Read the latest ASCP policy news from Washington, DC.
House Passes ACA Repeal Legislation
On May 5, House Republicans approved the American Health Care Act (AHCA) by a vote of 217-213. The measure would repeal the Affordable Care Act (ACA), aka Obamacare. The measure would end the ACA’s subsidies to help people purchase coverage, the Medicaid expansion, and the individual mandate requiring individuals to get insurance. Instead, the AHCA would provide tax credits to help individuals buy insurance.
In March, House Republicans were unable to pass the AHCA due to opposition from conservatives and the Freedom Caucus. Several deals since then secured the support of most Freedom Caucus members, clearing the way for the House to reconsider the measure. The key deal to secure the Freedom Caucus’ support was a change to the bill allowing states to seek waivers of the protections for individuals with pre-existing conditions. Under the deal, states could allow insurers to factor existing health conditions into premium costs. While lowering the cost for healthy individuals, this would substantially increase premium costs for those with significant health issues. The measure was opposed by a number of health care organizations, including the American Medical Association, the American Association of Medical Colleges and American Hospital Association, largely due to concerns about the bill’s impact on patients’ access to care.
The bill faces an uncertain future in the Senate, where Republics have only a two-vote majority. Senate Republics have signaled that a major overhaul of the bill is needed, particularly provisions of the AHCA that would end the Medicaid expansion.
President Trump Signs Bill to Fund Federal Government
Congress passed, and the president has signed into law, a measure to fund the federal government through the rest of Fiscal Year 2017 (September 30). The $1.1 trillion budget bill was passed with broad bipartisan support. The bill includes a $2 billion increase for the National Institutes of Health (NIH), bringing its funding to $34.1 billion, and a $22 million increase for the Centers for Disease Control and Prevention (CDC), bringing its funding to $7.3 billion. The bill also gives the Food and Drug Administration (FDA) $2.8 billion, a $39 million increase from its fiscal 2016 level and includes language instructing the FDA to work with Congress on a variety of issues, including the regulation of Laboratory-Developed Tests (LDTs).
Previously, the Trump administration had called for an overall $18 billion spending reduction that included cutting the NIH budget by $1.2 billion this year and specifically targeting research grants as well as a $314 million cut to the CDC.
The funding measure allows Congress to begin discussions on funding for Fiscal Year 2018, which begins Oct. 1. With the Trump Administration’s emphasis on reducing non-defense programs, we will have to see how that will affect recently enacted legislation, such as the 21st Century Cures Act passed under the Obama Administration to fund medical research. The bill called for an additional $4.8 billion over 10 years for the NIH, $1.4 billion for the Precision Medicine Initiative, $1.8 billion for Cancer Moonshot, $1.6 billion for the BRAIN Initiative as well as $500 million for the FDA.
Healthcare Workforce Subject of Capitol Hill Briefing
The evolving healthcare system calls for a modernization of the healthcare workforce, argued panelists at a recent Healthcare Leadership Council briefing on Capitol Hill. Panelists discussed changes needed to meet the growing demands for physicians and allied health professionals. Steve Wehn, Vice President of Government and Community Relations at AMN Healthcare, referenced data from the U.S. Bureau of Labor Statistics and reported that there are 14 million jobs in health care currently available for physicians, nurses, physician’s assistants, nurse practitioners and pharmacists in 2014; by 2024, this number will rise to 18 million healthcare jobs. Some factors that are driving increased demand have been the improving economy, shortage of clinicians and physicians, increased healthcare utilization, aging U.S. population, medical advances, and newly emerging clinical roles. The shortage of healthcare professionals, however, is becoming an epidemic, panelists argued. Institutions are faced with the question of what is driving high vacancies and how they can meet the rising patient demands.
During this briefing, data was also presented that many current healthcare professionals are aging and close to retirement. Participants in the discussion noted that interstate medical licensure for licensed professionals is needed, and developing a robust healthcare system in rural areas requires greater attention to address shortages. Matthew Jansen, MD, Division of Education Medical Director at Marshfield Clinic, argued that rural areas, in particular, need a reliable pipeline of health care professionals. The panel agreed that patients in these regions will be the most vulnerable if vacancies are not filled.
Surprisingly, the laboratory workforce was little mentioned during this discussion. Based on the ASCP wage and vacancy survey reports, the field of laboratory medicine is experiencing the same challenges as the other healthcare professionals discussed at the briefing. Inclusion of lab professionals in the healthcare workforce conversations is vital because these are the health professionals responsible for performing the tests and procedures needed to diagnose patients. ASCP believes that the severity of the medical laboratory personnel shortage requires the creation and development of federal policy initiatives such as grant programs, service learning, continuing education, and public service announcements.
Senate Approves Gottlieb as FDA Commissioner
In a largely partisan vote, the Senate approved, by a vote of 57-42, Scott Gottlieb, MD, as the new Commissioner of the Food and Drug Administration (FDA). Dr. Gottlieb has served in a number of different roles at the Agency, including as a Deputy Commissioner, a senior advisor to the Commissioner, and as the Director of Medical Policy Development. Dr. Gottlieb was approved by the Senate Committee on Health, Education, Labor and Pensions on April 27.
Dr. Gottlieb will now begin work addressing a number of issues facing the Agency. One of these issues is likely to be FDA’s oversight authority over Laboratory Developed Tests (LDTs). Given provisions included in the recent budget bill FDA is expected to work with Congress on legislation to clarify FDA’s oversight of LDTs. As ASCP reported in ePolicy last month, several members of the House Energy and Commerce Committee have introduced draft legislation to clarify the oversight of LDTs. This legislation is expected to be formally introduced later this year.
Dr. Gottlieb has neither embraced, nor rejected enhancing the regulatory oversight of LDTS. He has, however, said that increasing FDA’s oversight of LDTS would likely slow down innovation and increase the cost of development. It is open to question, he has said, whether the benefits of this increased oversight will outweigh the impact on innovation.
ASCP Supports Pink Ribbon Red Ribbon on the Hill
As a collaborating partner in the Pink Ribbon Red Ribbon (PRRR) organization, ASCP joined our partner organizations again on Capitol Hill on April 25 to educate legislators about the important work PRRR is doing to end cervical cancer deaths globally. For the past five-plus years, PRRR has led coordinated action to save women’s and girls’ lives from cancer in low-resource settings.
A total of 24 advocates circulated around the Hill, visiting 25 Congressional offices with messages about the burden of cervical cancer and ways the U.S. can do more. Specifically, advocates pressed leadership for (a) a robust international affairs budget and (b) language in Congress’ annual spending legislation that calls for a report on the burden of and plan to address global cervical cancer. Overall, advocates were encouraged by the bi-partisan support they heard from the offices they visited.
In addition to providing our support for PRRR’s Hill Day, ASCP recently signed on to letters to Congress and USAID to encourage support for strengthening US international health programs. ASCP will continue to support the important efforts of PRRR in the future to #defeatcervicalcancer.
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