We are at the start of a new fiscal year, but not much has changed due to a continuing resolution funding the government until December 3. Congress continues to negotiate full year appropriations, the Build Back Better reconciliation package, authorization for ARPA-H, and more.

The Senate Appropriations Committee released the FY22 Labor-HHS proposal

The Senate Appropriations Committee released the remaining nine proposals for FY22 funding, including Labor-HHS. The bills propose a 13 percent increase for non-defense discretionary (NDD) programs and a 5 percent increase for defense related-programs. Appropriations Ranking Member Richard Shelby (R-AL) has announced his opposition to the bills as they have a higher increase in NDD than defense, as well as programmatic concerns.

You can find a summary of the Senate FY22 LHHS bill HERE, bill text HERE, and the report language HERE.

This legislation would envision investing in the Agency for Healthcare Research and Quality (AHRQ) with an additional $42 million (12.4 percent increase). The legislation calls for several specific reports and research from AHRQ, in addition to AHRQ’s normal activities.

  • $7.35 million in new research on improving maternal health outcomes, particularly for underserved women
  • $7 million to support expanded research related to opioid use and misuse
  • $8 million to support research on the failures in diagnostic processes, which may include establishing the Research Centers of Diagnostic Excellence to develop systems, measures, and new technology solutions to improve diagnostic safety and quality.
  • Encourages AHRQ to establish and prioritize the Center for Primary Care Research
  • Calls for the Office of the Assistant Secretary for Health, NIH, ASPR/BARDA, CDC, and AHRQ to jointly brief the Senate and House Committees on antimicrobial research
  • Calls on AHRQ to study and assess heart disease research by developing and distributing quality measures for clinical outcomes and resources for improving them.
  • Encourages AHRQ to expand its efforts to include additional health extension program sites connected to public academic health centers in States with high populations of underserved minorities, rural communities, and tribal populations.

AcademyHealth manages the Friends of AHRQ, a voluntary coalition of hundreds of organizations that support AHRQ and advocates on its behalf. To join or learn more, email Advocacy@AcademyHealth.org.

Other notable investments in the L-HHS bill include:

  • The Department of Health and Human Services would be funded at $117.6 billion, an increase of $20.9 billion over FY21, but $1.8 billion less than the President’s Budget.
  • The National Institutes of Health would be funded at $48 billion, an increase of $5billion over FY21.
  • The Advanced Research Projects Agency for Health (ARPA-H) would be established at $2.4 billion, over the increase for NIH noted above.
  • The Centers for Disease Control and Prevention (CDC) would be funded at $9.7 billion, $1.85 billion above FY21.
    • This includes a new $600 million funding stream for public health infrastructure and capacity development.
    • $150 million for modernizing public health data surveillance and analytics at CDC and state and local health departments, an increase of $100 million over FY21.
    • $175.4 million for the National Center for Health Statistics (NCHS), flat funding year over year.
  • The Health Resources and Services Administration (HRSA) would be funded at $9.2 billion, an increase of $1.7 billion. This includes an extra $110 million in support for community health centers and $50 million more in HIV/AIDS support.

FY22 began on October 1 and is currently being funded by a continuing resolution (CR) until December 3. A CR provides level funding, so AHRQ and nearly all other federal agencies and programs are being funded at the FY21 levels. Now that the majorities in both chambers have released their priorities, the negotiations for a final appropriation amount will begin to heat up. Currently, congressional Republicans have come out against the appropriations bills in both chambers for having too high of spending in nondefense discretionary (NDD) accounts and too low defense spending. As such, it is likely that the final LHHS bill that gets signed into law will be somewhat lower than what is being proposed. The FY22 appropriations negotiations are occurring at the same time, although on an independent track, of the Democratic Build Back Better reconciliation bill and the bipartisan infrastructure legislation.

Rep. Eshoo introduced legislation to authorize ARPA-H

House Energy and Commerce Subcommittee on Health Chairwoman Anna Eshoo (D-CA) introduced a bill to authorize the creation of the Advanced Research Projects Agency for Health (ARPA-H), a new entity designed to catalyze high risk, high reward biomedical research. Representatives Diana DeGette (D-CT) and Fred Upton (R-MI) intend on introducing separate authorizing legislation that would be included in Cures 2.0. All three lawmakers sit on the Energy and Commerce Committee, which oversees the NIH and other health programs. AcademyHealth’s CEO Lisa Simpson was invited to provide testimony to NIH and the White House Office of Science and Technology Policy (OSTP) on how ARPA-H can be designed to reduce health disparities.

NIH Director Francis Collins retiring

NIH Director Francis Collins is stepping down as director by the end of the year. Dr. Collins is the longest serving presidentially appointed NIH director, having served three U.S. presidents over more than 12 years. He intends on continuing to lead the National Human Genome Research Institute (NHGRI). President Biden has not yet announced a nominee to succeed Dr. Collins.

President Biden expected to name an FDA Commissioner soon

The Food and Drug Administration (FDA) is currently led by Acting Commissioner Janet Woodcock, however federal law requires President Biden to either nominate Woodcock or pick an alternate commissioner by November 15. Biden is believed to be considering nominating former FDA Commissioner Robert Califf to serve again. Califf was last confirmed by the Senate with an 89-4 vote, however one of the four “no” votes, Sen. Blumenthal (D-CT) has expressed reservations about his confirmation. Of the 89 “yes” votes in 2016, 65 are still in the Senate, including Sen. Patty Murray (D-WA), who chairs the HELP Committee that oversees the nomination.

Federal drug negotiation reforms are popular among voters, but politically difficult for policymakers

Allowing the federal government to negotiate with drug companies to lower drug prices for Medicare beneficiaries and people enrolled in private plans – a key cost-saving proposal in the Democrats’ massive reconciliation bill – is favored by large majorities across political partisans, even after they hear arguments from both sides, a new KFF Health Tracking Poll finds. Initially 83% of the public say they favor allowing the federal government to negotiate with drug companies to lower drug prices on behalf of people enrolled in Medicare beneficiaries and private plans. However, congressional Democrats are struggling to coalesce around any prescription drug plan in their reconciliation bill.

SAPCDAC report on standardized reporting formats for group health plans released

State All Payer Claims Databases Advisory Committee (SAPCDAC) released a report on methods for standardized reporting formats for voluntarily reporting by group health plans to State All Payer Claims Databases. The SAPCDAC was created to advise the Secretary of Labor on standardized reporting formats as well as provide guidance to states on how states can collect the data.

What I’m reading

The COVID-19 pandemic has laid bare the deep racial, ethnic, and socioeconomic health disparities in our health care system. While health disparities are finally receiving more of the attention that it needs and deserves, a STAT investigation has found that many researchers with little or no background or training in health equity research, often white and already well-funded, are rushing in to scoop up grants and publish papers. Although these researchers mean well, by taking a cut of the still relatively small amount of funding flowing into health equity research, newcomers may be squeezing out scientists of color from one of the few fields within academic medicine where they have long worked and led.

An analysis by Kaiser Family Foundation found that nationally more than 90,000 deaths from COVID-19 since June could have been prevented with vaccines. More than half of those preventable deaths occurred in September. Vaccinations are the best and safest tool we have to end this pandemic and save countless lives – we must do all that we can to build trust and access to them.

As deadlines pass for the initial wave of large employers who mandated vaccinations as a condition employment, evidence is accumulating that the mandates were highly effective. United Airlines was one of the first big companies to adopt a mandate, and it announced that 98.5 percent of employees have been vaccinated. The New York hospital system went from about three-quarters vaccinated to over 90 percent within weeks of a mandate being put in place. Last month, AcademyHealth joined 13 other health care organizations in mandating COVID-19 vaccines as a condition of returning the office.

Many states tried new and innovative ways of convincing vaccine-skeptical patients to get vaccinated, however it is unclear if they were successful. Dave et al wrote in JAMA that a weekly $1 million lottery for vaccinated Ohioans was not associated with any statistically significant changes in vaccine uptake.

In addition to vaccines, wearing a face mask when indoors is one of the most effective options available for stopping the spread of COVID-19. Unfortunately, since the start of the pandemic, this public health intervention has been deeply politicized and making it harder to contain and recover. These fights are seen across the country, including in the halls of Congress. Public health measures should be kept away from partisanship.

A recent study by Gallup found that Americans spend approximately 12 million hours a week on the phone with insurers. Despite spending that much time on the phone, do Americans really understand what role the insurers play in paying for care or how employer self-funded plans function?

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