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Monthly Legislative Newsletter: April 2023
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Congressional State of Play

The primary focus of Congress remains centered on ongoing negotiations concerning the debt limit and potential legislative solutions. Following Treasury Secretary Janet Yellen's alarming announcement that the federal borrowing limit will be reached as early as June 1st, congressional negotiators have shifted their attention to this critical issue. Despite the increased awareness of the risks associated with a default, negotiations between the White House and congressional leaders have reached an impasse. A comprehensive analysis of the debt limit negotiations, as well as the potential consequences for brain cancer research and treatment in the event of a government default, is provided in the subsequent sections of this newsletter.

In parallel, Congress is steadily progressing through the annual appropriations process. House Republicans, led by House Appropriations Chair Kay Granger (R-TX), have outlined their plans for the upcoming fiscal year's spending bills. In a letter to her colleagues, Granger announced their intention to commence marking up the 12 annual spending bills later this month, with the goal of completing committee action by mid-June. The tentative schedule for subcommittee and full committee markups is set for May and June, although Granger acknowledged that it is subject to change. She also expressed her aim to bring the bills to the floor for action as early as June. House Republican appropriators will align the drafting of spending bills with Speaker Kevin McCarthy's (R-CA) debt limit legislation, which proposes a government funding level of $1.47 trillion for the fiscal year starting on October 1. While the defense budget is expected to receive minimal cuts, domestic programs may face significant reductions. Granger further emphasized that a majority of House members have requested earmarked funding for community-based projects under new GOP restrictions.

Also on Capitol Hill, agricultural committee members continue to conduct a series of hearings related to the farm bill. These deliberations have placed particular emphasis on the bill's commodity programs and climate initiatives. One key point of contention that has emerged during these discussions are proposed modifications to the bill's nutrition programs, with Republicans eyeing concessions on the Supplementary Nutritional Assistance Program (SNAP) as a primary topic in debt ceiling negotiations.

Finally, May is Brain Tumor Awareness Month, an important annual observance dedicated to raising awareness about brain tumors, advocating for better treatments and support for patients, and promoting brain tumor research.

Appropriations Update:

As part of the appropriations process, earlier this month several officials from the National Institutes of Health (NIH) were brought before the Senate Appropriations Subcommittee on Labor, Health and Human Services (HHS), and Education for testimony related to the NIH budget request for fiscal year 2024 (FY24). These witnesses included NIH Acting Director, Dr. Lawrence Tabak, Director of the National Institute of Mental Health Dr. Joshua Gordon, and Director of the National Institute on Aging, Dr. Richard Honus. A summary of this hearing is included below.

Debt-Ceiling Negotiations Update:

Congress is currently confronted with an imminent debt crisis that could unravel within a matter of weeks, posing a unique challenge as lawmakers may not be able to rely on their usual approach of delaying the issue. Key members from both the Republican and Democratic parties are rejecting the idea of a short-term increase to the debt ceiling as a means to buy more time for negotiations. Republicans are placing blame on President Joe Biden and the Democrats, arguing that talks were initiated too late. Conversely, Democrats are urging Republicans to cease engaging in risky tactics and support a clean debt increase. Despite recent warnings that the United States could breach its debt ceiling as early as June 1, both parties' positions remain deeply entrenched, mirroring the stances they've held since January. The available window for reaching a deal is now limited to just a few weeks. While Congress has shown the ability to expedite proceedings under pressure in the past, doubts are emerging as to whether they can act swiftly enough this time. To prevent an economic catastrophe, it is likely that negotiations between Congress and the White House will result in a temporary extension of the nation's borrowing capacity.

End of the COVID-19 Public Health Emergency:

The public health emergency for COVID-19, initially declared by the Trump administration in January 2020 and extended multiple times, is set to end on May 11, as planned by the Biden administration. The declaration allowed for expanded access to care through telehealth and hospital care at home, free treatment and testing, and the maintenance of Medicaid coverage for millions of individuals. The end of the emergency will lead to changes, including the following:

  • Private insurers and individuals with COVID-19 will bear a significant portion of the treatment costs, potentially resulting in higher out-of-pocket expenses for medication and hospital care, depending on insurance coverage. Preventive care like vaccinations is likely to remain covered by insurance, but uninsured individuals may still have access to vaccines and treatments at no out-of-pocket cost until 2024.
  • Medicare, Medicaid, and Children's Health Insurance Program beneficiaries may experience increased cost-sharing for tests and antivirals, but COVID-19 vaccines will continue to be free. The White House has announced the end of COVID-19 vaccine requirements for federal employees, federal contractors, and foreigners entering the US, with the mandate also being phased out for CMS-certified facility workers and educators in the Head Start preschool program.
  • Congress has extended eased rules for telehealth in Medicare and high-deductible health plans, as well as hospital at-home waivers, until the end of 2024. However, employers will no longer be able to provide telehealth as a separate premium, tax-free benefit.
  • Medicaid enrollment requirements have been ended, potentially leading to the removal of millions from the program, although many may be eligible for low-cost Obamacare plans. The White House plans to halt Title 42, which allowed the turning away of asylum seekers at the southern border on public health grounds. Republicans have argued for its continuation.
  • Work requirements for food-assistance programs will be reinstated in more than half of the states, primarily those controlled by Republicans. The end of state emergency declarations, such as those in Delaware, Illinois, and Massachusetts, will have specific impacts, including the lifting of the mask requirement for healthcare facilities in Massachusetts.

DEA Telemedicine Rulemaking Update:

The Drug Enforcement Administration (DEA) has announced that it will continue to allow doctors to prescribe controlled substances through telehealth, even as the agency finalizes new rules on prescribing following the end of the Covid-19 public health emergency. The DEA's statement suggests that it is reconsidering the regulations it proposed in February, which would have limited access to telehealth once the emergency period concludes on May 11. This proposal was described at length in the April edition of this newsletter.