Health Policy Roundup: Federal Policy Analysis and Priorities

Friday, January 14, 2022

This is an unedited transcript.

0:04

Hello everyone. Thank you for joining today’s briefing, Health Policy Roundup, Federal Policy Analysis, and Priorities. This briefing is the first in our round up series, which will reflect upon health policy priorities and initiatives from 20 21, and provide some insights as we move into the new year.

0:24

We will have these weekly Roundup webinars that will outline some major health policy minor milestones and informed predictions for 2020 jail. So please join us. The next couple of Fridays.

0:36

I’m Kathryn Martucci, Director of Policy and Programs at the Alliance for Health Policy.

0:42

For those who are not familiar with us, welcome. We are a non partisan resource for the policy community, dedicated to advancing knowledge and understanding of health policy issues, and I’m gonna go over a couple of housekeeping notes before we dive into the conversation.

0:58

I want to thank today’s sponsor under the Commonwealth Fund. Thank you so much for your partnership.

1:06

For those in the audience, you can join today’s conversation on Twitter, using the #AllHealthLive, and join our community at all health policy, as well as on Facebook and LinkedIn.

1:19

And today’s event is a roundtable discussion with some wonderful panelists that will help us reflect upon the various initiatives that might come up this year. And so we have some guiding questions that will lead our conversation through a couple of different themes. But please, be submitting your own questions to the panelists at any point.

1:40

I will be, we will be collecting those and giving them to the moderator throughout the broadcast. In order to do that, you should see a dashboard on the right side of your web browser that has a speech bubble icon with a question mark.

1:54

You can use that speech bubble icon to submit questions, and you can also use that to chat about any technical issues that you might be experiencing.

2:03

All right, so now I’m excited to introduce our moderator for today’s event, Rachana Pradhan is a national correspondent for Kaiser Health News and reports on a broad array of national health policy decisions and their effect on everyday Americans.

2:18

Prior to her time at Kaiser Rachana was at Politico for five years where she covered health care policy and politics on national and State levels. So no one better to moderate this discussion. So Rachana I’ll turn it over to you.

2:36

Thank you so much and happy Friday to all of our attendees and our panelists, I really appreciate you all inviting me to participate in this today. So we have a great panel, I’m just gonna get started with some introductions first joining us today. We have Jennifer Alton.

2:51

She is President of Pathway Policy Group, or she works at the intersection of government, external stakeholders and media. And prior to her time at pathway, she worked in the biotechnology industry.

3:03

And also has experience on Capitol Hill working for the US.

3:08

Senate Health Education, Labor and Pensions Committee, which, of course is very important for our conversation today.

3:14

So next we have Yvette Fontenot, but now she’s a partner at Avenue Solutions, and Yvette has nearly 25 years of federal health care experience, has held senior positions on Capitol Hill, as well as in the White House and at HHS.

3:28

Next up joining us today, we have Katie Keith.

3:31

She is the Director of the Health Policy and Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center. I can’t believe I got through that one breath, but anyway, Katie is also teaches a course on the Affordable Care Act, and she has been a very trusted, reliable expert for me and countless other health journalists, So welcome, Katie.

3:52

Next up, we have Cindy Mann.

3:54

She is a partner at …, where she uses more than 30 years of experience in federal and State health policy, two for her clients to develop and implement strategies around Health Reform, Medicaid, the Children’s Health Insurance Program, and delivery system reform.

4:13

Cindy previously was Deputy Administrator at the Centers for Medicare and Medicaid Services, where she fled the Obama administration’s efforts on Medicaid chip and the basic health program.

4:24

And, last, but certainly not least, of course, we have Rodney. Wait like, he’s Vice President at McDermott’s Plus Consulting.

4:31

Rodney previously was Health Policy Director for US Representative Charlie Norwood and was Health Policy Advisor for US Senator Chuck Grassley while he was Chair of the Senate Finance Committee.

4:43

So thank you all so much for joining us today. As a reminder, I am going to start today’s conversation but please submit your own questions to the panel at any point using the question mark button on the attendee interface.

4:58

So, to open up our question today, I want to add, let’s set the table. Yvette, I wonder if you could start with.

5:03

Build back better, is on everyone’s mind after. It’s relatively unceremonious, and not too long ago, or temporary.

5:11

And maybe I’m wondering if you could just give us an update on this very large piece of legislation, and in particular, what would be the biggest pieces as it relates to health care, and is there a path forward?

5:25

Yeah, sure, happy to do it, and thank you to the Alliance for having me. You all continue to be an invaluable resource in the congressional debate.

5:35

So the build back better, just to orient folks and take a step back, was a bill that was first proposed by the President, passed by the House before the holidays at a, about one point seven trillion. I think in the end price tag and was happily moving its way to the Senate.

5:56

And then, as you reference just for the break, Senator Manchin announced that he would, could not support the legislation as drafted.

6:05

And just to re-orient, the reason that’s important is because the Build Back Better proposal is moving through a process called reconciliation, which requires only 50 votes to pass in the Senate. Where most things require 60. And the Democrats in the Senate only have 50 votes.

6:25

And so they need every Democrat, plus the Vice Presidents vote to break, to break the vote and get that passed.

6:33

So they have the reconciliation instruction, which that allows them to do that, and they were moving forward.

6:39

I think where we are now is that the negotiations will continue with Senator Mansion to see if we can get him to a place where he is comfortable in terms of supporting the legislation. There’s a lot of technical work that needs to go on behind the scenes by staff to get it to a place where it’s ready to bring it to the Senate Floor, including work with the Congressional Budget Office to score it. And make sure it doesn’t increase the deficit, which is a requirement of reconciliation.

7:11

Conversations with the Parliamentarian, who will decide whether each and every provision in the bill is meets the rules of reconciliation and all of the drafting that has to happen with legislative counsel.

7:27

All of that technical work is, was being done, is being done, continues to be done.

7:33

And so really, this is about a negotiation. To see if they can get all 50 Senators and Senator Manchin in particular, in a place where he is comfortable.

7:43

There, current position to the Senate, as they are on voting rights, the Voting Rights Act, and they will continue to be until it looks like probably throughout next week when they will not be in recess, but they will be here considering the Voting Rights Act.

7:59

And I think the hope is that they will be able to turn back to build back better once they complete the, the, the consideration of the Voting Rights Act.

8:10

one thing to point out is, from Anne, from a procedural perspective, is that the, and I know we’ll talk about this more later, but that the government funding bill, that currently funds the government runs out February 18th.

8:23

So, we are running up against that, and obviously, that will have to be dealt with, you know, simultaneously or, in some way, at that time, while they consider build that better.

8:37

And so that, that may also help dictate the Senate schedule. In terms of the substance of the bill, itself, the, you know, there are, there are any number of provisions. In this bill.

8:52

I will focus on the health care provisions.

8:56

But, I think there are a lot of arguments for why you should pass this. I think the biggest argument is that it will reduce racial disparities in this country.

9:05

And that is, that is a focus of this administration, as it should be, as well as Congress at large.

9:14

It does contain a number of provisions, as I said, including paid leave, and the child tax credit, and housing vouchers, and climate change provisions, et cetera. In terms of the health care provisions, it includes an enhancement and expansion of the premium tax credits that are available under the Affordable Care Act for people to buy coverage.

9:39

It includes a provision that would fill what they call the Medicaid Gap, which are the people who live in states that have not yet expanded Medicaid, um, who and allows them to get coverage on the exchange, which currently they have absolutely no avenue for coverage. It includes about $150 billion in spend in spending on home and community based services under the Medicaid program.

10:06

It includes the addition of a metric of a hearing benefit to the Medicare fee for service package.

10:12

And it includes a number of provisions that would impact drug pricing and bring down drug pricing.

10:21

Including a $35 cap on insulin for people with coverage.

10:27

Um, I will just say, and then I will stop talking, is that the health care provisions in that were included in the bill seemed to be in pretty good shape.

10:39

As these conversations with Senator Manchin proceed, they, they do not seem to be the most controversial provisions in the bill that he has highlighted.

10:51

They do not, currently, as House passed, extend permanently, or through the 10 year window, and he has expressed a concern about that formulation. But in terms of the substance of them, they do not seem to be at the forefront of what he’s objecting to.

11:08

This could all change, but at the moment, they seem to be in pretty good shape In terms of if and when the bill, the bill moves forward, they seem likely to be included.

11:17

I just wonder if we could piggyback on that real quick and ask a politics question, which is of all of those health provisions that you mentioned and of course there many competing interests even within that.

11:27

Those bucket, what do you think provides the biggest political liability for Democrats if they do not get it done going into the 22 midterms?

11:37

I mean, I will just tell you what the polling says that I have seen. Which is that, generally speaking, the health care provisions pull the most popular of any of the provisions in the bill. It’s a true kitchen table issue, and of those provisions, the provisions that impact drug pricing pull the highest in that bucket of health care provisions.

11:58

Mmm hmm, I wonder if we can get me running like broadening to weigh in on that also.

12:05

Oh, this could be problematic, OK.

12:09

I think, obviously, drug prices is an easy one, I mean, who’s in favor of higher drug prices?

12:16

I think the challenge, I think the ABCs, the ACA tax credits, are a very interesting one, because of, first of all, they’re currently in place. They reduce the cost of healthcare. The question is whether or not anybody knows and cares.

12:31

Certainly, the enrollment numbers suggest that.

12:34

So I think it’s, I think it’s worth noting that when you give somebody something and take it away, it’s a little bit more challenging than just promising something and not delivering it. So that’s probably the one I’ve watch for most closely.

12:47

Right. Oh, is always difficult to take something away once you’ve given it to people that, it’s very true. As we’ve seen, time and time again.

12:53

Even, not even not too long ago, actually, with the, you know, with the attempt to repeal the ACA back in 20 17, which, I know it seems like an attorney Diego but was not that long ago. So, well, why don’t we, why don’t we pivot just slightly. Before we get more into looking ahead to 20 22, why don’t we think about what actually did happen Last year, 20 22 hasn’t quite registered in my mind yet by 2021 was last year technically. And I just wonder if, Katie, if you could get into this, what do you think was the most important piece of health legislation that passed in 2021?

13:30

I mean, in 20 21, I think it’s from my perspective. I think it’s undoubtedly the American rescue plan. I mean, for the issues that I work on and care about, there was so many things.

13:39

You know, I think that has been the the springboard for a lot of the proposals and build back better. You know, certainly extending the marketplace subsidies that were included there. I think I would add on, on rai’s political point, if they don’t extend those subsidies. You know they’re up at the end of the year.

13:56

Folks who are enrolled would get those higher premiums on November first of this year, which also coincides right before the midterm election. So if you want to take it political, I think maybe not having premium shock.

14:08

For the at least fourteen point two million people that have enrolled in coverage thus far is probably pretty important there too.

14:14

But even the rescue plan included some Medicaid enhancement, you know, several very important ones that states are either opting into, it included some additional money for states to take up and fill the coverage gap that event mentioned.

14:26

They are, by and large not doing that, which I think is why Congress is being more aggressive in the Build Back Better Act.

14:31

So I think there’s just a lot of, you know, from my sort of coverage perspective, precursor policies in the American restaurant that Congress is now working on building on, but I would love to hear others thoughts too if it’s not the rescue plan and why.

14:46

It would jump in and say I would agree. The rescue plan has is number one on the hit parade in terms of the impact in 20 21 and an ongoing and many other provisions that Katie mentioned. Would also note that there was that Back to Events, reference to the importance of promoting equity is the extension of the post-partum coverage for pregnant women. It’s temporary in our bow. And, again, like the marketplace, subsidies would be made permanent. If DVB is enacted, at least as, as, as, voted on in the in the house.

15:26

There’s also really important investment in home community based services, very important issuing a really strong public support for it, and every state picked up the option to to get some enhanced match, but the enhanced match in new funding cannot supplant other funding. So it really requires that you expand and strengthen your, your, your workforce and your services, your eligibility, and that, again, is connected to an even broader provision in the building.

16:04

Millimeter, Hm, I wonder if we actually have, We have an audience member, actually, with a question already event, mentioned this, We are running up against another RCR are running out very soon. They ask, Since the short-term spending measure expires in about a month, do you think there’ll be another short-term CR?

16:22

Will there be a budget with increases for healthcare or will act to keep funding at current levels for the rest of the fiscal year?

16:31

Yeah, I mean, my Sorry, my sense on that is that Well, they are working towards getting an Omnibus done, so that they don’t have to do another CR. My sense is, they’re going to need at least one more CR.

16:46

That’ll take, take them to probably April and that they I’m not sure they’ll be able to get over the finish line with an Omnibus before February 18th.

16:56

I do think that the and that’s been in the press this morning that the White House is contemplating another covered relief package. That would have to be bipartisan and ride with the CAR.

17:07

There’s also no talk of the possibility of another bipartisan health care package small package that would ride with the CR along the lines of some telehealth, waiver flexibilities and some other technical changes they need to make.

17:21

And there are, the CR is February 18th, but there are a number of other expiring provisions like the Medicare so cluster relief and the physician payment update relief that expires end of the April, and then end of the year.

17:36

So, there are a number of deadlines that are up and coming, but I think that it’s likely they may get some of those things done with a CR as opposed to an omnibus, and then have to come back and do, you know, either an additional current and next year, or further budget bill in April, would be my guess.

17:58

I’ll jump in just quickly enough to say, the cool thing about being an appropriator, the spending money, the way you want to, and that … don’t allow you to do your job.

18:09

With the National Defense Authorization Act passing just before Congress blew town. At the end of last year, it now really ups the pressure on the appropriators to get a deal done.

18:19

And really, it’s what other intervening factors play into it that actually complicate, getting their jobs done like that, the rollout of a potential supplemental and how does that complicate conversation? I think that’s what’s the big thing to watch.

18:34

I mean, so, going into this year and, Jennifer, I’d love for you to weigh in on this. I mean, we just talked about there might be another covert relief package, is 20 22 going to be another year in which health care legislation is very much dominated by this pandemic or are there other themes or areas that you think are likely to be pursued?

18:57

Yeah.

18:57

Well, certainly, pandemic preparedness is everywhere for the kind of the first time as somebody who’s worked in this field for a really long time.

19:08

And, it is, it will be interesting to me to see whether there is a shift from Cove in Response to looking towards the future of, of our readiness for and future pandemics or other health Security threats. And, you know, looking at the American Rescue plan.

19:24

It was interesting, we didn’t mention all of the multi billions of dollars that have been provided to to, to that side of, of the response, and, you know, looking at $6 billion going into medical counter-measures for vaccines, therapeutics, diagnostics.

19:45

But that’s all for the immediate response and now we have an opportunity to look ahead and say, what do we need to do to be better prepared to make sure that this kind of health crisis never happens again.

19:57

So I think there’s definitely an opportunity for that and the Senate Help committee, you know, everyone’s kind of waiting with bated breath to see what comes out of Senator Burr and Senator Murray’s process.

20:11

So I think there’s, there’s great enthusiasm for something getting done there in the year ahead.

20:18

I’m just piggybacking on that and one of the things I’ve been interested in my pandemic coverage is there’s always these perennial cause, and we need more domestic manufacturing to make a right now. The latest thing is covert tests, I mean, it’s very, very difficult. Right now, our supplies are very, very constrained. And part of that is because people say, especially with a global supply chain crisis, we have to rely on overseas manufacturing for so many things.

20:43

Do you think is there, is there an actual genuine appetite has the needle shifted at all as far as whether that can be a part of this, or is it Basically you’re going to fight fall by the wayside again.

20:56

Um, I think there’s genuine interest in domestic manufacturing of medical supplies, whether it’s vaccines, therapeutics, PPE, other things and there’s been major investments made already, but that’s really been focused on the immediate covert response.

21:13

So, but, I definitely think there’s concern about our overseas reliance for key products that we need for, for future health security threats, and I would anticipate that that would be part of what comes out of the Senate Help Committee process.

21:32

How about you? And is there anything else? Any big themes you see? being very heavily debated at this coming year. Whether it’s pandemic or not.

21:43

Well, I mean, I do think, as it relates to Congress, there do seem to be a handful of bipartisan themes that they’re looking into, there’s telehealth, as I mentioned, but also, mental health and substance use disorder, and the ongoing opioid epidemic.

21:58

There is the need to reauthorize the user fee, the FDA user fees, as those expire, I believe, at the end of September.

22:07

And there’s a lot of interest in that, and then I do think the Pandemic Preparedness theme will continue and there is this, the bipartisan process the Health Committee is running to develop legislation there.

22:19

So there there does seem to be, you know, some some interest in the health care space, particularly on issues that align somehow or have been exacerbated or highlighted more by this pandemic.

22:33

And I think, you know, racial equity and health equity, as an overarching an area of priority that I would say is as bipartisan as well.

22:42

Maybe not the solutions exactly, but the issue itself, and how this pandemic has highlighted that is, is going to be part of the ongoing conversation, for sure.

22:55

So, what I’d like, I’d like Rodney, maybe to kick off with this, so, what needs to be re-authorized in 20 22? So, we talks about there are some sequester relief is one thing. User fees are a big one with the FDA. So, and what would the impact be if not reauthorizing these programs that are must do this year?

23:14

So, the user fee X or this fascinating little triumvirate between the committees of jurisdiction, the manufacturers and the FDA, where they all come together to reach agreement to say, This is what we need to move forward and then they tell anybody who wants to be engaged to get the **** away from our work? We’ve reached an agreement. Go away.

23:36

I only speak of that from experience having watched this process occur every five years for a number of times where it really is tight.

23:44

Now, I think what’s going to be fascinating this year is what’s going to happen on drug pricing in BBB because if it doesn’t actually go through then it becomes a very complicated conversation, frankly, especially for Democrats. to explain to folks how it is. we’re coming up with this agreement with firm pharmaceutical manufacturers, which is to their advantage, but we sort of skip the drug pricing part of the conversation. That’s going to be fascinating to watch.

24:14

On the other side, the Cures Act, way back in 20 17, 16, 17.

24:20

That’s an interesting one, because it does have a few, not, you know, a one above the fold type programs that will hit a reauthorization, because it’s been five years. So there will be out there, which may motivate a lot of things and cures to point O How much that moves forward remains to be seen. But those are the ones. It’s not a long, extensive list of things that need to occur, like back in the old days of SDRs and things like that. It’s much more of a limited list, particularly watching for How does ufa play out politically?

24:51

Yeah. Well, SGR there’s an acronym I haven’t thought about in a long time.

24:56

I guess, fortunately, for me, but I, Well, it’s interesting, what you say, end user fees. I I’d like me, Yvette, and Jennifer to weigh in on this. These things, user fee acts, are very much under the radar to the average person. They happen every five years, as you said. And you know, people out in the world, and we’re not in Washington or in the industry, are involved, and FDA work do not pay attention to these things. And you’re suggesting that it actually might pose a political problem that it would this level of policy granularity would actually.

25:28

Perhaps cause issues for Democrats if they don’t do drug pricing legislation simultaneously. Of course, the FDA has nothing to do with prices. Right. So.

25:39

Actually, it’s the concerns about actually having to lay people off at the FDA. If you don’t get it done on time, that drives, you know, getting it actually done. And I agree. It’s not something that the public generally looks very closely at, but I agree with Rodney that just having major piece of legislation get past, even though it’s not something the public normally looks at. But, it is in the drug regulatory sphere that not doing something.

26:07

He would kind of look odd to the average person, I would imagine.

26:13

So, I wanted to shift a bit. We had some some big Supreme Court news this week on the binding administrations covert vaccine mandates. Of course, the test or get vaccinated, mandate for large employers for businesses was was not upheld. But then of course, the more narrow one away, still significant for healthcare workers was upheld by the Court. Katie would you be able to speak on major healthcare court cases from 221, and the impact, especially of that vaccine mandate ruling that we just received?

26:47

Yeah, nice, easy request their rational. Thanks so much.

26:52

Believe it or not, right, the Affordable Care Act was upheld by the Supreme Court in 20 21. I think we forget that right? there was that major California versus Texas. It was just this past summer. And so you had this overlay of American rescue plan like injecting a lot more federal funds.

27:07

And you had record high enrollment, and then at the same time, the case was before the court and it was upheld 72. And now we’ve all forgotten about it, and, you know, it’s over. But I feel always all the data doesn’t go back. That was no less than a year ago, that we were all sort of tied up and not about, you know, will they are, won’t they for the third time with the Supreme Court? And the Affordable Care Act. So, you know, that was a huge, major case.

27:32

You know, this, as we think about this year, you know, I think a lot of folks have definitely paid attention to. You know, that was just yesterday that we got the ruling the Russian was talking about on the vaccine or test mandates from ocean CMS. Those will still kind of proceed, right? This question on the merits. This question was about whether they would be put on hold for now. And so we’re actually going to continue to probably see litigation and rulings coming out of that. But, you know, for now, things are on hold on the workplace mandate, but healthcare workers that will go into effect. So more, if there’s even more to come on. That, I guess, is the warning to folks here.

28:06

So if you want to keep following that issue, you should be some of the other big cases that that I’m certainly watching this term. We don’t have anything Blockbuster on the Affordable Care Act itself. Certainly, many folks are paying attention to the … case, which is the abortion case. You know, they they did their ruling on the Texas SB eight case.

28:28

No, well mixing to me, that they allowed that law to go into effect. But here we are and will continue to see that one work its way through the court system.

28:37

There’s also a couple of, like, these are wonky weedy issues on Medicare policy, but they could have some really big impact. So, on, there’s one called Empire Health Foundation. There’s another called the HA versus Sarah and I’m not going to go into the details, but there are about sort of, complicated statutory interpretation questions. And, like, did HHS do right?

28:55

By the statute and, you know, interpreting the Medicare Disch formula and then making payment cuts to 2 or 3 40 B hospitals, and it, you know, there’s a, there’s billions of dollars at stake.

29:07

There can be, I think, there are some broader questions about how much flexibility federal agencies have in issuing rules and interpreting their own statutes. And, Cindy, you can speak to this as well, but it’s sort of the same issue, is, we just saw new vaccine mandate cases, and so with a much more conservative Supreme Court.

29:25

I think it’s sort of this long standing project, if you will.

29:29

two, I think you injustices that are very skeptical of the administrative state and of how much kind of how much of a long leash to give agencies. And you could sort of see that really cutting back on osha saying you don’t have the authority to do this.

29:41

You’ve gone too far, CMS, they found it, but CMS did have, you know, somewhat stronger, more, more explicit, more specific authority, and they sort of let that go forward.

29:51

They’re going to weigh in again on this, on these big Medicare cases that I’m talking about, which we will start to see come out this spring and summer.

29:57

And it’s something that I’m sure the byte administration is thinking a lot about, of, are they gonna, Is it going to be much more challenging to issue roles and do interpretations? I think that matters a lot more. Especially if the midterms flip and and you maybe don’t have a congress as willing to to do things. And you’re relying on your executive agent, you know, the executive authority, more than anything else. So, I, I think there’s a lot more to come from the core.

30:20

It’s not necessarily things that would affect day to day life, but a real people, but could be a signal, be signaling a major shift in how we do sort of executive policy, and would welcome comments on that, or correct, you know, friendly corrections from others as well.

30:37

Well, I think that’s actually where I was thinking. We have a question for the audience, for Sydney. Which is, what are, we haven’t talked about the binding restrictions, regulatory priorities a lot, but what? They’ve clearly 20, 21, they’ve issued a lot of rulemaking on that no surprises Act. So, you know, which, of course, just went into effect. As, Cindy, could you talk about what do you see as being the binding administration’s biggest priorities as far as health care, and, you know, regulations or other executive actions?

31:07

So first of all, I totally agree with Katie’s takeaway from some of the judicial actions, which is that it can really shift the balance in terms, what the executive can do or can’t do through regulations or the processes they need to take to. Can they do it through subregulatory guidance? Do they always have to proceed by thermal regulation? So I think that is an important area to look out for beyond the specifics of the particular cases. You know, if BBB passes, I think looking ahead the administration is going to be all about implementation of TPP because it’s so many. So many provisions that will need guidance. And certainly on the health pieces that that’s true guidance as well as actual implementation. For example, we talked about the fallback provision that would provide coverage for people.

32:03

In the states that have not expanded Medicaid, that would be a lift for the administration to move forward. First year is pretty much as is, but then some additions and complimentary provisions need to be adopted in, in outer years. But the Administration has made it really clear that it’s got priorities. They’ve issued lots of different blogs and in and policy and thought pieces around, expanding access, driving innovation coverage, and equity being really high priorities. So, I think what we can expect to see some new activity, an additional activity around social drivers of health and and equity.

32:53

Those aren’t those aren’t necessarily equator bull but they are certainly overlap. There. The administration recently approved California’s approach to social drivers of health and the interesting thing about the California approach that CMS adopted is that it doesn’t require special waivers for the most part.

33:13

And it really can be done under standard managed care authorities that really does open up some possibilities for not just California but for other states to really be moving in this direction To think. Many are doing and more so. Since Kobe highlighted the importance of that intersection, they’ve also signal to access review looking at regulations in the Medicaid program both for fee for service and for managed care to ensure that coverage actually equates to receipt of care. And that equity principles are really observed in, in, in how we think about providing access and monitoring access. There’s going to be real issues, new issues around that long standing debate, new issues raised by the workforce shortages, new issues raised by, how do we think about telehealth? And how does that fit into thinking about what standards of access should be?

34:09

Um, there’s gonna be some real thought around justice involved initiatives. The baby being has a provision that would require states to provide Medicaid coverage for 30 days pre-release. There’s already, though, provision that requires CMS to issue guidance on how states can move in that direction through waivers, and a number of states have waivers pending, or to submit waivers, to get into health care in sales, and really was an ID.

34:44

idea enough to stabilize, pupils, care, improve people’s care, and then to do some warm handoffs on re-entry.

34:52

one thing I just want to language, I think, is going to be an enormous issue, regardless of what passes in front of, both for the administration, and then for states, is the unwinding of the continuous coverage provision.

35:05

So, as part of one of the very early covered, really, packages, States were offered additional federal dollars, federal matching payments for their Medicaid program. one of the conditions was because.

35:23

People who are enrolled in the Medicaid program should stay enrolled in the Medicaid program through the duration of the public health emergency. And so, on the Medicaid side, we have seen a growth of the Medicaid program.

35:39

Pretty significantly, we’re probably around at least 84 million people.

35:44

up at least 10, 12 million people since the epidemic started.

35:48

The data lags a little bit, and everybody in the program, and nearly everybody in the program, is going to have to be pre-determined and have their eligibility considered. And I’ll be taking any point in time, particularly now with staff shortages at the state level and also because people have moved and relocated. So there’s just a lot of risk points and they’re going to be a lot of attention to this as there should be given that the focus on both coverage inequity.

36:19

Millimeter. Hmm. I wonder if 1, 1 thing I thought of actually relate to that a different kind of perhaps a great unwinding but we’re only a year into the bind administration and of course at the start of administration, many times the priorities as to what gets looked at is unwinding what the prior administration did. So that’s certainly happened. Started the Trump administration, and it did happen. It started by an administration also. But is there anything left, big ticket health items, where people thought, you know, they’re probably really going to open this up again and undo what, you know, what are those things.

36:52

Yeah, you’re absolutely right. And I kind of, like the Supreme Court’s decision on the ACA, kind of skipped over that. Yes, that was this year to write. Every administration looks at the last administration did and sees what they want to do to change often. Take actions.

37:12

To do that is the administration did that mainly gag rule, for example, around Title 10 rules, and, you know, significantly pretty quickly with respect to work requirement waivers, making it clear from the jobs that are consistent with the actions that define administration. Determined that didn’t for those those waivers. Didn’t further with the objectives of the Medicaid program, and and rescinded them, which is a big step to take in an administration, in terms of changing waiver policy.

37:48

But it’s it’s a policy that have the potential of really undermining the coverage calls illustration, as we noted, was certainly contested. So I think there are some additional things that are still remaining the Administration recently notifying just in the last couple of weeks.

38:08

Some states that it will no longer approve and maintain waivers that have allowed museums for people in the Medicaid program. And it took that action in line of general evidence of premiums.

38:21

dampening participation, but also in light of what the Congress steps the Congress did, too.

38:28

To provide for zero premiums for people in the marketplace, and somewhat higher income levels than than what might have been imposed on Medicaid. So I think they’re both looking at the parity issues and just generally access issues.

38:41

So there’s still a few things that probably remain to be addressed. But they, they are working their way through that list.

38:48

Katie, feel free to jump in.

38:52

Thanks. Not not to be a modest. I have a recent analysis up with the Commonwealth Fund. Actually, I had looked at sort of public facing recommendations to the transition team, I think, directly, you know Russia, and sort of looked at what, what the policies, where, where there was consensus among a whole bunch of healthcare stakeholders. from that we identified 13 sort of high priority Federal administrative actions there, as both of you suggested a sort of straight up reversals of Trump era policies. So far the vita Ministration has accomplished seven of those 13.

39:25

And so, you know, at some of it is, you know, funding navigators, which of course they did, or you know, opening the special enrollment period, which they did for six months. And it was bolstered by the rescue plan subsidies. Some of that, I say that because some of it’s been easier to do than others.

39:39

And then I am a dork like and I think I’m in good company on this But I spent a lot of time digging through the the fall Unified agenda which sort of list out their priorities for the next year. It’s not binding, they don’t have to do it, but it isn’t the sort of good sense of what direction they want to go in and it’s sorta prepares agencies.

39:59

So even from that, there were another three of those 13 policies that I had on this list.

40:05

Fixing a family glitch, which would extend marketplace subsidies to about five million people, who are still kind of left out in the cold, even under the rescue plan. More than half are children.

40:15

So very, I think, important policy there and something that, No, that’s created by the, the Obama Administration or isn’t Obama era issue to the family glitch limiting short-term limited duration insurance? So the, you know, the so-called junk plans, but kinda tamping down on those And then reversing the Section 15 57 non discrimination goal.

40:36

There are some links to the court, as Sandy was suggesting for many of these policies.

40:40

But they’ve suggested that to the courts, even, that they’ll have that proposed rule out. No later than April of 2022.

40:47

So those are sort of, those are all pretty big lifts. That’s all in addition to the No Surprises Act that yeah, you mentioned Russia, which we haven’t really talked about.

40:55

But we could, because that’s taken up an incredible amount of work, and I’m tracking a lot of litigation now challenging the rules that were issued over the past year.

41:02

But, you know, some numbers to put to that progress that I think we all are sort of feeling there for what that’s worth.

41:08

Yeah. Real quick before we do Oh, yeah. Jennifer, go ahead, please.

41:12

Thank you so much. I just wanted to add one other thing. It’s not really a regulatory initiative by the trumpet or the Biden Administration, but just in August, it doesn’t feel like that long ago. They put out what was called the American Pandemic Preparedness Plan.

41:27

And this was an initiative where they proposed $65 billion over 7 to 10 years to get the country in a much better position to respond to and really prevent future pandemics.

41:40

So, it includes transforming, medical defenses, ensuring situational awareness strengthening, public health systems, kind of managing the mission through a mission control function and building core capabilities. So I think that’s one thing I wanted to make sure people were aware of, and hopefully will be incorporated. Some of that. Initial funding was incorporated into the build back better. Act, whether that proceeds are not as obviously an open question for, for everyone. But if not, then, will they incorporate funding for implementing that plan in the 23 budget request, and beyond? is an open question.

42:20

Absolutely. I do want to ship … back to the Hill in a minute. But we have an audience question actually related to surprise billing. So I’m going to throw that to KT, which is, um, so notable developments in 20 22, I imagine they’re going to be quite a lot.

42:33

So this, this audience question is, Do you expect notable developments or attention on surprise billing and price transparency, which we saw a good amount on last year?

42:47

Yes. I do think they said, well.

42:55

No, I mean, if, I think, for anyone who may be things that, the surprise billing has done an over, that, that is not what we’re doing, and how policy these days, because, now, the issue is before the Court said, there, I mentioned this just briefly, there’s five lawsuits challenging the Biden Administration’s interpretation.

43:11

And there are somewhat narrow challenges focused on, you know, the big issue of how employers and insurers would pay out of network providers through an independent dispute resolution process, is kind of the heart of the matter that was being heavily debated on the hill between the stakeholders.

43:28

Vita, Ministration issued what I think is a quite a strong role, and it’s now being challenged in Court. And so in, there’s one case in Texas, there’s two in DC, there’s one in Illinois, and there’s one in Georgia, I think most folks are familiar with, the case brought by the American Medical Association, American Hospital Association.

43:43

So you have some heavy hitters bringing these challenges, and I think that’s just going to kind of continue to influence.

43:50

At least that part of it, Consumers are fully protected in terms of, out of pocket costs. And I think we need to keep a close eye on how the actual implementation goes.

43:57

I think there’s, no, I think the bite administration and state insurance commissioners and others, consumer groups, are doing some of the education to make sure folks understand their rights, and that they should be protected, and all that.

44:08

I think, but I think there’s still gonna be questions about enforcement, and how all this goes, Particularly probably in the first six months of the year. It’ll be something good to keep a close eye on, and then we’ll kind of be waiting and watching for the courts. I don’t have as much of a sense on transparency, so I would, you know, other folks can sort of speak to that. They’re, they’re moving forward. They keep kind of the timeline for have been shifted around, but it does not seem to me like they’re kind of backing away from a lot of those initiatives. But again, would welcome other thoughts.

44:38

I think the biggest question that I think of when it comes to price transparency and there’s been research that’s been published on this is that compliance is very uneven. You know, whether it’s actually usable information. You know, for for even researchers or other people, let alone the average person trying to weigh. How much things cost. And so, I just wonder, is there any, you know, I guess maybe we can Ivette, or, Jennifer, I don’t know if you want to weigh in on this.

45:02

If there’s any teeth that can be put behind, you know, actually, insurance compliance among among no institutions that are required to, to, in theory, do this.

45:13

Yeah, and I think this, this was sort of moving along two tracks. There was a hospital, transparency requirement, And there was a plan transparency requirement.

45:22

I think in terms of the hospital transparency requirement, this is an area, I think, where the bind administration has actually double down on what the Trump administration put into place, but just to say that they are tracking compliance. And they, they have recently issued no the series of CMP that will, or the civil monetary penalties, that will be assessed against hospitals that are not in compliance with that transparency requirement.

45:44

The plan, transparency requirement was, I think, delayed a little bit while they are enforcement was delayed while they figure out whether there is some redundancy between what was required as part of the, the congressionally past transparency requirements in the Consolidated Appropriations Act. And then the transparency requirements that were put into indirect by the Trump administration. But I don’t think those are, those are far behind. And I, to your point, I do think the question is, the continued tracking of compliance here.

46:21

But also, both on the hospital and the, in the payer side, how to make this information usable and helpful to consumers? I don’t think anybody opposes. I mean, the stakeholders don’t love transparency. But I don’t think anybody opposes the idea of transparency. It’s sort of hard to be against it. I think it’s really just a function of figuring out how to make this information helpful for consumers.

46:46

How do you actually make it, you know, functional so that it can help impact the way that they purchase health care? And I’m not sure that any of these regs necessarily lead to that outcome quite yens.

47:04

I’m going to take up one other audience question before I talk about things related to the Hill again, including reconciliation. So, yeah, this is a great question.

47:12

Workforce shortages, especially in the care of older adults, that is, of course, been, acutely, People realize how big of a problem it is, especially, you know, with our with the pandemic, and certainly now everyone’s getting sick. It seems like, because of the …, so any sort of workforce challenges are being exacerbated.

47:32

So, can any of you share any possible action to alleviate this problem? And how do you expect workforce strain and shortages to impact any sort of policy action in 20th and two, whether it’s in the bind administration or in Congress.

47:48

Jumpin’ on site, and certainly, the Build Back Better provision around investment into home and community based services was very much focused on the workforce. And if you think about what it means to provide home and community based care, it is really all about workforce. And I think coven laid bare. How fragile that system is, how fragile the system is in nursing homes, and and in, in home, and community based services. And also, I think, a little bit of light on who are the people to deliver this care. And they are largely women. They are often women of color they’re caring for. Kids coven hint. Hit them as well as as well as their patients.

48:36

And they’re often working 2 or 3 jobs. Their pace is often quite low and often lack leaves, benefits sick leave, which becomes even a bigger issue of course during the pandemic.

48:50

So, I think the question is is right on in terms of really Targeting an area that needs a lot of attention.

49:01

You know, I was just talking to a health system, a large health system, in a rural area today, and there, their workforce shortage right now, because of … is just extraordinary. And, of course, they’re getting backups from the nursing homes, because the nursing homes aren’t taking any more individuals. So, people are getting backed up in the hospital. And so, you know, it’s a very acute problem, but it’s also a longer term problem as to how do we really kind of write the focus on where we spend our money on health care and really think about the worst workforce as the central element that it really is.

49:39

It’s gotta be worked into that comes good judgement.

49:43

I just say one other workforce issue, I wanted to highlight is the public health workforce at the state and local level. That has just been totally decimated and no undercut in many regards during this pandemic too. And so that’s another area that is ripe for, for action and support at the federal level.

50:04

Rebecca, I’ll put in a shameless plug for some of my colleagues at Kaiser Health News and the AAP had a year long investigation called …

50:11

funded under threat that looked at our significantly depleted public health workforce, and why it’s certainly matters right now, but also in the future. And increasingly, how people who are working in that line of work, are subject to threats, forced firings, and retiring because it’s just so difficult. So, I think it’s required reading. But unbiased, so you know, But if anyone is curious, you look for any of that … dot.

50:39

org, So Yeah. I think it’s It’s very But it’s very, very important at this time. And I think, if anything, it’s even harder now to work in public health than it was, you know? certainly two years ago.

50:53

So I do wonder, but I don’t know if there’s public health workforce. And Jen, do you think that there’s an appetite? It can cannot be bolstered federally in any way right now. A lot of this of course is happening, you know, because of state and county level activity that, you know, people here don’t.

51:08

No, it’s not necessarily picked up upon.

51:12

Yeah, well, certainly, from a funding standpoint, there’s a lot that the federal government can do, and that was a major part of the build back, better public health and pandemic preparedness provisions. There was $7 billion to CDC for supporting state and local public health infrastructure. And that’s primarily workforce challenges, so.

51:35

But, yeah, you’re right.

51:36

I mean, the regulations and laws are really state level.

51:41

So they have to be addressed there, but certainly resources can be made available from the federal government.

51:47

Sure.

51:48

Well, I know we we’ve been talking about build back better, but I am wondering if maybe I’ll kick this to Rodney reconciliation, Do we think that we could see another round of reconciliation in Congress this year, and what would the priorities be, if so?

52:08

Well, this current one’s gone so swimmingly.

52:10

Of course, another one would listen that the existing instruction is allowed to stay in place through the end of the fiscal year. So they can work with the existing one through September 30.

52:25

They can create a secondary one, which would be for the following fiscal year.

52:29

What that means is that, and as much as Democrats feel like they can find some ways to come together, to move legislation, they have alternatives and structural ways to get it done. Their problem is this whole unanimity thing that they continue to struggle with. Absent that the tools aren’t the issue, it’s the, the actual votes that are the issue.

52:54

That voting matters, when it comes, especially in a 50 50 Senate, right? So I mean, it is, so if, yeah, I know, it’s shocking so. Well, does anyone else have any thoughts on what can reconciliation current? Instructions are good for a little while longer?

53:08

But, is it basically build back better or buster? Can anything else potentially move under those instructions?

53:17

Well, I don’t know about anything else. But I do think you know, as you think about build back better. And the importance and significance of the of that piece of legislation and that concept, I think that is still driving the White House and the caucus, which is that failure is not an option in terms of getting something done and reconciliation. If only, because of the, you know, the.

53:43

What does the 73 million, three million people stuck in those 12 states, 60% of whom are people of color, according to the Center for Budget Policy priorities that have no other Avenue for coverage.

53:56

And the, but eight million people who have enrolled through healthcare dot gov and will see their premiums double, if they do not extend those premium subsidies.

54:10

I think that what will likely pass using reconciliation will not be the size and scope of what we saw in the house, nor will it be close to the size and scope of what we were all hoping for last year.

54:23

But they will pass something. I still believe that they will pass something through reconciliation.

54:31

This year, using, using that process, that is a scaled back, yet significant investment in, in working families and what they need.

54:41

You know, going into the, the rest of this public health emergency. Which, by the way, the administration just renewed.

54:48

Because it was expiring two days from now, tomorrow, sorry. They just renewed for another 90 days and I believe we will, will renew for, you know, 90 days after that, if not till the end of this year.

55:03

Right? But, actually, I wanted to ask you all that, right? They just came in under the wire, I think no one thought it was really going to lapse, but realistically speaking, how long are we talking about, you know, there’s public health emergency being extended force.

55:15

This isn’t just about as a way, I think our audience probably knows, but as long as this is, in effect, it has, of course, tremendous consequences for the availability of our … vaccines and tests, and so many things that have been authorized under emergency use.

55:31

And so, how long were you thinking? Is this going to go through the end of 2022, potentially, into 2023.

55:40

Yeah, I mean, as you point out, and I think people understand, but it is worth reiterating the public health emergency triggers any number of things that goes way beyond the rhetorical value of us all acknowledging that we are in a public health emergency. To, to things like, vaccine approval and testing and, and flexibilities. To providers, to use telehealth and waivers of certain requirements, like the, you know, three day admissions from nursing homes, et cetera. So, it, it reverberates, way past.

56:11

Just just the national psyche to a lot of a lot of tools that it gives the federal government to use to help people through this emergency.

56:21

I, I think a lot of how long it took, how long it lasts, depends on, you know, is there another variant behind this? You know, when does this one peak?

56:32

I mean, there’s so many unknowns at this point and I have no doubt that you know, whatever politics should bring This administration will extend it as long as they need to have the tools that they need to address this pandemic. So my guess is it goes, you know, at least through the end of this year, but, you know, you can, there’s sort of betting odds on on that question.

56:57

It’s better to just the, one of the early X from the binding administration was to promise the governors that there would be at least a 60 day notice it when it comes to an end. Because of all the issues that, that event identified, there’s just a tremendous amount of authorities, health providers rely on that.

57:24

States rely on hospitals rely on and so forth, that are triggered by the public health emergency. So to just shut it off without without ample notice to stakeholders is would really create a lot of chaos So they’ve committed to that, and I think are respectful of the need for good notice in advance.

57:45

But uh.

57:48

Is the political point that Yvette made and even Sandy made there?

57:53

Don’t rule out as utterly ridiculous at least January 20th, 2025.

58:00

I mean, it seems quite likely at this point, like you said. I mean, because there are so many things that are tied to this declaration.

58:07

I mean, I just wonder if it, is there any, It seems like, again, it’s important, but these things, relatively, people pay attention to it, and they, they sign it, it goes for another 90 days, is there any pressure, or do you think there would be any pressure from anyone to not extend it, and if so, where does that come from?

58:33

Anyone, The payers, who, and particularly the utilization that that these flexibilities and how it creates changes, that, oh, will there be pushback?

58:48

If there is really, arguably, well, we’re no longer in now, a public health emergency.

58:55

I mean, the reason I made my somewhat inflammatory comment there was that, you know, if you end up in a situation where, oh, that the only way to extend certain activities that have occurred under the public health emergency is through legislative action. It’s the inability to reach that agreement that creates the pressures that cause that, that, that’s where I’m, where I’m coming from. With that, I mean, again, greatest example is telehealth. I mean, we’ve worked in this space for a long time. All of us have none of this stuff that’s being done in, through, through the public health emergency. Would we ever have gotten through legislatively? Not even clear, we’d gotten laughed at for. Hey, can we know?

59:30

Going to CBO with that no, No. No, you may not go? No. We’re gotten hard nosed for years. Now it’s being done regularly.

59:40

I haven’t seen my doctor Emerson and more to almost 24 months. Oh, I imagine that, OK.

59:46

So it’s those transitions and, you know, resetting the clock that is going to cause the pressure there mm. I’m sorry.

59:58

And Sydney raises earlier, but and I don’t know that this equates to pressure to end the public health emergency.

1:00:05

But just, the, just to put it on the table that the this requirement for continuous eligibility of for the Medicaid program is tied to the increase and the federal matching rate for Medicaid, which is tied to the public health emergency.

1:00:23

And for some GOV’s, I think that requirement has has no for further state budgets.

1:00:33

And for them politically, it has sort of overtaken the the value of the additional Medicaid funding at least in perception.

1:00:45

And so, I don’t: I think: all things being equal, the the value that they get from a public health emergency being in place for all of their stakeholders and for various other reasons probably outweighs that.

1:00:58

But I, but it’s worth just keeping in mind that that does weigh heavily on the minds of some GOV’s I think.

1:01:08

I think that’s true, though.

1:01:10

I think it does tend to be more maybe more rhetorical but when they’re actually looking at the numbers, the 6.2% increase has been pretty significant, But it definitely is a very long time for that provision to continue.

1:01:27

Obviously, also, there are a public health emergency to still be ravaging the nation and people needing coverage.

1:01:36

Right?

1:01:36

And I’m sure as we’ve seen, of course, before, it’s been a there’s it may not be politically Tenable to have that many people on the program but if there’s any usually threat or risks, that money goes away well, you know, privately, they will say something. And sometimes even public, it will say something completely different even in the states where it’s not exactly popular too.

1:01:57

Expand enrollment in Safety Net programs. But can I just say another word about the continuous coverage, which is that.

1:02:08

Generally if you look at it income dynamics over time and certainly if you look at it during the period of the pandemic, to the extent that the data are available. It’s pretty likely that the people that are on the Medicaid program are either continuing to be eligible for Medicaid, or, if not potentially the marketplace. So, we’re not talking about you. Know, it’s not very realistic to think that people who go into the Medicaid program are eligible for, the Medicaid program, have suddenly gotten tons of income, and a job that brings them affordable, private health insurance through the workplace. So, it’s really, what continuous coverage has done, in many respects, is to just eliminate the churn. That happens. Where eligible people lose coverage and sometimes go back.

1:02:56

So, the end, there’s a lot of states that have actually recognize the health value of eliminating turn and being able to really be able to provide continuous care and address people’s health needs in a way that doesn’t get interrupted by occasional loss of coverage. So it is It’s not You know, it’s important to recognize that these are largely people who are probably eligible for Medicaid or for the marketplace and and and which is why people are concerned about how the unwinding happens. Trying to make sure we’re really identifying eligible people as opposed to having people lose coverage, because the process.

1:03:35

Are there are there concrete measures that you think the binding administration could take to ensure that you minimize any coverage losses from that eventual and windy?

1:03:44

I think there’s lots of concrete measures that they can take, and they’ve really been prioritizing it and put out a lot of materials and are continuing to put out a different flexibilities, best practices. And I think they’re looking very closely at different authorities that they might be able to offer state some options to to smooth the transition or to make sure that the determinations of eligibility are done in a way that they don’t lead to procedural denials. So, I think we’re, we’ve seen already a fair amount of guidance come out from them, but I think we will see a lot more, and they’re, you know, also planning to do some very one-on-one technical assistance and support with, with states.

1:04:29

Great. Well, I’m going to kick another audience question here. We’re going back to build back better the topic that keeps on giving. So, Jennifer, I wonder, can you, I would love for you to take this if that entire package can’t or won’t move fairly soon.

1:04:44

At what point do lawmakers breakout the health care provisions into separate legislation, especially because, as you referenced earlier, that many of the health provisions are broadly or very popular?

1:04:58

Sure.

1:04:58

I can start and then welcome other folks, input, I mean, I think certainly from the kind of public health and pandemic preparedness side of things, which is where I kind of focus my time there, Know, there already is another vehicle for some of that to move potentially through the Senate Help Committee process. So, you know, that the pieces that are not going to be able to be attached to that are significant new resources because the help committee process is an authorizing process. By appropriations.

1:05:32

So, but, yeah. I mean, I think there are other things that will potentially, move and, and, and things can be attached to that as well.

1:05:41

But then it comes down to whether there can be agreement on a broader over 50 member vote threshold.

1:05:51

So therein lies the problem. We’re in a reconciliation moment, right? Maybe some advances on, on some of the public health investments, but certainly filling that Medicaid coverage gap that Yvette mentioned for the 12 states that haven’t expanded Medicaid coverage, keeping the Affordable Care Act, ARPA provisions going Those are not necessarily bipartisan priorities.

1:06:18

Just drug pricing is an interest room for us to watch, in this sense that, to get to 218 and 50 in the House and Senate.

1:06:27

if it is under reconciliation, can drug pricing go with the ACA tax credits or does drug pricing need something called salt? And I personally don’t know salt from pepper or anything, but I hear salts important to a lot of democratic members, particularly those are in the nose north-east. So when we start looking at that, it’s not clear that, to me, the health care provisions could be pulled out and ride separately. Or are they really tied to other provisions as part of global deals? That’s the part I don’t go.

1:07:01

So, I guess, related to legislation. We’ve also, we haven’t talked really about by person that cures to zero and also proposed the ARPA E program, and funding, and NIH. I wonder if, Jennifer, if you want to take a stab at that. That was an audience question, to I’m sorry.

1:07:17

Sure, yeah. I mean, I think ARPA E is definitely something where there’s some bipartisan support for it. And, you know, Senator Blunt has made it clear that he supports it.

1:07:28

So, and there’s be, you know, Ben pieces of legislation that have been introduced already to authorize that, and then funding included for ARPA E H in a couple of different bills. So, I think that’s very possible.

1:07:40

Um, what was the other piece, I think, of as NIH funding funding funding in NIH, as well as this question. Yeah.

1:07:51

Yeah, and I think that goes kind of hand in glove with with our page, because that would most likely be within the NIH as well. But, definitely, that’s a bipartisan priority and has been for many years. And we see big billion dollar increases for NIH in most years. So, I think that could could happen, as well.

1:08:11

Right. I think, I mean, just for political, I mean, NIH funding, there’s very large bipartisan support for maintaining or increasing funding for the NIH right in Congress. And I just wonder, I mean, comparative the CDC, let’s say, right.

1:08:24

I do think CDC funding seems to be a bit more politically fraught, especially recently, because, you know, people have had many bones to pick with the CDC and the pandemic response.

1:08:33

And so, I wonder if you think, does that also help any sort of odds with NIH funding?

1:08:41

I think they’re pretty distinct And, you know, historically, I would say CDC is not, you know, a partisan.

1:08:52

There’s not been a big partisan divide there, but I think there there is more now post, or in the midst of this pandemic and people seeing some, you know, things that they’re not happy with, and unclear guidance and, you know, behaviors that make folks question, whether the, you know, the resources have been spent wisely.

1:09:16

So, it is an area where there is more of a partisan divides, and there has been in the past.

1:09:23

I wanted, there’s a, there’s another great audience question here about Medicare, which we have not talked about a bit, but, uh, Yvette Rodney, I wonder, could you address the question? Is any concerns and Congress regarding Medicare Trust Fund solvency, Could there be any upcoming provider or MA payment reductions to help extend solvency of the trust fund?

1:09:46

I’m in Medicare solvency is always a concern. I think, and Rodney or somebody correct me if I’m wrong, I think the latest Trustee’s report had solvency through 1024, which is not nearly critical enough for Congress to actually deal with it. So I think, you know we of course we will have a conversation as we get closer to that insolvency date.

1:10:13

But it does seem like at this point the concerns about you know providers actually being able to provide care, you know hospitals being overwhelmed, et cetera sort of outweighs the concern about the Medicare solvency. In terms of where the funding is, is going.

1:10:35

I do think, though, and, and I defer to Rodney about this, but if, if the 2022 election goes the way conventional wisdom I think expects it to go, I expect we will be in a much, much larger, longer, a deeper conversation about deficits and entitlement reform and Medicare solvency than we are now.

1:11:01

The last President to go into his first midterm election with his party in control of both houses of Congress and come out of set election with his party in control of both houses of Congress, was James Earl Carter. That’s the trend that Biden is fighting this this term, and if the election goes, as it has for all those years since Carter, oh, I can tell you right now, the theme of this presentation next year will be Medicare Solvency.

1:11:34

Lot lots of oversight I imagine also. Which which they’ve already made clear, I guess, that’s more of a house.

1:11:39

So while I would be remiss not talking about politics, I did work about, you know, Politico for five years, as is mentioned at the top of this call so let me tell you I will let’s see. Let’s see who I want to kick this question to. I think, maybe I’ll go to Katie.

1:11:56

Tell us what’s top of mind for voters going into the midterm elections, and how’s that going to impact what actually gets done on this, this year?

1:12:02

Health care.

1:12:03

Or otherwise, as you know, right now, we’re in a debate about voting rights.

1:12:07

So I’m not, I’m not gonna, I’m gonna steer clear of that and maybe we stick to, that, helps up, the least qualified person to answer this question. Why not? Think, I mean, I think it’s gotta be the pandemic response.

1:12:20

I mean, as much as I sort of even care about all these other issues, I think, know, the testing in school and maybe if we’re channeling sort of the Virginia election and the result, they’re kinda harbinger of kind of power.

1:12:32

How is life still feeling as disrupted as it is is Probably the metric that, I would guess most people would use. But I would add, you know, some of these other strains like if we don’t have these, you know, marketplace subsidies and other, there are things that could be more disruptive.

1:12:45

But heading and I bet that would be my guess as a law professor type with no real pair. Hang at all. I think it’s interesting you know, I figured after I have to mix it up a little bit so.

1:12:59

Wants to weigh in on that.

1:13:03

Yeah, I mean I think Katie, despite you self deprecating you hit the nail on that. They, the the pandemic is, you know, going to be front and center, but I also think, you know, the issues of inflation and economic, you know, economic issues related to that.

1:13:22

I do think health care always resonates and polling an elections and and rises to the top as as the kitchen table issue.

1:13:33

You know, I think there are other issues of election disruption and and voting rights, you know, play well, and I think going into an election will that will weigh on people as well.

1:13:49

So, you know, if it gets going to be, it’s going to be interesting action fraught with with issues, as always.

1:14:02

Is always a big issue for people around health care, right? And it just, it goes back to think both would deliver even in Katy. You’re saying it’s very, very much sort of the bread and butter issues. In the kitchen table issues. You know, which, is not my kids getting, to go to school during a daycare. You know, can I go to the job? But, you know, so all of that kogod related issues, but also, you know, can I afford my healthcare? Do I know that my you know, can I find a home health aide to take care of my?

1:14:29

you know, my aging mother and You know, what happens when I go Get a prescription filled on my drunk? so those those those, you know, may not be categorized so much by the electorate as healthcare issues, but they are very much front center I think on people’s mind.

1:14:50

I’m going to be the the skeptic, the Cynic here. No, it’s not gonna be a health care election. How am I, how am I doing? I feel like we’re going in a positive direction. Am I concerned about the direction we’re going in to? I feel like the things are in control out of control, all of those more amorphous things and I don’t feel like that. I’m going to weigh in and say, I don’t think there’s a lot of BBB That affects that and certainly not a lot and BBB That will affect that strong ways between November eighth, save for of course, … because that’s taken away, something from someone they already have.

1:15:22

I mean, I do wonder if the pressure that was R I mean, there was, of course, over the summer before, I think, inflation and schools right now or a mass of the pandemic. And all these things were weighing much more heavily, I think, when people are getting vaccinated and cases are going down and everyone thought, We’re going to have hot back summer and then that, you know, by the wayside.

1:15:45

I just, I do wonder, is it really going to be a referendum on on kovac policies in school closures, and and trying to navigate this?

1:15:56

Constantly changing, you know, landscape. People are tired of what has been happening.

1:16:04

But I, you know, when it comes to health care, is there going to be the same kinds of political pressure to say, try to get millions of uninsured? People covered trying to lower drug prices, which, of course, you know, Democrats have been promising since 2006 and Congress. They ran in 2006 on this.

1:16:21

And so, is that still going to, I guess, we have a longtime until November, but you know, it’s still kind of bubble up as a, as an issue.

1:16:34

There’s always room for us to sit here on January 14th and prognosticate, as to how things will be on november eighth, **** out of already retired from the money automate, and the sports books listen.

1:16:45

I think it’s a, it is, it is, again, it’s so much of the personal feel of how you, how you are and how you feel like the direction is. The other thing I think we also need to remember is how incredibly polarized this country is, I mean, goodness knows we’re all living in the sorting hat.

1:17:04

If you, if you’re, of one party and, you, the odds are that it’s a 640 county meeting 60% for one party, 48 landslide county. The odds are greater, you live in one of those places than not in America right now. That’s how sorted we are.

1:17:20

And so it’s we have to be careful that we’re not representing our echo chambers and that we’re only speaking of something that only represents where we are. Here I’ll give you this one. I bet Democrats won a lot of seats in California.

1:17:33

Just, I’ll call that right now, that they do in the House of Representatives, but that doesn’t necessarily spread out across the rest of America, and that’s the thing that’s hard for us to, to read. And I say this all the time, I walk. When I work in Washington, I really want to hear from people from America.

1:17:54

Yeah, I mean, look at, I mean, the world’s an uncertain place, it’s been, it’s been, even more so, obviously since 2020, and it’s not clear, you know, exactly what happens in the voting booth, or what can happen between, I mean, you know, between now and November is a lifetime away, in a political sense.

1:18:14

So, I think you’re gonna see a lot of, no, where we are this year, relative to where we were, which is that, you know, in terms of coverage, we’ve got nearly 14 million Americans covered under the ACA plan.

1:18:32

You’ve got close to five million newly signed up for marketplace coverage.

1:18:37

You’ve got, you know, 83 million who have coverage through Medicaid or chip.

1:18:45

You’ve got close to 250 million, have at least one shot and close to 76 million have had at least one booster. I know, most importantly, my kids are in school.

1:18:57

Most kids are in school so you know, I think you could paint a picture even though the world may feel chaotic.

1:19:07

That is a that is a much improved picture and I don’t agree that BBB would not make a difference.

1:19:14

I know that there are not a lot of deliverables in the first year, but I think the idea that paid leave is coming, that Universal pre K is coming, that more childcare is coming, That we have taken a first step on climate change, I think delivering something like that.

1:19:34

And even if people don’t feel the impact immediately, the fact that those policy changes would be coming in would be pivotal to people, particularly middle-class people, being able to go to work and do their job, and not worry about their health insurance, and whether they can actually afford it, and access it when needed.

1:19:56

And the idea of, you know, just being able to take care of those people stuck in those 12 states that have no avenue for coverage, I think, I think, does make a huge difference going into people’s, into an election and affecting people’s psyche in terms of how manageable their lives will be in the future.

1:20:20

And, you know, the, the overlay of that is that and, you know, my elected officials can get some things done, right? So, so which I think addresses some of the General melees even if they’re not totally clear and feeling the immediate benefits of build that better.

1:20:40

Yeah, there is an interesting story from some of my former colleagues who cover Congress in Politico not too long ago saying that in any other year, I think passing a massive, you know, relief Bill And bipartisan infrastructure bill would be, Hey, all this, monumental achievements.

1:20:57

You know, legislatively to do, but because they may or there’s expectation setting or whether, you know, they’ve said these are the things we’re going to do and then build back better has stalled out. And now a voting rights is sort of on the vine also.

1:21:13

People perceive it to be, you know, that they haven’t done things, but in reality, the those two pieces of legislation alone are very significant to get done in such a short amount of time.

1:21:24

So, so, but I guess expectation setting always matters, especially here, so I wonder if anyone else, Jennifer, Katie, do you want to weigh in on that at all anymore?

1:21:36

No, I think, I agree with what you said for sure.

1:21:38

And I think the other thing that we’ve all mentioned is: November is a long time from now and there’s a very uncertain world out there.

1:21:47

And you know, I think about like what’s going on in Russia and what could potentially happen in other parts of the world, like: we’re going to have curveballs between now and November. And that can definitely quickly change the calculus of what the voters are concerned that I’m worried about.

1:22:06

I think that’s the only certainty that we can be sure of at this time, there will be at least six things that will come our way in the next 10 months that no one can really anticipate now. We just have about about five minutes left so I’m going to just quickly sort of ask you all you know, are there any final thoughts that you have from all of our panelists on this conversation? Anything top of mind that I did not ask you barter. Didn’t come up from our audience questions.

1:22:40

Well, I could start. I mean, I think one of the areas in public health that I’m concerned about is the impact of this pandemic on vaccine confidence overall.

1:22:54

No.

1:22:55

I think that’s an area that has not been partizan until now, and it has certainly become so.

1:23:05

And so I’m concerned about the implications, um, for for public health writ large, and the other thing I would just say is partisanship is really hard right now. But I do believe that economic preparedness is one area where there can be bipartisanship. And my old boss, Senator Burr said that your success in Congress is depends on picking the right partner.

1:23:33

And so I’m really hopeful that Senator Byrd, Senator Murray have pick the right partners in each other and that we are able to get something good done this year to make sure that we’re never in this predicament again.

1:23:47

Also new Config that we haven’t talked about, which is kids.

1:23:53

Not really a topic but. They’re just. There’s as as if that is identified There’s a number of really important things and build back better with respect to kids but you know what’s really frightening is the impact of this pandemic has had on them. And both in terms of the material losses, but just the stress and the isolation and all the things that we know are going on with kids and they’re really the crisis in, in mental health for, for, for youth and children. And there was a recent Surgeon General’s report on it. And so, I am hopeful that maybe there can be that bipartisan agreement that is being forged at least in the in the Senate Finance Committee around doing something on on mental health. And particularly focusing on mental health supports or for kids and youth.

1:24:50

I can go next. This is sort of a crosscutting issue, I mean, this is a really big year for rulemaking.

1:24:56

You know, if you think about sort of the timeline, there’s there’s always counter pressure, I think, maybe wait and see what happens with Congress, which, you know, maybe with a little bit happening last year, too.

1:25:06

But the rulemaking process sort of take so long that to get things out this year that go into effect next year, that then have some sticking in staying powder, assuming they’re not struck, they’re challenged in court.

1:25:18

And then you have a executive record to run on in 20 24. I think this is the year for rulemaking to really happen, and they’ve, they’ve gotten started on that on some of the Affordable Care Act work, Medicare Advantage. They’ve put out central and, you know, they’re leading with health equity, they’re leading, I think, with some accountability measures, At least from the marketplace roles.

1:25:37

And they’re pushing for nothing for comment, and a lot of different areas.

1:25:40

This would be the This stuff just takes along that if they want to get some things done it, I think it would be a mistake to wait till 20 23 to do some big roles to sort of weight to lose Congress or wait to see what happened at the back better before really turning to that in earnest.

1:25:55

So, I hope the Vita Ministration is quite in vicious, the constrains that the law, but quite ambitious on rulemaking. And I hope they turn to it pretty quickly, or else you’ll just run out of time, which is that to think about. But it’s sort of how this stuff works.

1:26:10

Term, But I really want to second what Katie says. We, you know, we tend to focus and did focus a lot on, on the Congress in this conversation. But the administration has a lot of a lot of authority, and a lot of plans. And, as you said earlier, that they’ve moved past the undoing of some of the things from the last administration. And I think they are really poised, whether it’s through regulations, as well as waivers, as well as CMMI initiatives, to really move forward and to see what they can accomplish.

1:26:46

That, you want to go first. You want me to?

1:26:49

The line I’m really fond of that I keep using here, which is biggest problem America has right now, is the way we talk to each other. So I’d like to use this moment to say to my friend … and Cindy, how wonderful it is to be with you, and have a civil conversation. And then I will also take a moment as the University of Georgia alarm to express my well earned in software ability. Go down.

1:27:11

I was waiting for the hat to appear it. I’ve never seen riding on a panel without the hats. That was only a matter of time.

1:27:17

Yeah.

1:27:20

Wow.

1:27:22

Well, I know this has been really great. I hope that I certainly got a lot of value out of it. I hope our audience still did as well. Thank you all for all your insights. We covered a lot of ground in just over an hour and a half. And just a couple of housekeeping things for our folks who listened in today, or please take the time to complete a brief evaluation survey that you are going to receive via e-mail later today, as soon as this broadcast ends.

1:27:50

And then the alliance has another. The next briefing in this series is going to be on recent trends in coverage and affordability, that will be on January 21st, in one week, and, finally, a recording of this and materials will be available on its website.

1:28:08

So, thank you so much to Jennifer, Event, Katie, Sydney, and Rodney. It’s been a joy to speak with you, so thanks for joining us.

1:28:18

Thank you.

1:28:19

Thanks.

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