Policy Updates: Hill Happenings and Administration Activities

By Emily McCloskey February 5, 2018

Hill Happenings

Appropriations and Budget Updates

Government funding will expire again on February 8, likely requiring Congress to pass its fifth short-term spending patch in the absence of a grand compromise on defense and nondefense budget caps. Republican leaders have floated a proposal that would significantly raise caps on domestic spending during the next two years. Most of that boost would be set aside for funding President Trump's infrastructure promise, according to lawmakers and sources familiar with the budget talks.

House and Senate appropriators are reportedly discussing a proposal to extend the next continuing resolution (CR) through March 23. The proposal may also include additional increases for opioid funding and other nondefense spending that could be categorized as mandatory spending or supplemental spending outside the discretionary caps. More information can be found here.

NASTAD will continue to advocate for the highest possible funding amounts for HIV and hepatitis programs.

Debt Ceiling

The U.S. government’s cash reserves are expected to run out faster than previously anticipated the Congressional Budget Office said Wednesday, a result of lost revenue from last year’s tax cut law. If the debt ceiling isn’t raised by the first half of March, CBO said, “the government would be unable to pay its obligations fully, and it would delay making payments for its activities, default on its debt obligations, or both.”

Treasury Assistant Secretary for Capital Markets, Clay Berry, in a statement Wednesday, urged Congress to act to raise or suspend the debt limit soon.

State of the Union Address

On January 30, President Trump delivered his first State of the Union (SOTU) address to Congress. Opioids were a key theme during the SOTU, but much of the focus was on "law and order" and not prevention or treatment. At least a dozen members of Congress wore purple ribbons at the SOTU address to help raise awareness about the country’s opioid epidemic. More information can be found here

NASTAD will continue to advocate for increased funding for opioids and infectious diseases programs. 

Opioids

The House Energy and Commerce Committee, which has been investigating the opioid epidemic, revealed that 20.8 million hydrocodone and oxycodone pills have been delivered to Williamson, WV, a town with a community college, a rail yard — and fewer than 3,200 residents, according to the most recent Census figures. Committee leaders sent letters to two regional drug distributors, asking why the companies oversupplied this town, among others, with painkillers.

The Affordable Care Act

House Republicans are warming to a proposal aimed at bringing down Affordable Care Act (ACA) premiums, raising the chances of legislative action this year to stabilize the health-care law. Speaker Paul Ryan (R-WI-1) noted the possibility of action on an ACA stability measure, particularly funding for reinsurance, at an event in Wisconsin in January, saying he thought there could be a “bipartisan opportunity” on the issue.

According to recent reports, Republicans are moving away from their plans of repealing the ACA.  “It would be a heavy lift. I think everybody knows,” said Senator John Thune (R-SD) “We sort of tested the limits of what we can do in the Senate last year. And we’re one vote down from where we were then.”

Administration Activities  

CDC Personnel Updates

On Wednesday, the Centers for Disease Control and Prevention (CDC) Director Brenda Fitzgerald resigned amid untenable investments in tobacco and other companies that posed clear conflicts of interest. Politico reported that Fitzgerald bought $1,001 to $15,000 worth of shares in Japan Tobacco after taking the CDC post in early July. She also made similar purchases of shares in drug companies Merck & Co. and Bayer, as well as of big health insurer Humana, according to the article. 

From the official statement from the Department of Health and Human Services (HHS):

“Dr. Fitzgerald owns certain complex financial interests that have imposed a broad recusal limiting her ability to complete all of her duties as the CDC Director," the agency said. "Due to the nature of these financial interests, Dr. Fitzgerald could not divest from them in a definitive time period. After advising Secretary Azar of both the status of the financial interests and the scope of her recusal, Dr. Fitzgerald tendered, and the Secretary accepted, her resignation.”

Anne Schuchat, MD (RADM, USPHS), who had been CDC's principal deputy director, was named acting director of the agency after Fitzgerald resigned.

Division of Viral Hepatitis

On Friday, Dr. Jonathan Mermin, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, announced that “Dr. John Ward, [CDC’s Director of the Division of Viral Hepatitis (DVH)] has accepted an opportunity with the Task Force for Global Health where he will assist the organization in developing global viral hepatitis prevention, treatment, and control programs. Dr. Ward will begin this assignment as a secondee from [CDC] on March 5, 2018.”

NASTAD will be working closely with the Center to provide our input and recommendations regarding this transition and recruitment of a new director for DVH. 

HHS Secretary 

Last Monday, Alex Azar was sworn in as President Donald Trump’s second HHS secretary. During the ceremony, President Trump said, “He’s going to get those prescription drug prices way down as a little bit of an extra, right?  It’s going to come rocketing down.” President Trump also highlighted the ongoing opioid epidemic and the role HHS will play under Azar.

Medicaid Waivers
The Centers for Medicare & Medicaid Services (CMS) has granted Indiana's Medicaid waiver that imposes work requirements and premiums on its beneficiaries. Indiana estimates that 30%, or 130,000 of the 438,604 Medicaid enrollees, will have to comply with the new requirement after factoring in all the exemptions.