Congressional health legislative roundup

Washington Watch

Normally, in a presidential election year, Congress doesn’t get much done. This year is no exception. But with a few months before July’s political nominating conventions, a brief window of productivity exists and some lawmakers are pushing bipartisan proposals to help change Congress’ gridlock image. Let’s look at what’s on the agenda (with the exception of the seemingly never-ending attitudes and activities surrounding Obamacare) over the next couple of months before politics overwhelms all congressional activity.

Congress left town for most of May, with lawmakers missing deadlines on resolving the budget. Must-do items facing lawmakers upon their return include finding money to counter the Zika virus, and a scary July 1 deadline for averting a fiscal disaster in cash-strapped Puerto Rico.

To their credit, the Senate finally passed a major energy bill, the first in nearly a decade, and made some progress on providing help for Flint, Michigan, which is grappling with a water contamination crisis from lead pipes.

But efforts to revive the moribund process of passing more than $1 trillion worth of annual spending bills ran aground and talks on finding $1 billion-plus to help fight the Zika virus continue to appear shaky.

The budget

A budget agreement is critical because it would contain virtually all options for passing any health care legislation as amendments to a larger bill. It would also authorize spending for key health care proposals.

But both the House and Senate missed an April 15 deadline for producing a budget blueprint, which was particularly embarrassing for House Speaker Paul Ryan, R-Wisc., who as Budget Chairman had successfully passed four budgets. Meanwhile, in the Senate, lawmakers have gone directly to the 12 annual spending bills in hopes of avoiding a year-end omnibus measure. Nonetheless, some lawmakers are working privately to find bipartisan measures they can get through to show accomplishments as they face voters for re-election.

Drug prices

With pressure building on Congress to find a way to lower skyrocketing drug costs, one of the few pieces of legislation that might be able to find a bipartisan consensus and move forward comes from Sen. Ron Wyden, D-Ore., the ranking Democrat on the Senate Finance

Committee. He introduced legislation aimed at protecting seniors from high drug costs by capping drug cost-sharing for Medicare enrollees. This would limit how much seniors would have to pay out of pocket to no more than a cap of roughly $7,500.

Wyden is hoping this legislation would be particularly helpful to seniors in Medicare who often have multiple medications that are costly. The Affordable Care Act already caps out of pocket costs under health insurance plans sold on the law’s marketplaces, but those same protections are not always available under Medicare. Under current law, once beneficiaries reach the $7,500 out of pocket threshold, they must pay 5 percent of any additional drug spending. That can quickly add up.

In 2013, Wyden noted, almost three million seniors in Medicare’s drug program had to pay costs above that cap. “It defies common sense that protection from high out-of-pocket costs exists for almost all other types of health coverage, but not for traditional Medicare,” Wyden said.

But you can expect strong opposition to the proposal from the health insurance industry.

They counter that caps on out-of-pocket costs don’t really help reduce the actual price of drugs and instead will just force insurers to pass on any costs to consumers in the form of higher premiums or deductibles. It’s unclear if the legislation can get through Congress, since many lawmakers count on dollars from the pharmaceutical industry in their re-election efforts and few want the drug industry as an enemy.

Meanwhile, a second fight is already underway over a proposed Medicare idea aimed at fighting high drug prices. Medicare wants to change how it pays for certain drugs and that has united both Democrats and Republicans in opposition. Republicans want it to be completely scrapped, while Democrats have expressed serious reservations and called for changes.

Dr. Patrick Conway, the deputy administrator at Medicare, said his agency will take

feedback and make adjustments as needed. Speaking at an Alliance for Health reform event, Conway said the five-year pilot program would change the way Medicare Part B pays for drugs.

Currently, Medicare pays doctors the average price of a drug plus 6 percent. The administration argues the system incentivizes doctors to prescribe higher cost drugs so that they get paid more.

The pilot program would reduce the 6 percent add-on to 2.5 percent plus a flat fee of about $16.

Conway says Medicare will follow Congressional suggestions and make the proposal apply only to a smaller geographic area and also insure it doesn’t have harmful effects on rural or smaller providers. Some fear the program could harm patients by limiting their access to treatments if doctors’ costs to acquire drugs become higher than the reimbursement amount from Medicare, particularly in rural areas.

In a letter to Medicare from every Democrat on the Senate Finance Committee, lawmakers called for changes. Republicans, meanwhile, have called for the program to be scrapped altogether. But the Medicare official has been defending its proposal, arguing that nothing in the proposal limits access to any medication.

But Conway acknowledges that the subject is “complex” so he’s not surprised by the strong Congressional reaction. This subject remains a work in progress and a battle that is expected to continue for some time.


One piece of legislation that could find some bipartisan agreement is being offered by Sen. John McCain, R-Ariz. It would expand and make permanent a program allowing veterans to go anywhere for health care. After the frustration over the slow pace of improvements in the U.S. Department of Veterans Affairs’ system, McCain’s proposal would remove the current restriction that veterans must wait more than 30 days or live more than 40 miles away from a VA facility in order to go outside the VA system for care.

His plan would allow veterans to go to walk-in clinics for minor illnesses, expand operating hours of VA clinics and pharmacies and expand telemedicine to allow VA health care providers in one state to treat veterans in other states. It would also encourage VA facilities to undergo a best-practices peer review by some of the leading hospitals networks in the country.

McCain said he has met several times with Sen. Johnny Isakson, R-Ga., chairman of the Senate Veterans Affairs Committee and that he expects the proposal to attract Democratic support and have a likely chance of passage before the end of this Congressional session.

Mental health

If any health-related legislation has a good chance to get enacted, it is a bipartisan effort to modernize the system for treating mental illness. But, anything could get derailed by politics in an election year. Still, a package of bills approved by the Senate Health Committee, with strong bipartisan support, has galvanized dozens of groups representing patients, physician and state and local leaders.

Separately, the Obama administration has proposed more than $500 million in new federal spending to expand mental health services nationwide. The big fear is not that an agreement can’t be reached, but that the typical dysfunction and partisan rancor in an election year may remove any chance of any legislation getting through the House and Senate and getting the president’s signature.

An estimated 1 in 5 Americans suffered from a mental illness in the last year, according to federal data. Nearly 10 million people have a serious disease such as schizophrenia or bipolar disorder.

For decades, the U.S. has had a patchwork system of mental health care that leaves tens of millions of people without access to vital services. By one estimate, more than half of U.S. adults with a mental illness do not receive treatment. Inadequate community services and too few psychiatric hospitals are widely seen as major factors in epidemic levels of homelessness and incarceration among the mentally ill.

So last month, the Senate Health Committee advanced a package of bills that, among other things, would strengthen a 2008 law that requires health insurers to cover mental health services at the same level they cover treatments for physical health conditions. The so-called parity law extended new protections to the mentally ill, but minimal enforcement by state and federal regulators has left in place substantial barriers for patients with mental health and substance abuse conditions, advocates say.

The Senate mental health bill — developed by a group of lawmakers including Senate Health Committee Chairman Lamar Alexander, R-Tenn., and its senior Democrat, Sen. Patty Murray, D-Wash. – drew unanimous support in the committee this month. But advocates want the bill to go even further, adding money for community-based services such as mental health clinics, housing and crisis response teams.

Alexander has not committed to those additional funds but said the Appropriations Committee might consider them later when money is appropriated. Earlier this month, Senate Republicans rejected calls to appropriate new money for drug treatment programs even as lawmakers passed a sweeping bill to respond to the widening epidemic of heroin and opioid abuse.

But getting comparable mental health legislation through the House of Representatives may be more challenging. While Speaker Ryan has signaled interest, a House version of the Senate bill has been stalled for some months, mostly over the issue of increased funding.

At the same time, the House Budget Committee last month approved its budget blueprint, which would slash federal spending by about $6.5 trillion over the next decade, including rolling back Medicaid health insurance coverage for millions of poor Americans. Medicaid is the single largest payer for mental health services in the U.S.

Also contributing to this report were: AP, the Hill, Roll Call, Politico, the Los Angeles Times, StatNews and Morning Consult.

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