State of Infrastructure and Reconciliation Negotiations
Democratic leadership has started making progress on legislative pieces that may come together to form the basis for a partisan reconciliation package to be passed before the looming midterm campaign season and the September 30 procedural deadline. On July 6, Senate Democrats sent an agreement on drug pricing to the parliamentarian for review, an important step forward in talks. Energy and climate provisions remain in flux, as Senator Joe Manchin (D-WV) has reiterated his opposition to direct payment of tax credits. A reconciliation deal will still take significant compromise, legislative text drafting, and vetting through the Byrd bath process, but optimistic notes from both Sen. Manchin and Majority Leader Chuck Schumer (D-NY) may provide the spark needed to push ahead on a clean energy and healthcare focused bill before the August recess.
On June 22, 2022, the House Appropriations Committee approved the Fiscal Year 2023 Defense funding bill on a 32-26 vote. The funding bill included two of SNO’s appropriations priorities for Fiscal Year 2023. The Peer-Reviewed Cancer Research Program received $130 million in funding and “pediatric brain tumors” and “brain cancer” remained eligible funding categories. The inclusion of these provisions is the direct result of advocacy from the SNO Public Policy Committee.
Additionally, on June 30, 2022, the House Appropriations Committee also approved the Fiscal Year 2023 Labor, Health and Human Services, Education, and Related Agencies funding bill on a 32 to 24 vote. The legislation includes:
Department of Health and Human Services (HHS) – The bill provides a total of $124.2 billion for HHS, an increase of $15.6 billion above the FY 2022 enacted level and $298 million below the President’s budget request. Of this amount, the bill includes:
- National Institutes of Health (NIH) – The bill provides a total of $47.5 billion for NIH, an increase of $2.5 billion above the FY 2022 enacted level. The total includes:
- $7.4 billion, an increase of $466 million above the FY 2022 enacted level, for the National Cancer Institute, including $216 million for the Cancer Moonshot;
- $3.7 billion, an increase of $200 million above the FY 2022 enacted level for Alzheimer’s disease and related dementias research;
- $25 million, an increase of $12.5 million above the FY 2022 enacted level, for firearm injury and mortality prevention research;
- $75 million, an increase of $50 million above the FY 2022 enacted level, to support research and expanded access to promising treatments authorized in the ACT for ALS Act;
- $3.4 billion, an increase of $200 million above the FY 2022 enacted level, for HIV/AIDS research;
- An increase of $100 million for research related to opioids, stimulants, and pain/pain management;
- An increase of $100 million for health disparities research;
- $260 million, an increase of $15 million above the FY 2022 enacted level, for Universal Flu Vaccine Research;
- $90 million, an increase of $15 million above the FY 2022 enacted level, for the INCLUDE initiative related to research for Down syndrome;
- $64 million, an increase of $5 million above the FY 2022 enacted level, for the Office of Research on Women’s Health; and
- An across-the-board increase of 3.2 percent for NIH Institutes and Centers to support the biomedical research workforce and expand promising research.
- Creates a new 10 percent set-aside within the MHBG to support prevention and early intervention services.
- Centers for Medicare & Medicaid Services (CMS) – The bill provides $4.3 billion for CMS administrative expenses, an increase of $322 million above the FY 2022 enacted level and equal to the President’s budget request. This funding level includes an increase of $96.9 million above the FY 2022 enacted level for State Survey and Certification activities to strengthen improvement efforts, increase health and safety inspections of nursing home facilities, and ensure that long-term care and other facilities have proper infection controls in place.
- Office of the Secretary—Public Health and Social Services Emergency Fund (PHSSEF) – The bill provides $3.7 billion for PHSSEF, an increase of $500 million above the FY 2022 level and $115 million below the President’s budget request. The bill provides funding to improve the nation’s preparedness for public health emergencies, including:
- $382 million, an increase of $82 million above the FY 2022 enacted level, for pandemic influenza.
- $845 million, an increase of $100 million above the FY 2022 enacted level, for the Biomedical Advanced Research and Development Authority (BARDA).
- $800 million, an increase of $20 million above the FY 2022 enacted level, for Project BioShield.
- $855 million, an increase of $10 million above the FY 2022 enacted level, for the Strategic National Stockpile.
- $262 million, an increase of $30 million above the FY 2022 enacted level, for Hospital Preparedness Program cooperative agreements.
- Advanced Research Projects Agency for Health (ARPA-H)—The bill includes $2.75 billion, an increase of $1.75 billion, to accelerate the pace of scientific breakthroughs for diseases such as ALS, Alzheimer’s disease, diabetes, and cancer.
Cancer Moonshot Update
The White House
White House Cancer Moonshot Update
July 11, 2022
Cancer Moonshot Coordinator
On July 11, 2022, the White House held a brief webinar providing an update on the White House’s Cancer Moonshot initiative. Danielle Carnival, the White House Cancer Moonshot Coordinator, delivered remarks on current progress and briefly mentioned actions that her group intends to take in the coming weeks.
After summarizing the goals of the Cancer Moonshot, which was revived in February 2022, Carnival outlined the seven pillars of focus for the initiative: improve cancer screening; enhance prevention; address inequities; target effective treatments to patients; develop approaches for deadly and rare cancers, including childhood cancers; support patients, survivors, and caregivers; and learn more from people with cancer. She called special attention to expanded screening tools, research connecting toxic exposure to cancer diagnoses, and cutting-edge research from the private sector to assist patients.
She also mentioned the efforts of the Cancer Cabinet to advance the goals of the Moonshot. The group, consisting of leadership from a variety of federal agencies, will add new members later this week. She said that the group will further flesh out the seven identified priority areas, with more specifics to be announced in the coming weeks.
The telehealth industry has seen a great expansion since the start of the pandemic due to several policies enacted by the government to encourage its use. These include reimbursing providers for telehealth visits, allowing controlled substances to be prescribed remotely, allowing pre-deductible telehealth coverage, and most importantly of all, allowing doctors to perform telehealth visits with patients in any state, not just ones where they are licensed to practice medicine. However, with the threat of COVID-19 fading, these benefits may soon disappear. With the midterms approaching, lawmakers want to convince the public that COVID has been defeated and may not be willing to further extend pandemic-era benefits. Several of these benefits will be lost the moment the federal state of emergency ends in October, assuming it is not extended again. Already, there are signs of backsliding in the telehealth industry. The Department of Justice is ramping up investigations into telehealth startups that prescribe controlled substances, indicating that the government may return to a ban on remote prescriptions of controlled substances. Additionally, a number of states which passed waivers to allow patients to have telehealth visits with doctors in other states have allowed those waivers to lapse.
Another big source of uncertainty for telehealth providers is the abortion debate. As states scramble to set in place their rules on abortion, every aspect of the medical industry is being scrutinized for any possible role it might play in abortions, and telehealth is no exception. The primary concern is over the ability for doctors to remotely prescribe abortion pills. In states where patients are still allowed to have telehealth visits with out-of-state doctors, this could serve as a way to circumvent abortion bans. Thus, the telehealth industry could be a savior for those seeking abortions—but this is a role the industry has no interest in playing. Telehealth lobbyists have been able to take advantage of a broad bipartisan coalition thus far, and the divisiveness of the abortion issue could destroy that coalition. Any action by the industry to protect or limit abortion rights would burn bridges, potentially accelerating the rollback of pandemic-era telehealth expansion. But with headlines like “What does Utah’s trigger law say about abortion pills by mail or telehealth?” running around the country, it’s clear that the telehealth industry has no power to downplay this debate or keep itself out of the greater conversation on abortion laws.