Changes in store for the scorekeeper

Sep 24, 2024

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The U.S. Capitol building

Congress aims to improve the CBO's access to data, particularly for health care-related cost estimates. | Francis Chung/POLITICO

CBO REFORM MOVES FORWARD — Lawmakers haven’t moved much significant legislation during this Congress, but reforms to the nonpartisan Congressional Budget Office impacting health care have gained momentum.

To do its work as a cost scorekeeper, the CBO often leans on data from federal agencies like HHS, some of which isn’t public, requiring the agency to lean on formal and informal agreements to get information from agencies while maintaining confidentiality. For example, the agency has said it accesses confidential CMS data on Medicaid and Medicare drug rebates through such agreements.

Sometimes, negotiations for information can bog down developing the cost estimates lawmakers rely on and make or break legislation. On Monday, the House passed Senate-approved legislation by voice vote that would expand the CBO’s authority to speed up data-sharing.

The broader push: The move comes as a different bill to help expedite information sharing with the CBO awaits President Joe Biden’s signature after passing the Senate earlier this month. The House also passed legislation in March that would require the CBO to weigh whether a bill would save money over a 30-year budget window instead of 10 if Congress requests such an estimate.

Still, the legislation passed Monday has its limits, budget experts told Pulse. G. William Hoagland, senior vice president at the Bipartisan Policy Center and former staff director at the Senate Budget Committee, noted the legislation only goes so far.

“These are not easy cost estimates,” Hogland said, but added that the legislation could potentially speed up the process. “Things are changing so fast in health care, [including artificial intelligence] … this is a helpful move.”

Demian Brady, vice president of research at the National Taxpayers Union Foundation, noted that the CBO has had difficulty getting data from the Census Bureau, the National Institute on Aging and the Bureau of Labor Statistics.

“All that information would be very valuable for determining the impacts of healthcare legislation,” Brady said, adding that the legislation passed Monday would complement the bill that reached Biden’s desk last week. “CBO will be able to get the data that they need in a much more timely manner, and it will help to produce more high-quality cost estimates for healthcare.”

WELCOME TO TUESDAY PULSE. The Longworth Dunkin’ in the House has been renovated, and we miss the old dungeon-feeling pre-renovation. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.

A message from the Alliance for Fair Health Pricing:

Rising costs, driven by consolidation in the health care market, are hurting American businesses. As large health systems buy up hospitals and physician practices, they use their monopoly power to drive competition out and prices up, raising costs for employers providing health insurance. These inflated prices stifle economic growth and lower wages, hitting small businesses and low to middle-income workers hardest. Congress: Stand up for employers. Pass legislation to address hospital consolidation. More.

In Congress

Rep. Michael McCaul walks in the U.S. Capitol

A bipartisan bill from Rep. Michael McCaul and two colleagues to reauthorize the FDA's priority review voucher program for rare pediatric diseases was passed on the House floor Monday night. | Alex Brandon/AP

HOUSE GIVES HEALTH CARE SOME LOVE — The House had a busy session Monday evening, passing health care legislation on the floor — not something we’ve seen much this year from either chamber of Congress.

Arguably the most significant health care bill to pass Monday was a five-year reauthorization of the FDA’s priority review voucher program incentivizing drug development for rare pediatric diseases. The vouchers are given to drugmakers developing medicine for diseases with unmet needs and can be used to speed up agency review for another drug or be sold to another company.

The voice vote on the package — from Reps. Michael McCaul (R-Texas), Gus Bilirakis (R-Fla.) and Anna Eshoo (D-Calif.) — comes as the House is set to vote on a stopgap measure that would extend the program’s reauthorization until Dec. 20. It’s due to expire at the end of the month.

Sen. Bernie Sanders’ (I-Vt). Health, Education, Labor and Pensions Committee is scheduled to mark up a version of the legislation Thursday.

Here’s what else passed Monday night:

Prescriptions by mail: The House passed legislation from Reps. Diana Harshbarger (R-Tenn.) and Debbie Wasserman Schultz (D-Fla.) that would permanently allow independent doctors to send prescriptions to Medicare patients via mail. They were allowed to under the Covid-19 public health emergency but that expired last year.

Organ transplant nondiscrimination: The chamber also passed a bill from Reps. Kat Cammack (R-Fla.) and Debbie Dingell (D-Mich.) that would bar discrimination in the organ transplantation process based on mental and physical disabilities.

Reauthorizations: The House passed legislation to reauthorize a sickle cell research and treatment program, the National Alzheimer’s Project and a congenital heart disease research and surveillance program.

WHAT DIDN’T GET A VOTE — A Senate-passed bill to stop drug manufacturers from what lawmakers see as gaming the patent system to stifle biosimilar competition was potentially set for a House floor vote this week but is no longer on the calendar.

The legislation was initially listed as a candidate for a vote under suspension of the rules — meaning it would need a two-thirds vote to pass — but didn’t make it to the final floor schedule. The legislation from Sens. John Cornyn (R-Texas) and Richard Blumenthal (D-Conn.) passed the Senate unanimously in July, and the CBO has estimated it could be a significant cost-saver.

A spokesperson for House Speaker Mike Johnson didn’t respond to a request for comment.

Brand-name drug lobby PhRMA has raised concerns that the bill would threaten innovation. The measure was amended before it passed the Senate to remove a prohibition on “product-hopping” — when companies try to move demand for a brand-name drug with impending generic competition to a different brand-name drug that wouldn’t face such competition.

“Can’t speak to the House calendar, but as we’ve said in the past, research-based biopharma manufacturers have concerns with Congress prohibiting innovators from enforcing lawfully granted patents,” PhRMA spokesperson Megan Van Etten told Pulse.

AROUND THE AGENCIES

MPOX CHANGES — The CDC has widened its mpox vaccine recommendation, POLITICO’s Sophie Gardner reports.

The agency is adding people traveling to the Democratic Republic of the Congo or another country with sustained spread of the variant of the virus, clade I, that’s spreading rapidly in some African countries — and who “anticipate certain sexual exposures while traveling.”

Previously, the agency had recommended that gay and bisexual men — who experienced the worst of the 2022 outbreak in the U.S. — and anyone with suspected exposure to get two-vaccine doses.

The bigger picture: The expanded recommendation represents the latest effort by the federal government to keep clade I from spreading to the U.S. The clade is thought by some epidemiologists to be more deadly than the one that caused the 2022 outbreak in the U.S.

A message from the Alliance for Fair Health Pricing:

OPIOID CRISIS

WATCHDOG HAS IDEAS FOR CMS — Most people with opioid use disorder don’t get treatment, studies have shown, and CMS should take more action to encourage providers who may be “unable or unwilling” to treat them, a watchdog said Monday.

In a report released Monday, HHS’ inspector general said that in hundreds of counties with high treatment needs, many providers don’t treat Medicare or Medicaid enrollees with buprenorphine. Even in counties with providers that do, many don’t treat Medicare or Medicaid patients.

While CMS has taken several steps to ease access to medication treatment for opioid use disorder, it could geographically target efforts to boost providers treating Medicare and Medicaid patients and work with states to ensure payment rates are sufficient to attract providers, the watchdog said.

The response: CMS said it “supports the spirit” of the recommendations, HHS’ OIG said, but didn’t say whether it agreed with them.

The bigger picture: The findings come amid an opioid crisis for which successful policy solutions have been few and far between, though overdose death rates fell for the first time since before the Covid-19 pandemic between April 2023 and April 2024, according to preliminary data released this month.

Many barriers to treatment have remained despite efforts to boost access, including DEA regulations, awareness, stigma and insurance requirements.

Names in the News

Lindsey Trickett has joined LifeSci Advisors as managing director. She was previously at Prelude Therapeutics.

WHAT WE'RE READING

Healthcare Dive reports on Cigna rolling back its Medicare Advantage footprint.

CNN reports on some experts calling for age restrictions on nonalcoholic drinks.

POLITICO's Erin Schumaker reports that the Pentagon is investing $500 million in women's health research.

A message from the Alliance for Fair Health Pricing:

From large companies to small businesses to entrepreneurs—rising health care costs are squeezing employers.

Right now, Congress has an opportunity to protect employers and workers from excessive costs by advancing policies that promote competition and rein in hospital consolidation that drives up prices.

Codifying hospital and insurer price transparency requirements will hold health systems accountable for fair and reasonable pricing. At the same time, comprehensive site-neutral payment reform will ensure patients aren’t overcharged for routine services and reduce the incentives for hospitals to buy up physician practices. These actions are critical for safeguarding the financial health of American businesses and workers’ access to quality, affordable health care. The AFFHP is calling on Congress to advance transparency and site-neutral reforms to make health care more competitive and affordable. Employers, providers and consumers agree, now is the time. Congress: Take action against rising health care costs. Read our message.