The House Energy and Commerce Subcommittee on Health July 11 held a markup on key priorities for AAMC, including Medicaid Disproportionate Share Hospital (DSH) payments, the Patient-Centered Outcomes Research Institute (PCORI), and diversity programs in the health care workforce. The panel also advanced surprise billing legislation that would establish hospital and physician rate setting to resolve related payment disputes between insurers and providers, an approach opposed by the AAMC.
The Subcommittee amended and approved by voice vote H.R. 2328 with provisions on Medicaid DSH, PCORI, and investments in the health workforce programs.
In a July 11 letter submitted in advance of the markup, the AAMC praised the Subcommittee for repealing the scheduled Medicaid DSH cuts for fiscal years (FYs) 2020 and 2021, the bipartisan commitment to reauthorize PCORI, and investing in workforce programs at the Health Resources and Services Administration (HRSA) within H.R. 2328.
The legislation also would reduce the scheduled Medicaid DSH cut for FY 2022 from $8 billion to $4 billion. Additionally, it includes a Government Accountability Office study on establishing an equitable formula for determining Medicaid DSH allotments moving forward and for hospitals to publicly report upper payment limit demonstrations for hospital services that states submit to the Centers for Medicare and Medicaid Services.
Rep. Eliot Engel (D-N.Y.), who led a “Dear Colleague” letter in the House calling for a two-year delay in the cuts that received over 300 signatures [see Washington Highlights, May 17], noted that the Medicaid DSH payments “help hospitals and health systems serve some of the most vulnerable patients” and called the impending cuts “simply unsustainable, untenable.”
Following the markup, Energy and Commerce Committee Ranking Member Greg Walden (R-Ore.) issued a statement applauding the Subcommittee on its passage of several important health care programs, including the elimination of the Medicaid DSH cuts. He stated, “This will provide certainty to hospitals that serve our at-need communities as we work on a long-term solution, and includes important transparency measures to strengthen the integrity of the program.”
The bill also extends PCORI and its funding mechanism for three years through FY 2022. AAMC lauded the bipartisan recognition of the need to continue the institute’s important work, but also cautioned that limiting the reauthorization to only three years could “create uncertainty that could limit the ability of the institute to pursue new research projects and hamper subsequent implementation efforts.” The letter reiterates the support of more than 170 organizations for a 10-year reauthorization, and some subcommittee members at the markup also expressed an interest in pursuing a longer-term reauthorization.
As amended, H.R. 2328 also reauthorizes and extends the National Health Service Corps for four years, providing $310 million annually in mandatory funding, and invests in the Teaching Health Center Graduate Medical Education (THCGME) program for an additional four years, providing $126.5 million annually [See Washington Highlights, June 21].
The subcommittee also advanced the “No Surprises Act” (H.R. 3630) in a voice vote. The legislation would take patients out of the middle in surprise billing situations, but it would also set a benchmark rate for payment to resolve surprise billing disputes between providers and insurers. The physician and hospital communities have strongly opposed benchmark rate setting [see Washington Highlights, May 31] and several of the subcommittee members expressed a desire to modify the legislation to include an arbitration approach.
Rep. Raul Ruiz (D-Calif.), who has his own legislative proposal, urged full Committee Chair Frank Pallone (D-N.J.) to continue negotiating with committee members and to consider arbitration as a solution. Pallone responded that he was reluctant to “throw away a bipartisan, bicameral solution” that also has the support of the president but reiterated that he will continue working with his colleagues to come to an agreement.
The subcommittee also passed the Educating Medical Professionals and Optimizing Workforce Efficiency Readiness for Health Act of 2019 (EMPOWER for Health Act, H.R. 2781), which reauthorizes the Title VII health professions diversity and workforce development programs for five years [see Washington Highlights, May 17].
The AAMC July 10 sent a letter endorsing the EMPOWER for Health Act, highlighting how “Title VII programs increase the supply, distribution, and diversity of the health care workforce and improve access to and quality of care for vulnerable populations — including children and families living on low incomes, veterans, seniors, and individuals in underserved communities.”
During the markup, Health Subcommittee Chair Anna Eshoo (D-Calif.) cited the AAMC workforce projections, noting, “Title VII programs provide funding to medical schools to train the next generation of physicians and the programs help to increase health workforce diversity by increasing the representation of minority and disadvantaged students in the health professions.”
A manager’s amendment was introduced by Health Subcommittee Ranking Member Michael Burgess (R-Texas) that increased the proposed Health Careers Opportunity Program funding level to match the House-passed FY 2020 appropriations bill [see Washington Highlights, May 10]. Another amendment was introduced by Rep. Bobby Rush (D-Ill.) that would authorize $5 million per year for grants to improve diversity among allied health professionals. Both amendments passed the committee by voice vote.
Additionally, the Subcommittee advanced the Fair Accountability and Innovative Research Drug Pricing Act of 2019 (FAIR Drug Pricing Act, H.R. 2296), which would require drug manufacturers to submit documentation to the Health and Human Services Secretary 30 days before increasing the price of a qualifying drug.
The full Committee is expected to markup these bills the week of July 15.