Advocacy Update – April 2023: Spring on Capitol Hill

Congress recently returned from its two-week spring recess, kicking off a busy work period leading to the Memorial Day recess. This week, four House committees held health-related hearings, and the Senate HELP Committee is expected soon to take up Pharmacy Benefit Manager (PBM) legislation.

The House is also set to vote on a $4.5 trillion debt limit bill, the Limit, Save, Grow Act, which raises the debt limit into 2024 while cutting federal spending by tens of billions of dollars. The package would instate work requirements for Medicaid. A Congressional Budget Office report estimated that Medicaid work requirements would cause two million people to lose health coverage. Work requirements are unlikely to result in significant savings or large increases in enrollee employment rates, since most Medicaid enrollees are already working or would likely qualify for exemptions. Notably, the current package is a nonstarter for Democrats controlling the Senate and the White House. Nonetheless, UMDF is sharing with congressional leaders that employment should not be a prerequisite to receive medical treatment or coverage.

The debt ceiling political impasse over threats to entitlement programs comes when the suspension of Medicaid eligibility reviews has been lifted. The Consolidated Appropriations Act of 2023 decoupled the Medicaid continuous enrollment provision from the PHE and terminated this provision on March 31, 2023. In 2020, states that received enhanced Medicaid funding were prohibited from dropping individuals from the program while the Public Health Emergency (PHE) was in place. During the pandemic, Medicaid enrollment increased significantly, and over 91 million people were enrolled in either Medicaid or the Children’s Health Insurance Program (CHIP). The continuous coverage requirement ended last month, and HHS estimates that around 15 million people will lose health benefits as states begin their redetermination processes to evaluate eligibility. If someone is ineligible for Medicaid, they will have until July 31, 2024, to sign up for coverage via the federal Affordable Care Act (ACA) marketplace. Currently, states are working with several organizations, including Medicaid plans, hospitals, insurance marketplaces, and nonprofit groups, to reach people at risk of losing coverage.

Meanwhile, the COVID-19 PHE will end on May 11, 2023, and several pandemic-era healthcare provisions and waivers will end. However, the federal government plans to continue providing COVID tests, vaccines, and treatments at no charge while supplies last. Still, after that, cost-sharing is expected to begin, at least for individuals with private insurance. For those on Medicaid, COVID-19 testing, vaccines, and treatments will be covered for a year after the end of the PHE. Additionally, Congress and the Biden administration extended several telehealth provisions through 2024, thanks to the advocacy efforts of UMDF members.

On the agency front, the White House is close to nominating Monica Bertagnolli to run the National Institutes of Health (NIH) – more than a year after Francis Collins resigned. Currently, Bertagnolli is serving as the director of the National Cancer Institute (NCI). She is the first woman to lead NCI, and since she took over the role in October. If nominated and approved as NIH director, Bertagnolli would be the second woman to lead the agency after Bernadine Healy, who was appointed by President George H.W. Bush in 1991.