for all the Medicaid changes contained in Reconciliation and links to their research on those topics.
- KFF also published a state-context guide to what the Medicaid changes would do on a state-by-state basis.
- Speaking of Minnesota, the state legislative session is scheduled to end this week with many budget questions as yet undecided.
- While they haven’t yet come for pharmaceuticals, many pharmacies are stockpiling drugs ahead of potential tariffs.
- New York City’s plan to switch retirees to Medicare Advantage is heading to the state’s highest court.
- DOGE’s efforts to find fraud at the Social Security Administration turned up very little, with less than 1% of claims found to be a problem, leading to those efforts being abandoned.
- Everyone’s favorite MA insurer, United Healthcare, continues their terrible month with shares plunging more than 10%, following news of a possible criminal investigation into the company’s practices.
- Florida is struggling with getting their budget done, even as the internal dysfunction in the GOP continues.
Comments 0
Post a Comment