Healthcare takes Center Stage in DC This Week: Here’s What to Watch

Congress returns to DC this week and the agenda for health industry watchers is full: here’s my top 3:

  1. Reactions to the Oklahoma opioid verdict against J&J: On August 26, Cleveland County District Court Judge Thad Balkman ruled that Johnson and Johnson and its Janssen Pharmaceuticals subsidiary played a role in the opioid crisis and ordered the company to pay a $572 million penalty. Similar lawsuits are pending in CA, NY and MD and others might follow. The court’s final judgement is expected this week after which the defendants have 5 days to comment. J&J is likely to appeal based on its assertion that the company has operated in compliance with federal and state laws and the Judge’s ruling is “a misapplication of public nuisance law” rejected in other states. This will be closely watched by officials in every state.

  2. The Democrats Debate: The 10 leading Democratic aspirants for the White House return to the debate stage Thursday with healthcare and climate change the issues where they’ll seek to win favor with core Democratic primary voters. Mayor Pete’s sweeping mental health plan (released 8/23) will get attention along with Bernie Sanders proposal to forgive $81 billion in medical debt for qualified households. The administration’s efforts to restrict funding for Planned Parenthood will be referenced as each candidate positions as the electable-alternative for the party. Looming larger is the party’s conundrum about Medicare for All: of the top 10, Sanders, Warren and Harris favor versions of M4A while the rest favor improvements to the Affordable Care Act. “Fix and Repair the ACA” will be the Democratic counter to the Republican “Repeal and Replace” position as the debate unfolds.

  3. Surprise Medical Bills and Drug Pricing Legislation: The House Ways and Means Committee meets this week to discuss both issues on the heels of late August passage of bills by the Senate Finance and Health, Education, Labor and Pensions Committees. But passage of anything is not a sure thing: Republicans, Democrats and the White House differ on approaches.


Other issues will be working their way through agencies and committees this week as well: the inclusion of social determinants in Medicare Advantage coverage by private sponsors, how CMS’ site neutral payment policy will be enacted, definition of privacy guidelines for patients with substance abuse disorders and state reinsurance programs intended to stabilize the individual insurance market are on the agenda.

And the FY2020 fiscal calendar for the federal government starts October 1: projections are for $3.645 trillion in revenue and $4.746 trillion in spending—a deficit of $1.101 trillion (up 23% over FY2019 deficit). Mandatory spending for social security ($1.102 trillion), Medicare ($679 billion) and Medicaid ($418 billion) are the biggest expenditures. There’s no doubt deficit hawks will aggressively pursue cuts in Medicare and Medicaid: that’s standard fare.

With the summer behind, the wheels of government and commerce are in motion again and it’s election year. Stay tuned.

Paul








PS I hit the ripe old age of 70 this week and can’t believe it. I don’t feel like a “senior” and bristle at the notion. What I realize is that the pace of change in healthcare has quickened across each decade. In 1949, there were 6,788 hospitals, (9.6 beds/1000), 203,000 physicians (1.34/1000) and spending was 4.3% of the nation’s GDP. Today, there were 4899 hospitals (2.5 beds/1000), 963,000 physicians (2.95/1000) and it’s almost 18% of the GDP. This week, Walmart will open its first freestanding primary care clinic in Dallas GA providing a full suite of primary and preventive health services. And CVS Health will push forward its plans as “America’s front door” to health having gotten final clearance from the court last week. Healthcare is big business: unique, complicated and dynamic. Staying abreast is what keeps old farts like me young.