Welcome to the March 18, 2019 edition of the New England Council Weekly Washington Report:

Mar 18, 2019

Healthcare

White House Budget Plan Calls for Dramatic Cuts to HHS Programs - On Monday, the White House released its 2020 federal budget request. The blueprint has little impact on how legislators ultimately craft the budget, however the request serves as a guide to the administration's priorities and how it's viewing health care strategy in FY 2020. The plan called for trillions in cuts to the growth of Medicare and Medicaid over the next decade, marking the second year in a row that the president sought massive reductions in the growth of those entitlement programs. The cuts in growth would total $1.5 trillion over a decade for Medicaid and $818 billion for Medicare. Last year the administration made similar proposals, which would have resulted in $1.4 trillion and $530 billion cuts over a decade to Medicaid and Medicare, respectively. Most of the Medicaid and Medicare changes are unlikely to go anywhere in the current political environment. The main source of Medicaid savings would replace the federal contribution to state Medicaid programs with block grants, which would lead to $1.4 trillion in savings compared to current Medicaid projections. The budget also proposed giving states more flexibility on Medicaid requirements, such as enabling states to consider an individual's savings when assessing eligibility and allowing them to increase cost-sharing for nonemergency uses of emergency rooms. The administration envisions long-term changes to Medicare that could result in around $818 billion less in spending over a decade. Most of that would come from what the administration deems wasteful spending.
 
The proposal's discretionary cuts are spread around many of HHS' divisions but mainly affect its most popular one: the National Institutes of Health. The budget suggests $33 billion for the NIH, after Congress gave it a record $39 billion for 2019.
 
Ned Sharpless Named Acting FDA Commissioner - On Tuesday, the Trump administration named Ned Sharpless to serve as acting commissioner of the Food and Drug Administration. Sharpless previously served as the director of the National Cancer Institute, and head of the University of North Carolina's Lineberger Comprehensive Cancer Center. Departing FDA Commissioner Scott Gottlieb has already signaled he'd like Sharpless to be the next full-time commissioner. Sharpless's appointment has been applauded by advocates who support the reduction in youth vaping.
 
HHS Secretary Azar Testifies Before Congress - Last week, Health and Human Services (HHS) Secretary Alex Azar testified three times before Congress. On Tuesday, Azar appeared before the House Energy and Commerce Committee where he discussed the White House's budget proposal, the administration's role in consumer costs, drug prices, and family separations. On Wednesday Azar testified before the House Labor-HHS Appropriations Subcommittee on a range of issues which included family separations and detention facilities. On Thursday, Azar appeared the Senate Finance Committee where he emphasized that the agency is working with states to help implement Medicaid block grants without approval from Congress, a move that could draw legal challenges. The HHS head indicated that the department is eyeing caps on spending for those who have gained coverage through Medicaid expansion, but did not say how many states were engaged in these conversations.
 
Judge Hears Medicaid Work Requirement Cases - On Thursday, a federal judge heard oral arguments in a lawsuit brought by the National Health Law Program and Kentucky Equal Justice Center, alleging that Medicaid work requirements approved by the Trump administration are in violation of federal law. District court Judge James Boasberg previously put a hold on work requirements in Kentucky, citing that the administration failed to sufficiently consider whether the imposition of requirements would violate the purpose of the Medicaid program. The Trump administration has made Medicaid work requirements a centerpiece of its health care strategy, and the president's latest budget proposed taking them nationwide. Patient advocates, meanwhile, counter that millions of patients could lose coverage if work requirements were nationally implemented.
 
CMS Unveils New Guidance for States Seeking Medicaid Work Requirements - On Thursday, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma released guidance how the agency will review and approve state applications for Medicaid work requirements, including templates for would-be applicants and instructions for evaluations. CMS already has approved Medicaid work requirements in seven states - Arkansas, Arizona, Indiana, Kentucky, New Hampshire, Michigan, and Wisconsin. Applications from eight other states are still pending.

For more information on the Council's work on healthcare issues, please contact Sean Malone.