The Senior Citizens League (TSCL) Monthly Washington Update for the end of November 2023
Biden Administration Takes Another Step Toward Lowering Drug Prices
The Biden administration has determined that it has the authority to seize the patents of certain high-priced medicines, a move that could open the door to a more aggressive federal campaign to slash drug prices.
As part of its first move in that direction, the administration has issued a framework for the National Institutes of Health to more broadly use so-called “march-in rights” — a policy that allows it to seize patents from drugmakers whose products rely on federally funded research. The framework will lay out when the agency might assert this authority and endorse using a drug’s price in that determination. The price and availability of that product to the public are among the factors the department will recommend that agencies consider.
However, the administration will not endorse the widespread use of march-in rights and is not expected to take action against any individual medicines, said the people familiar with the matter, who were granted anonymity to discuss internal decision-making.
The administration’s decision comes as Biden officials seek fresh opportunities to lower drug prices and boost industry competition amid renewed attention on President Joe Biden’s health agenda.
The move, which an inter-agency working group must still finalize, is already causing uncertainty over the extent to which drugmakers may lose valuable monopolies and consumers will save money.
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Medicare Advisory Board Recommends Increasing Doctors’ Payments
A prominent congressional advisory panel is considering formal recommendations for lawmakers to increase Medicare payments in 2025 for physicians, hospitals, and dialysis centers.
However, during its most recent meeting, the Medicare Payment Advisory Commission presented another draft recommendation that urges Congress to provide no Medicare payment hike for hospice providers in 2025.
The commission provides Congress with analysis and policy advice on the Medicare program. Its recommendations are nonbinding, but Congress relies on the panel’s expertise when making funding decisions.
Each year, the commission advises lawmakers on payment updates for a variety of care providers that treat Medicare beneficiaries. The commission’s draft recommendations for these payment updates will be formally voted on in January 2024.
Once finalized, the recommendations for 2025 will then be included in the commission’s March 2024 report to Congress on Medicare payment policy.
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Senate Panel Looks to Medicare Policy to Fix Drug Shortages
Drug shortages are plaguing the country, with particularly acute problems for people being treated for cancer. Members of the Senate Finance Committee have taken their first steps toward using Medicare payment policy to fix drug shortages. Economic factors — the complicated way Medicare pays hospitals or the dominance of group purchasing organizations that buy hospital drugs — are implicated in the problem because they force generic drug makers to operate on razor-thin profit margins. That means less-than-proper maintenance of facilities, leading to shutdowns.
Witnesses for the Senate Finance hearing emphasized that solutions should focus on encouraging hospitals to buy from suppliers that maintain resilient supply chains. The committee didn’t coalesce around a solution. Still, several lawmakers from both parties asked about a Medicare policy that would increase payments to hospitals that buy from suppliers that focus on the strength of their supply chains.
TSCL hopes that appropriate legislation to fix the problem will soon be forthcoming, and we will continue to monitor the issue in the coming year.
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House Passes New Veterans’ Nursing Home Care Alternative Bill
The House of Representatives has passed bi-partisan legislation, H.R.542 - Elizabeth Dole Home Care Act of 2023, that addresses home care and caregiver programs provided by the Department of Veterans Affairs (VA).
Under the bill, the cost of providing noninstitutional alternatives to nursing home care generally may not exceed 100% of the cost that would have been incurred if a veteran had been furnished VA nursing home care. (Under current law, these expenditures are limited to 65% of the cost.)
However, for specified veterans, the VA may exceed 100% of the cost if it determines the higher cost is in the best interest of such veterans (i.e., veterans with amyotrophic lateral sclerosis, a spinal cord injury, or a condition the Secretary determines to be similar to such conditions).
The Elizabeth Dole Home Care Act would expand the VA’s Home and Community Based Services (HCBS) to all Department of Veterans Affairs (VA) Medical Centers (VAMC), ensuring that veterans who need home care can receive it and avoid costly nursing home care. It will also improve the VA’s care coordination and outreach to better connect veterans and their caregivers with critical services and support.
The bill directly addresses the need for improved home care by expanding existing home-and community-based services so that veterans needing institutional care, which is costly and often isolating, can be delayed or prevented. When veterans can stay in their homes, families can stay together, caregivers have the support they need, and veterans remain connected to their communities.
About 50% of veterans in the US are age 65 or older. Many veterans are opting to age at home instead of seeking long-term institutional care, with an estimated 5.5 million military and veteran caregivers in the US in 2014, according to a March 29 testimony on the measure from the Elizabeth Dole Foundation, a nonprofit supporting military caregivers.
The bill now goes to the Senate for consideration.
TSCL supports H.R. 542, and we urge the Senate to pass the bill as soon as possible.
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Congress Takes Closer Look at Medicare Advantage Complaints
“Enrollment in Medicare’s private-sector alternative is surging — and so are the complaints to Congress.
“More than 30 million older Americans are enrolled in Medicare Advantage plans, wooed by lower premiums and more benefits than traditional Medicare offers.”
So begins an article in Politico, a Washington, D.C., based news site that reports on political and legislative activity in our nation’s capital.
The article continues, “But a bipartisan group of lawmakers is increasingly concerned that insurance companies are preying on seniors, and, in some cases, denying care that would otherwise be approved by traditional Medicare.
“It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care,” Sen. Ron Wyden (D-Ore.) said in an interview, referring to a bevy of complaints from colleagues during a recent Senate Finance Committee hearing.
“Congress has already gone after insurers for their celebrity-filled ads and misleading directories. But its scrutiny of these care denials, expected to continue into next year, could have a far greater impact and reshape the rules for one of the most profitable parts of the insurance industry.”
You can read the rest of the article by clicking here: https://www.politico.com/news/2023/11/24/medicare-advantage-plans-congress-00128353
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House Budget Committee Chairman Wants Commission to Cut Federal Deficit
House Budget Chairman Jodey Arrington (R-Texas) said he wants to win support for attaching a bill to create a fiscal commission to a government-funding package early next year. Such a move would be part of the House Republicans’ often-stated goal of reducing the federal deficit. However, House Democrats warn that such a commission could include proposals to cut Social Security and Medicare.
Senators Joe Manchin (D-W.Va.) and Mitt Romney (R-Utah) released a bill (S. 3262) in November to create a fiscal commission. They testified at a House Budget Committee hearing last month in favor of the idea, along with Reps. Bill Huizenga (R-Mich.), Scott Peters (D-Calif.), Steve Womack (R-Ark.), Ed Case (D-Hawaii), and Lloyd Smucker (R-Pa.).
Rep. Jim McGovern (D-Mass.) also testified, criticizing the proposals and saying Congress already can address the debt and deficit trajectory. House Minority Leader Hakeem Jeffries (D-N.Y.) said members of his caucus are wary of the proposal, saying it could harm entitlements.
“There are real concerns that any so-called commission being backed by the extreme MAGA Republicans is part of a backdoor way of trying to gut Social Security and Medicare,” Jeffries said at a Nov. 30 press conference.
While cutting the federal deficit is an important goal, how it’s done is just as important. When Congress created a commission to close military bases around the country a number of years ago, the commission was given the power to select the bases to close, and it was all but impossible for Congress to block the commission’s selections. TSCL believes it is the responsibility of Congress to make decisions about Social Security and Medicare, not some unelected commission that is not responsible to voters.
TSCL will monitor the progress of such a bill as we head into next year and keep you informed as things move forward.
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For progress updates or more information about these and other bills that would strengthen Social Security and Medicare programs, visit our website at www.SeniorsLeague.org or follow TSCL on Facebook or Twitter.