21st Century Cures Draft Provides $10 Billion Increase for NIH

Posted on April 29, 2015

Bipartisan House Energy and Commerce Committee leaders have released a discussion draft marking continued progress in the 21st Century Cures Initiative. The discussion draft is the product of months of bipartisan negotiations and bipartisan staff continues working toward finalized legislation.

The biggest and best provision included in the draft provides for an increase in funding for the National Institutes of Health (NIH), both through reauthorization and $10 billion over five years in mandatory funding, starting in FY 2016.

The discussion draft also includes provisions to:

Incorporate the patient perspective in the discovery, development, and delivery process.
Foster development of treatments for patients facing serious or life-threatening diseases.
Repurpose drugs for serious or life-threatening diseases and conditions.
Modernize clinical trials.
Break down barriers to increased collaboration and data sharing among patients, researchers, providers, and innovators.
Help the development of personalized and precision medicines so the right patient can receive the right treatment at the right time.
Provide for continued work in the telehealth space.
Advance a truly interoperable health care system.
Provide clarity for developers of software products used in health management and medical care.

A complete section-by-section summary of the discussion draft is available online here and a one-page summary is available online here.

Budgets, Doc Fix, and Reid Retiring

Posted on March 27, 2015

Breaking News: Senate Minority Leader Harry Reid will not run for reelection in 2016, he said in a video message released this morning.

Budget: GOP leaders in the House and Senate have achieved a major goal of approving their fiscal 2016 budget resolutions this week. The House approved their proposal on Wednesday with the Senate following suit in the early morning hours Friday. The two chambers now face the task of reconciling their two bills before the April 15^th deadline, which would establish the framework for annual appropriations bills and set the direction for other legislation through the privileged reconciliation process. The last time lawmakers adopted a budget conference report was in 2009. Both budgets push more funding to the military while laying the groundwork to dismantle the health care overhaul.

Doc Fix: On Thursday the House approved a package to replace Medicare’s oft-criticized physician payment formula in an overwhelming bipartisan vote. The legislation (HR 2) passed 392-37, with 212 Republicans and 180 Democrats joining to support the deal negotiated by Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA).

If it clears the Senate, the bill will put an end to a cycle of 17 short-term “doc fix” bills that temporarily averted cuts to Medicare doctors dictated by the sustainable growth rate formula, or SGR. In addition to replacing the formula, the bill includes a two-year extension of funding for the Children’s Health Insurance Program (CHIP) and Teaching Health Centers for another two years, and would require wealthier seniors to pay more for their Medicare outpatient and prescription drug coverage to help offset the cost. The measure is only partially paid for, with the Congressional Budget Office projecting that it would increase the federal deficit by $141 billion over 11 years.

Unfortunately, the Senate left for a two-week recess early this morning without taking any action on the bill. Instead they have vowed to make it their first order of business when they return to the Capitol on April 13^th.

The current one-year payment patch expires in four days and CMS has said it doesn’t have any plans to hold off on processing claims as it has done in the past to buy Congress time. But in an email to health professionals, the agency noted that electronic claims aren’t paid until at least 14 calendar days after they’re received, providing something of a cushion before doctors feel the scheduled cut. CMS also said it would provide an update by April 11 about whether Congress has acted.

Busy Budget Week in Congress

Posted on March 23, 2015

It’s shaping up to be a busy week as Capitol Hill continues its efforts to finally pass a repeal and replacement of the much-maligned Sustainable Growth Rate (SGR) or “Doc Fix.” While a group of bipartisan legislative leaders released the broad outlines of a proposal last week, we are sure to see more detailed legislative language as early as today – and the official cost of the proposal. A vote could take place later this week, just a few days before the increased rates are to take effect (March 31^st) if Congress takes no action.

In addition to impending action on the SGR proposal, Congressional leaders from both chambers continue to debate their respective budget resolutions. Unlike the potential SGR fix, the budget debate will be largely partisan and include attempts (again) to repeal the Affordable Care Act. The result of these budget negotiations could go a long way toward setting up their overall strategy — and the tone for what they accomplish — heading into the heart of the legislative year.

Congress will then recess for a two-week Easter break, returning to the Capitol on April 13^th.

Two Things We Learned this Week

Posted on February 27, 2015

1. Republicans are on a collision course over DoD spending: The long-brewing squabble between GOP defense hawks and fiscal hawks over defense spending is coming to a head, with the House Budget Committee planning to move a budget resolution that sets base defense spending next fiscal year $35 billion below what the Pentagon requested. But the defense hawks are lobbying furiously to avoid that outcome, and Senate Armed Services Chairman John McCain (R-AZ) is even vowing to personally oppose a budget resolution that doesn’t increase military spending above what’s allowed under the Budget Control Act of 2011. Sequester? What sequester?

And on the House side, Armed Services Chairman Mac Thornberry (R-TX) is asking the House Budget Committee to boost defense spending, which would bust the BCA caps by more than $50 billion. In a letter he plans to send to the Budget panel today, Thornberry will seek $577 billion in defense spending for the House’s budget resolution and argue that “the lowest acceptable level is $566 billion, the amount identified for 2016 in last year’s House budget,” the aide said.

Thornberry’s request of $577 billion is the amount that was projected for the Pentagon in FY2016 before the 2011 Budget Control Act was approved and sequestration took effect. It’s higher than President Barack Obama’s FY2016 request of $561 billion, which includes base Pentagon funding as well as other spending considered part of the “national security” budget. The GOP aide said that Thornberry’s letter is signed by 31 of the 36 Republicans on the Armed Services panel.

2. Government shutdowns are still a thing: Shortly after the November midterm elections that gave Republicans control of the Senate, then-incoming Majority Leader Mitch McConnell said, “We will not be shutting the government down.” Now here we are, just three months later – with the Department of Homeland Security set to run out of funds at midnight. And House and Senate leaders remain at an impasse over whether to pass a “clean” DHS spending bill or continue pushing to tie DHS funding to the president’s executive order on immigration.

House leaders are now looking at staving off a shutdown by passing a three-week continuing spending resolution for DHS. Read more here.

Source: Politico

It’s Budget Day!

Posted on February 2, 2015

President Obama will release his FY2016 budget today and it will push for tens of billions of dollars more in federal spending by arguing the deficit has been cut and the economy is much improved since he first took office six years ago. His fiscal 2016 budget plan will flip that by making the case that the economy has turned around, which should allow for more federal spending to ensure the improving conditions benefit everyone.

Obama will propose a mix of tax increases and changes in spending programs that, besides paying for the repeal of the sequester, would reduce cumulative deficits by $1.8 trillion over 10 years according to an administration fact sheet.

The administration said the increases would be more than offset by other spending cuts and closing of tax breaks. The plan also proposes repealing the post-sequester discretionary caps through their scheduled end in 2021, raising both defense and non-defense spending on a dollar for dollar basis. The increases would total $74 billion in spending above sequester caps — raising defense spending by $38 billion, to $561 billion, and non-defense accounts by $37 billion, to $530 billion. Obama has suggested the non-defense increase will go toward more infrastructure spending, new research into precision medicine, education programs, and foreign aid for Central American nations to combat child migration. To be sure, the White House also views entitlement spending as an investment and is not expected to make any significant calls for scaling back Social Security, Medicare or Medicaid.

The budget debate will play out over the next several months as appropriators write the annual spending bills and focus on whether to raise the sequester caps. Congress has found ways around those caps three out of the past four years, but that was when Democrats controlled the Senate. The latest sequester proposal seeks Republican support by calling for equal increases between defense and non-defense spending.

Additional reading:

Obama’s Budget: Five Things to Watch

Obama to unveil $4 trillion budget that busts spending limits

Join Bloomberg Government for a rapid response webinar tomorrow, February 3, as they analyze the numbers behind the FY2016 budget request.