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Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | |  | | By Daniel Payne | | | With help from Kelly Hooper, Robert King, David Lim and Megan R. Wilson
| | |  A House subcommittee is expected to hold a hearing next week on the need to reform how Medicare pays doctors. | Darren Hauck/Getty Images | TAKING A LOOK AT MACRA — The House Energy and Commerce Committee will examine how Medicare pays doctors, Robert reports. The panel’s Investigations and Oversight Subcommittee will hold a hearing next week to get an update on the 2015 Medicare Access and CHIP Reauthorization Act, which overhauled the formula used to pay doctors under Medicare, members confirmed. Doctors have complained that their Medicare payments are effectively being cut under the current system, fueling consolidation among doctors and hospitals. CMS updates payments every year. However, any update must be budget neutral, which has partly led to smaller payments to doctors in recent years. Last fall, CMS finalized a cut of about 4 percent to doctor payments for 2023. However, Congress changed the amount to 2 percent this year and 1.5 percent in 2024 as part of a spending package passed in December. Several committee members were livid that doctors have seen decreases in payment updates. “There should have been a positive update for doctors for the past four or five years,” said Rep. Michael Burgess (R-Texas), a medical doctor. “That was a mistake, and we need to correct it.” Lawmakers also want to know why the transition to value-based care, which pays doctors based on the level of care provided instead of the volume of items and services, has slowed despite efforts under MACRA. Rep. Larry Buschon (R-Ind.), a physician and surgeon, said he wants to learn more about “why we don’t have more alternative payment models developed and not moving more towards value-based care.” Lawmakers acknowledged that reforming MACRA in the current budget environment could be tough. The debt ceiling deal installed a cap on spending for the next two years. WELCOME TO THURSDAY PULSE. Did you see Marty the moose on the Hill yesterday? What about a closed-door meeting that piqued your interest? Let me know at dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Megan R. Wilson, who explains how partisan bickering in the House threatens the reauthorization of the Pandemic and All-Hazards Preparedness Act, which is designed to improve how the U.S. responds to public health crises, by a Sept. 30 deadline.
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Rep. Rosa DeLauro of Connecticut was among the Democrats condemning provisions in the FDA spending bill. | Francis Chung/E&E News | HOUSE FDA BILL INCHES OUT OF COMMITTEE — The House Appropriations Committee advanced its fiscal 2024 FDA spending bill Wednesday despite vocal opposition from Democrats over language related to abortion-pill access and tobacco regulation limits, David reports. Efforts to strip the provisions out of the funding bill failed during a daylong markup. House Appropriations Committee ranking member Rosa DeLauro (D-Conn.) and numerous Democrats condemned a provision in the GOP-led bill that would limit telehealth prescribing for abortion pill mifepristone. “There is no one in this room qualified to make this medical decision,” DeLauro said of the policy that would nullify the FDA’s January decision to permanently remove the in-person dispensing requirement. Another hot-button issue is a policy rider that would block the FDA from using taxpayer funds to prohibit the sale of menthol cigarettes and flavored cigars or limit the amount of nicotine permitted in cigarettes. Next steps: Senate Appropriations Committee markups are expected to begin next week, and major differences between the two chambers will have to be resolved before government funding runs out at the end of September.
| | | | A message from PhRMA: Middlemen like PBMs are charging fees tied to the price of medicines, which means they make more money when the price of a medicine goes up. This business model allows PBM profits to soar and can lead to higher costs for patients. It’s time to lower costs for patients by holding middlemen accountable. | | | | | POLITICS TAKE CENTER STAGE — One of the year’s biggest health policy debates — building up the country’s health workforce — has been overshadowed by the politicized debate over gender-affirming care for minors. Democrats argued for a clean reauthorization of the Children’s Hospitals Graduate Medical Education program after Republicans added a provision that would prevent money from the program going to hospitals that provide gender-affirming care. The bill was introduced last week by Rep. Dan Crenshaw (R-Texas), who said the issue is “a hill we’re going to die on.” While Congress has time to pass a reauthorization bill, the debate shows the power of the politics around gender-affirming care — and its ability to disrupt health care policy. The program, which has enjoyed bipartisan support for decades, funds training for a large number of U.S. pediatricians. The Children’s Hospital Association, which lobbied for the program’s reauthorization for months, opposed the legislation, arguing that tying funding to any type of care threatens efforts to train more doctors. Several medical associations support gender-affirming care for adolescents. But most medical experts say gender-affirming care for children rarely includes surgery. Instead, doctors are more likely to recommend counseling, social transitioning and hormone replacement therapy. More on what those hospitals want lawmakers to focus on … YEAR-END SPENDING BATTLE STARTS EARLY — The Children’s Hospital Association is out with a seven-figure public relations campaign called “Made Possible by Your Children’s Hospital” to highlight how its members improve the lives of babies, children and teens, Megan reports. The campaign — which will run digital and radio ads and advertisements at airports, bus stops and metro stations — focuses on the Washington area and is set to run through the end of the year, when lawmakers on Capitol Hill will likely be fighting over government spending, including how much providers are reimbursed.
| | | | SUBSCRIBE TO POWER SWITCH: The energy landscape is profoundly transforming. Power Switch is a daily newsletter that unlocks the most important stories driving the energy sector and the political forces shaping critical decisions about your energy future, from production to storage, distribution to consumption. Don’t miss out on Power Switch, your guide to the politics of energy transformation in America and around the world. SUBSCRIBE TODAY. | | | | | | | | | HEALTH SPENDING TO HIT $7T — New estimates from CMS project health care spending will make up roughly 20 percent of the American economy, or $7.2 trillion, by 2031, Kelly reports. The figures released Wednesday underscore the looming challenges that face the federal government as it absorbs the baby boomers into Medicare. It also demonstrates that health spending is again growing faster than the overall economy following a modest pandemic-related decline. Health care expenditures are expected to grow 5.4 percent on average from 2022 to 2031 compared with an average of 4.6 percent for the nominal gross domestic product, according to the study from CMS’ Office of the Actuary, published in Health Affairs. About 92.3 percent of Americans were insured in 2022, an all-time high, the study said. While the authors expect Medicaid enrollment to decline as states begin redetermination of eligibility for the first time in three years, they still expect the uninsured rate to remain below 10 percent because of projected increases in enrollment in private health insurance.
| | | | A message from PhRMA:   | | | | | SUPPORT FOR ABORTION RIGHTS PERSISTS — Support for access to abortions remains high after rising to new heights in the wake of the Dobbs decision last year, according to new polling from Gallup. The portion of people supporting legal access to first-trimester abortions — 69 percent — was a record high since the group began tracking trends on the issue in 1996. Opinions on Roe being overturned have remained largely the same since last year, though the percentage of people supporting the court’s decision grew. And most Americans want abortion pills to be available in the U.S., according to the polling. The survey found 63 percent of people supported access to the drug while 35 percent opposed it. A significant portion of Republicans — 41 percent — believed access should be protected, concurring with 86 percent of Democrats. EYEING PENTAGON’S ABORTION POLICY — A House defense spending bill would block a Pentagon policy aimed at ensuring troops’ access to abortion, POLITICO’s Connor O’Brien reports. That policy, issued last fall by Defense Secretary Lloyd Austin, allows troops to be reimbursed for costs associated with traveling to seek abortions and other uncovered reproductive care — and offer soldiers leave time for care. Republicans have sought to overturn the policies, arguing the Pentagon undercuts laws that prevent taxpayer funding for abortions in most cases. But the provision is likely to be seen as a nonstarter for many Democrats who want abortion access expanded for service members stationed in states where it’s banned.
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| | | | A message from PhRMA: PBMs control your health care. Pharmacy benefit managers (PBMs) decide if medicines get covered and what you pay, regardless of what your doctor prescribes. They say they want lower prices, yet they often deny or limit coverage of lower-cost generics and biosimilars, instead covering medicines with higher prices so they make more money. This business model allows PBM profits to soar and can lead to higher costs for everyone. What else are they hiding? | | | | | | | Follow us on Twitter | | | | Follow us | | | | |  |
