Lawmakers set to face ticking clock on health care priorities

The House and Senate left Washington for the month of August with a lengthy, time-sensitive to-do list waiting when they return, including multiple key health care priorities. 

There will only be three weeks before the end of the fiscal year to get everything done, and just 11 legislative days when both chambers will be in session at the same time. 

Congress faces a Sept. 30 deadline to reauthorize a sweeping pandemic preparedness bill, fund community health centers and renew opioid addiction services.

But the largest looming deadline is the appropriations bills to fund the Food and Drug Administration (FDA) and the Department of Health and Human Services (HHS), which are tied up in the House amid disagreements over abortion policies and spending levels. 

GOP leaders scuttled a vote planned for Friday on legislation funding the FDA and the Department of Agriculture after moderate Republicans objected to a provision that would reverse the FDA’s decision to allow the abortion pill mifepristone drug to be dispensed through the mail and in retail pharmacies. 

House Freedom Caucus members have also been demanding even deeper spending cuts than agreed to in the bipartistan debt ceiling deal. 

The Labor-HHS bill advanced through a House Appropriations subcommittee earlier this month, but hadn’t even made it to the full committee before recess. The Republican-led House bill would slash or eliminate funding from a range of programs that deal with everything from family planning to teen pregnancy and even HIV.

Both FDA and HHS funding bills face a major fight in the Democratic-controlled Senate, where the Appropriations Committee has already passed its own version by near unanimous margins, owing to an agreement by Democratic and Republican leaders not to insert “poison pill” amendments. 

House Democratic Whip Katherine Clark (Mass.) argued in a floor speech that lawmakers should stay in Washington to strip out the “toxic, divisive, bigoted riders” in the bills, and ripped Republicans for delaying votes until September.

Pandemic preparedness

The House and Senate are taking different tracks in the reauthorization of the pandemic preparedness bill, complicating its path forward. 

The Senate advanced a bipartisan version of the Pandemic All-Hazards Preparedness Act out of committee, but the House is divided. House Energy and Commerce Committee Republicans advanced a bill on party lines after Democrats introduced their own version.

The primary disagreement is over drug shortages. Democrats are clamoring to give FDA more oversight authority to address the shortages, but Republicans are insisting on keeping the issues separate. 

The Senate version contains some provisions addressing drug shortages, but only one involves beefing up FDA authority. 

Congress is under pressure to stem drug shortages amid reports of doctors rationing cancer drugs and other medicine. Republicans on the Energy and Commerce Committee have said they are committed to dealing with the problems, but that it shouldn’t be part of the preparedness bill. 

Energy and Commerce Committee GOP leaders released a discussion draft Friday of drug shortage legislation focusing on the economic reasons for shortages, including giving some generic drug manufacturers the ability to raise the cost of their drugs if hospitals keep prices “artificially low” to the point where there’s no economic incentive to produce or sell them. 

Health centers

Legislation to reauthorize funding for community health centers also faces partisan challenges. But in this case, the House cleared its bill on a bipartisan basis, while the Senate is still working through disagreements, highlighting the work to be done.

Sen. Bernie Sanders (I-Vt.), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, originally wanted tens of billions of dollars more for the centers. He was asking for $130 billion to fund the centers over the next five years as well as $60 billion to help grow the health care workforce.

But Sanders ended up canceling a planned markup during the last week of July. Raising some eyebrows, Sanders said he is working with Sen. Roger Marshall (R-Kan.) to craft a bipartisan bill that will be “ready by the first week of September.” 

Separately, Sanders and Senate Finance Committee Chairman Ron Wyden (D-Ore.) issued a joint statement pledging to partner and work toward legislation in the fall aimed at addressing primary care and other health care workforce shortages.

Opioids

At issue are several provisions of sweeping legislation signed into law in 2018 called the Support Act, which aimed to tackle the country’s drug overdose epidemic. 

The House Energy and Commerce Committee advanced a bipartisan reauthorization and expansion bill, but advocates are concerned the Senate is behind. 

HELP Committee ranking member Bill Cassidy (R-La.) introduced his own version of the bill July 20, but hearings won’t be scheduled until September. Cassidy has warned that the committee is wasting time on partisan bills instead of easy bipartisan wins, such as the Support Act. 

Insulin/PBM reform

Senate Majority Leader Chuck Schumer (D-N.Y.) has said for months that he wants to move legislation that would cap the cost of insulin at $35 per month for people with private insurance. 

There’s hope to combine it with legislation reforming the pharmacy benefit manager (PBM) industry into a package that could get bipartisan support. 

But there’s no looming deadline and no guarantee it will get taken up in September.  

Sen. Jeanne Shaheen (D-N.H.), who is a co-sponsor of one of the insulin bills with Sen. Susan Collins (R-Maine), said she still has Schumer’s support heading into the fall but has not heard anything about timing.

Multiple committees have advanced PBM reform bills in both the House and Senate, so they will all need to be combined into one floor-friendly package.