House Appropriations Committee released a L-HHS bill with deep cuts, Senate response to come
Following the deal on the debt limit, Congress has begun moving on FY24 appropriations bills. The two chambers are taking dramatically different approaches to government funding, which sets the stage for gridlock and possible shutdowns before FY24 is over. Congress must pass either an appropriations bill or a continuing resolution by Oct 1 to avoid a government shutdown.
The House Appropriations Committee Subcommittee on Labor-HHS has released and passed their FY24 bill, which calls for a 30 percent cut and the elimination of numerous federal agencies and key investments in science, research, and patient safety, including the complete elimination of AHRQ, which has seen bipartisan increases in its funding the last two years. AcademyHealth sent a statement to Congressional offices rejecting this bill that undermines patient safety, patient-centered care, AHRQ, and biomedical research innovation, which you can see HERE. This bill is widely recognized as being too extreme and reckless to become law, but it is deeply troubling to see such a bill being released as a negotiation tactic at all. It is critical that we all communicate to Congress the importance of research, patients, and public health investments.
The Senate Appropriations Committee just released their FY24 Appropriations bill and passed it on a big bipartisan vote of 26-2. Notably, this bill funds the Agency for Healthcare Research and Quality at $370.5 million, a tiny haircut of $3 million from the FY23 levels. This bill also provides $47.8 billion for NIH, a $943 million increase.
The path forward for Congress on FY24 remains murky. There is over $100 billion difference in the total funding proposed between the House and Senate, with far-right House Members calling for significantly deeper cuts. The House has shown this week that they are unlikely to pass many of their appropriations bills as written as they attempted to vote on two of the historically easier bills for Congress to pass – Military Construction/Veterans Affairs and Agriculture. Speaker McCarthy ended up pulling the Agriculture bill and barely passing the VA bill after a week of brinkmanship and counteroffers within his caucus. Both chambers have entered the six-week August recess leaving little time for negotiations.
Agency for Healthcare Research and Quality (AHRQ) Appropriations
Appropriation, FY23, enacted $373.5 million
Change from FY22 +$23.5 million
Friends of AHRQ request, FY24 $500 million
President’s Budget Request, FY24 $447.5 million
Change from FY23 +$74 million
House Recommendation, FY24 $0
Change from FY23 -$373.5 million
Senate Recommendation, FY24 $370.5 million
Change from FY24 -$3 million
Florida hospitals will now ask for immigration status
Starting on July 1, a new anti-immigration law in Florida requires hospitals that accept Medicaid to ask patients about their immigration status and report it. Providers are worried that this will be a deterrent for undocumented patients to seek help as they will be worried that a doctor’s visit could lead to an immigration action against them or their families.
National Center for Health Statistics has found excess deaths has reached zero
The National Center for Health Statistics (NCHS) at CDC reported that the United States has reached a key milestone in the fight against COVID-19 as the total number of Americans dying each day from any cause is no longer historically abnormal, i.e. the excess deaths have fallen to a near zero. During Covid’s worst phases, the total number of Americans dying each day was more than 30 percent higher than normal. This progress is largely a combination of nearly all adults either having been vaccinated or gained natural immunity from an infection, along with better post-infection treatments.
Senators consider a bill to investigate weaknesses in drug supply chains
Senator Gary Peters (D-MI), chairman of the Homeland Security and Governmental Affairs Committee, has teamed with several Republican Senators in introducing a bill that would create a federal database to map supply chain vulnerabilities for pharmaceuticals. It would require the Department of Health and Human Services (HHS) to catalog the origin of each drug, quantities available and the location of facilities used to manufacture them. It also would map inspections, recalls and import alerts. With this information, the HHS could assess supply chain threats and decide how to address them through investments in domestic manufacturing.
Emphasizing the fragility of the supply chain, a tornado that tore through Pfizer’s North Carolina manufacturing site risks significantly worse shortages coming ahead. The company estimated that one-fourth of the injectable medications it supplies to U.S. hospitals were made at the Rocky Mount property, including drugs used during surgeries and other procedures to help block pain, keep patients sedated and fight infections. Though the company has yet to disclose the extent of the storm’s impact, video footage of the site and interviews with the Nash County sheriff and with people briefed on the damage indicated that the tornado caused the worst damage at the company’s warehouse.
Strict anti-abortion laws in Texas may be fueling a spike in infant mortality
Texas’ abortion restrictions – some of the strictest in the country – may be fueling a sudden spike in infant mortality as women are forced to carry nonviable pregnancies to term. Some 2,200 infants died in Texas in 2022 – an increase of 227 deaths, or 11.5%, over the previous year, according to preliminary infant mortality data from the Texas Department of State Health Services. Infant deaths caused by severe genetic and birth defects rose by 21.6%. That spike reversed a nearly decade-long decline. Between 2014 and 2021, infant deaths had fallen by nearly 15%.The increase in deaths could partly be explained by the fact that more babies are being born in Texas. One recent report found that in the final nine months of 2022, the state saw nearly 10,000 more births than expected prior to its abortion ban – an estimated 3% increase.
Report: Only a third of hospitals are in compliance with price transparency rules
The nonprofit Patient Rights Advocate (PRA) released its fifth semi-annual report, which found that only 36 percent of 2,000 surveyed hospitals were in complete compliance with the federal hospital price transparency rules. Since Jan. 1, 2021, hospitals have been required to give “clear, accessible pricing information” on their products and services, either through an online file or a “consumer-friendly” display of shoppable services. The PRA’s report specifically found that while most hospitals have posted files about their prices, 64 percent of them had files that were incomplete or listed prices that were not “clearly associated with both payer and plan.” Another 69 hospitals — 3.5 percent — did not post usable files on their charges. While less than half of all hospitals were found to be in complete compliance, that is still higher than the 25 percent compliance rate that was reported in February.
Congress is moving on pandemic preparedness bills
The Senate HELP Committee voted 17-3 to advance a bipartisan pandemic preparedness bill on July 20. The approval marks the next step to reauthorize the Pandemic and All Hazards Preparedness Act, which has many programs that expire on Sept. 30 unless Congress acts. On the same day, the House Energy and Commerce Committee advanced its own version of the bill on a party-line vote as Democrats objected to a lack of provisions on drug shortages.
What I’m reading
Once regarded as the global gold standard for public health agencies, the CDC faces an unprecedented crisis in trust as chronic underfunding comes against anger and politicization surrounding the COVID-19 pandemic. This piece in Nature clearly outlines the many challenges that Dr. Mandy Cohen, a physician who served as North Carolina’s health secretary until the end of 2021, will face as she starts her tenure at the head of the agency. Among the many that Cohen inherits are restoring public and political support for the CDC, rebuilding the agency’s infrastructure and improving its ability to make quick decisions in the face of emergencies.
The Washington Post reported on the growing practice of private equity firms buying up medical practices and the implications that these larger entities have on influencing prices. An example they discuss is how the multibillion-dollar private equity firm Welsh, Carson, Anderson & Stowe took less than a year to create, from scratch, Colorado’s biggest and most prominent anesthesiology practice. The company raised prices for its services — one by nearly 30 percent in its first year in Colorado — and continued raising them for several years. The price hikes boosted patient bills and pushed up insurance rates, former company physicians and managers said. Eventually, some of the company’s own doctors became disillusioned, physicians said, with about 1 in 3 leaving the company over a three-year period.
Kuo and Kawachi wrote in JAMA about their research on county-level income inequality and social mobility and the relationship with deaths of despair. They found that higher income inequality and lower social mobility were associated with a higher burden of deaths of despair for Black, Hispanic, and white populations. If we are to reduce the number of these deaths, policymakers must address the underlying social and economic drivers.
Dr. Aaron Carroll wrote in the New York Times about some of the lessons he gained from a study trip with AcademyHealth and the Commonwealth Fund to New Zealand, Australia, and Singapore to study different health care systems for insights into reforming America’s. Some of his takeaways are: that universal coverage matters, but not how it was created; public health systems are essential, but there is an important place for private options too; and that strong social policies are important for social determinants of health. He noted that we are already doing the hard part as we spend more on health care than other countries for worse outcomes, but that we just need to spend the money for effectively.
Medical debt is a crisis within our health care system. KFF Health News published a report on how patients’ faith in doctors, hospitals, and the health care system has been shaken as a result of shocking medical bills that they can’t afford, collection notices, threatening phone calls, and being blocked from appointments because they owe money. This has led to many Americans saying they simply no longer trust their medical providers.
The sharp rise in AI has brought critical conversations about the implications of bias in AI to the forefront of all of our thoughts. Ferrara published an interesting take in The Conversation where he argues that eliminating bias is the wrong question, we should instead be focused on controlling and directing the biases within AI systems. Attempting to remove biases could have a butterfly effect of providing biased answers in unpredictable ways. Instead, Ferrara discusses creating techniques for controllable levels of bias an AI system will tolerate, which may produce outputs that better align with human values and still allowing for nuance and flexibility.