January 28, 2023

We hope that you enjoyed a wonderful Thanksgiving break. Congress is returning to work with only three weeks left before the government runs out.

  • We met with senators, staff and lobbyists Monday for an update on our lame-duck preview. Here’s our sense of the outlook so far.

A newsy comment by Sen. Richard Burr: He Peter was told Monday that there was no chance of FDA reforming oversight of dietary supplements by the end of the year.

  • Later, a senior Republican HELP Committee aide said that there are possibilities for reforming FDA surveillance of cosmetics and that it is “linked to the VALID Act reforming diagnosis test oversight, a measure pushed in part by Burr.
  • The aide stated that if there is consensus on VALID, cosmetics could flow with it.
  • Another candidate is also the PREVENT Pandemics Law, which Burr introduced together with Sen. Patty Murray.
  • Burr stated, “Everything is in discussions right now. Hopefully in the next week or 10 days we will get some read on it.” “I think VALID and the PREVENT Act are currently on the table.

The outlook is brighter For items that have a deadline, such as avoiding Medicare PAYGO cuts, or at least partially avoiding a cut of 4.5 percent to physician payments.

  • Burr’s comments suggest that dietary supplement reform looks very unlikely. However, there are some opportunities for FDA items such as cosmetics, VALID and accelerated-approval.
  • A former Democratic aide stated that it will be easier for public health policies, such as the PREVENT Pandemics Bill, to pass and to negotiate than policies that need extensive pay-fors.
  • An extension of the telehealth flexibilities seems very likely, though the specifics on how long the extension will be — and whether permanency is on the table — are still up in the air.
  • According to a House Republican aide, bipartisan negotiations over the FMAP rate for Puerto Rico and the number of years it takes to expand Medicaid funding are a low priority. This is the starting point. Bipartisan 2021 Energy and Commerce Bill The FMAP rate was 76%, which allowed for an increase in funding for five years.
  • Two health care proposals that Republicans oppose — vaccine mandates and paying for abortion travel — could also hold up the annual defense spending bill, which needs to pass in December.
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What’s really looking tough: COVID-19 funding. The White House made another request for $10 billion to cover COVID requirements, including the development of next generation vaccines that are more effective in targeting new variants.

  • But Republicans have been resisting new COVID-19 funds for months, and there’s no sign they are changing their minds.
  • We’re also hearing more and more that the $16 billion price-tag associated with Medicare Advantage prior authorization reforms that passed the House earlier this year is likely to mean it won’t end up in an end-of-year package.

The big picture: There’s definitely uncertainty about what’s going to happen. Negotiations are still not intense, so there is still a lot to decide. The biggest unknown is how much money can be spent on health-related items.

  • It’s always a safe bet to say Congress is going to kick the can down the road, at least a little bit, and we’re hearing the funding deadline could be extended from Dec. 16 to Dec. 23. (So don’t book your flights home for the holidays too soon!)
  • “I don’t know if it will get us there.” [the package] completed by the 16th. Sen. Richard Shelby said Monday evening that the 16th day is the best day to do it, but that we might not be done until Christmas.