Congressional Update and Outlook

Since Congress returned to Washington post-election, the key legislative focus has been finishing up seven outstanding FY2019 federal funding appropriations bills. Funding for these bills was set to expire Friday, December 7. 

As last week’s funding deadline approached, certain high-stakes issues remained unresolved, including whether to provide $5 billion for President Trump’s “border wall.” Recognizing that more work needed to be done to finalize the funding packages – and to honor the passing of George H.W. Bush – Congress paused its work and voted to extend appropriations funding to Friday, December 21.  This extension provides lawmakers two more weeks to resolve outstanding funding issues, before adjourning for the year.

As appropriations efforts continue, policymakers are also working to finalize the legislative agenda for early 2019. Lawmakers on both sides of the aisle have suggested that tackling the high cost of prescription drugs will be a top health care priority in the new Congress. To that end, Senator Wyden (the ranking Democratic Member of the Senate Finance Committee) and Senator Grassley (the likely incoming Republican Chair of the Committee) unveiled bipartisan legislation last week that aims to recoup Medicaid rebate savings for drugs that are misclassified as generic in the program. In addition, lawmakers have suggested that increasing drug price transparency and providing more scrutiny of pharmaceutical company mergers will be a priority.

Beyond the issue of drug pricing, it is expected that Democrats will make oversight of how the Trump Administration is administering the Affordable Care Act (ACA) a key focus. Among the priorities in this area will be reviewing various recent regulatory efforts, including Administration proposals that would allow consumers to purchase barebones, short-term, limited duration health care coverage and also increased scrutiny around whether the Administration has scaled back efforts to assist consumers in enrolling in health insurance plans. At the same time, other policymakers – such as Senator Alexander (incoming Republican Chairman of the Senate HELP Committee) and Senator Murray (incoming Ranking Democratic Member of the same Committee) have expressed interest in working on a bipartisan effort to strengthen the Affordable Care Act. In total, we would expect increasing patient access to affordable and quality health care coverage to remain a key focus in the new Congress.

Regarding Medicare, a growing number of Democrats are developing legislation that would allow more individuals to be eligible for the Medicare program. Proposals being developed range from Medicare “buy-in” proposals that would allow individuals age 50 or older or those with limited insurance options to buy-in to the Medicare program to broader, “Medicare-for-All” concepts. It is too early to tell how far these efforts will go in 2019, but it is likely that both the House and Senate will hold hearings next Congress as a first step.

Finally, there are a host of Medicare home health, hospice and palliative care bills introduced in the 115th Congress that may be re-introduced in the new Congress. Regarding home health, a priority is legislation (S. 3458, H.R. 6392 and S.3545) that would ensure the new Medicare home health PDGM model does not inappropriately reduce payments for home health services. Other priority legislation includes the “Home Care Planning and Improvement Act (S. 445)”, which would allow nurse practitioners, clinical nurse specialists, certified nurse midwives and physician assistants to order Medicare home health care.

Regarding palliative and hospice care, there are a number of legislative proposals we would expect to engage on again in the 116th Congress. These include the “Palliative Care and Hospice Education and Training Act (S. 693 and H.R. 1676)”, which aims to increase training and education of palliative care providers and the “Patient Choice and Quality Care Act (S. 1334 and H.R. 2797)” that would establish new Medicare models for management of advanced illness and better support for advanced care planning.

Finally, the new 116th Congress is scheduled to kick-off on January 3, 2019. The first week of Congress will be consumed by House Leadership elections – with a floor vote on whether or not Rep. Nancy Pelosi will be House Speaker as the main event. Also, House and Senate Committees will also unveil new Members of the key legislative Committees. Once these decisions are finalized, we would expect Congress to announce a slew of hearings and new legislation on key priorities. 

VNAA and ElevatingHOME will continue to keep you updated on any legislative proposals or Congressional activities that would impact our members and the patients we serve.

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