Health policy issues remain unaddressed as Congress nears summer recess

It’s summertime, which means people all across the country take time off of work to relax and unwind, including the 118th United States Congress.

In about a month, leaders on Capitol Hill will break for the annual August recess. Upon their return in September, there will only be a few months left before 2024 – giving lawmakers a short timeframe to hone in on any health policy priorities leading up to the presidential election year.

Policy wonks predicted at the end of 2022 that this year would be largely uneventful when it comes to major healthcare legislation, mostly due to Congress being narrowly divided. That prediction has, for the most part, been proven true. 

There has been no milestone healthcare legislation this year that even comes close to topping the Inflation Reduction Act passed last summer.

However, this isn’t for a lack of trying. 

In March, President Biden released his 2024 budget proposal, which included several major healthcare priorities, including a continued fight to lower drug costs, boost future pandemic preparedness, increase mental health care access and extend Medicare solvency.

On that front, Biden has sought to secure long-term funding of Medicare by increasing taxes on Americans who make more than $400,000 per year and by strengthening drug pricing regulations to help Medicare save money. 

One of his legislative proposals involved bolstering the rule that requires pharma companies to pay rebates to Medicare when their drug prices rise faster than inflation.

Medicare cuts escape debt ceiling deal

While many of Biden’s healthcare priorities remain up in the air, Congress still has one major accomplishment under its belt for 2023: bringing an end to the COVID-19 public health emergency in May.

“[Ending] the COVID-19 emergency was one of the top healthcare priorities of Republicans – and many Democrats – in the new Congress,” said Terry Haines, founder of healthcare consultancy Pangaea Policy.

Another significant legislative accomplishment, Haines noted, was keeping healthcare spending “pretty much intact” during the spring’s contentious debt ceiling negotiations.

Despite strenuous efforts on the Republican side to make cuts to Medicaid and Medicare, those federal health programs remained largely unscathed. Of note, Medicaid work requirements – a policy favored by Republicans that would potentially put up to 1.7 million enrollees at risk of losing coverage – were not included in the deal. 

That exclusion indicates that congressional Democrats and the Biden administration remain in the driver’s seat for crafting health policy at the federal level.

“One thing this budget deal suggests: Democrats won’t go along with Republican proposals to cut or impose restrictions on Medicaid,” Larry Levitt, EVP for health policy at Kaiser Family Foundation, noted in a recent tweet.

One thing this budget deal suggests: Democrats won’t go along with Republican proposals to cut or impose restrictions on Medicaid.

— Larry Levitt (@larry_levitt) May 28, 2023

Still, the spending fight isn’t quite over. The debt ceiling deal isn’t a final decision on healthcare spending or how specific priorities should be funded, Haines noted. 

“That’s still ahead – but it’s worth noting that there’s not [much] sympathy for massive defunding of anything in particular,” he said.

Ongoing opioid fight

The nation’s multi-decade fentanyl crisis worsened during the course of the COVID-19 pandemic, which may prompt lawmakers to craft policies that will address the high overdose death rates. 

More than 109,000 people died from drug overdoses between January 2022 and January 2023, recent data from the Centers for Disease Control and Prevention shows – marking a 0.7% year-over-year increase.

To counteract this trend, Reps. Morgan Griffith, (R-VA), and Bob Latta, (R-Ohio), introduced the HALT Fentanyl Act, which passed the House in May. 

The bill would permanently label fentanyl under Schedule I of the Controlled Substances Act, the highest classification of illegal drugs. It would also create mandatory minimum sentences for fentanyl distribution, among other restrictions. Though Biden has voiced support for the bill, opponents argue it would exacerbate unjust incarceration.

Beyond Congress, the Department of State also launched a Global Coalition to Address Synthetic Drug Threats, which includes more than 80 countries and will seek solutions to the global opioid crisis.

Drug pricing, revisited

Finally, more drug pricing regulation – a topic that has received persistent attention in recent years – continues to be prioritized by both sides of the aisle.

With the Inflation Reduction Act’s Medicare negotiating provision set to take effect in the coming years, policymakers have turned their attention to getting more bills out the door that would further restrict both pharma companies and pharmacy benefit managers (PBMs) from increasing the cost of drugs.

Recently, PBM reform has amassed both Democratic and Republican support, though it’s unclear what policies will rise to the surface as a result of the momentum. 

This year, lawmakers have introduced a number of bills targeting PBMs, such as the Pharmacy Benefit Manager Transparency Act of 2023, which would bar PBMs from spread-pricing or charging plans at a different price than what the PBM reimburses pharmacies.

Just last month, a group of bipartisan senators introduced another PBM reform bill – the Protect Patient Access to Pharmacies Act. That bill aims to save money for people on Medicare by prohibiting PBMs from charging direct and indirect remuneration clawback fees.

Despite the bipartisan support for these PBM reforms, Haines is not so easily convinced that any of them will pass this year.

“There’s not any bipartisan consensus to make major changes anywhere in healthcare, whether it’s drug pricing or the Affordable Care Act,” Haines explained. “There might be some minor changes, but that will come as part of the spending bill or appropriations process. That’s just getting started and will go on for the entire second half of 2023, most likely.”

What can be expected, however, is a continued publicity and legal battle between proponents of drug pricing regulation and the pharma industry.

In June, Sen. Bernie Sanders, (I-VT), announced he would oppose Biden’s nominee for the director of the National Institutes of Health, Dr. Monica Bertagnolli, until the White House brings forth another tangible plan to reduce drug prices.

Still, the pharma industry remains entrenched and has already shot back plenty – with Merck being the first Big Pharma to launch a lawsuit against the federal government over Medicare negotiations while lobbying group PhRMA continues its attacks via multi-million dollar ad campaigns.