Late yesterday, the White House issued a Statement of Administrative Policy (SAP) in support of the 21st Century Cures legislation, which is on the House Floor today.
The SAP expressly calls out the Innovation Fund in the measure, which targets funding for several of the Administration’s health care priorities, as a highlight of the measure.
President-elect Trump is expected to name Elaine Chao as his pick for Secretary of Transportation. Cho was Secretary of Labor in the President George W. Bush Administration, and Deputy Secretary of Transportation in the President George H.W. Bush Administration. Chao is the wife of Senate Majority Leader Mitch McConnell (R-KY).
Early today, President-elect Trump announced he has selected Congressman Tom Price (R-GA) as his nominee for Secretary of HHS and Seema Verma as Administrator of CMS.
Rep Tom Price (R-GA)
Price is the current House Budget Committee Chairman. An orthopedic surgeon by trade and a staunch conservative, Price has been a vocal and active opponent of the ACA since its inception. He began his rise through House leadership starting as Chairman for the influential, conservative House Republican Study Committee. He is a six term Congressman and was a state legislator for nine years. Also, he was a Trump healthcare surrogate during the campaign.
Since 2009, Price has championed his own legislation, H.R. 2300 the Empowering Patients First Act, to repeal the ACA. In its latest iteration, the proposal includes refundable, age-adjusted tax credits for individuals to buy insurance if they don’t have access to coverage through an employer or government program. Individuals in a government program, such as Medicare, Medicaid, or Tricare, would also be allowed to opt out of that coverage and receive tax credits toward the cost of private coverage instead.
Price attended University of Michigan for undergrad and medical school, his residency was at Emory, and he was medical director of the orthopedic clinic at Grady Memorial Hospital in Atlanta.
Seema Verma
Verma is the founder and CEO of SVC, Inc., a health policy consulting firm. Verma has strong ties to Vice President-elect Pence as she lead the health overhaul for the state of Indiana. She also was the architect of the Healthy Indiana Plan, the state’s 2015 Medicaid expansion waiver. She was active in crafting the Republican Governors Association’s Public Policy Committee Report, A New Medicaid: A Flexible, Innovation and Accountable Future, which established seven principles for Medicaid.
She has a Master’s degree in Public Health with concentration in health policy and management from Johns Hopkins University and a Bachelor’s degree in Life Sciences from the University of Maryland.
The House Rules Committee has noticed that 21st Century Cures will be considered next week. The package is expected on the House floor on Wednesday, November 30. The legislation is expected to be added as an amendment to an existing bill (H.R. 34) to allow for expedited action in the Senate.
The House Rules Committee’s summary memo is 44 pages. The bill text is just under 1,000 pages. The package contains major provisions in the Cures and Senate Innovation packages, and the Mental Health Crisis Reform Act of 2016, (which includes Sections 9031 and 9032 on college mental health training and services grants and establishes interagency working group on mental health).
Generally
NIH is reauthorized until 2020 and the bill includes provisions intended to address the regulatory burden imposed on researchers, among other provisions. Rather than establish mandatory funding increases for NIH, appropriators would have to release (appropriate) funding each year to the Office of the Director. The bill establishes a similar mechanism providing $500 million for initiatives at FDA for FYs 2018-2026, and $1 billion for the Secretary to provide to states in FYs 2017 and 2018 for opioid abuse prevention and response efforts.
There are limitations to the general funds going to the office of the Director. The bill also establishes an “Innovation Projects” account for specific initiatives at NIH and FDA, which are special limitations on the general appropriations going to the Office of the Director. For NIH, the bill provides a total of $4.796 billion for FYs 2017-2026 to the NIH director, including $1.4 billion for the Precision Medicine Initiative, $1.564 billion for the BRAIN Initiative, $1.802 billion for cancer research, and $30 million for clinical research to further the field of regenerative medicine using adult stem cells.
The funding for the Innovation Fund is discretionary, but due to the phrasing in the legislation, monies the Innovation Fund does not count against the appropriators caps. However, the language essentially says that appropriations from the account are subtracted from the discretionary budget authority. What’s more important is that both CBO and the Administration (the OMB specifically) agree that spending from the Innovation funds do not count against the caps and the language works the way described below. The money will be put in a specific fund every year for the appropriators to use specifically for NIH, FDA, Cancer Moonshot, etc. In lay terms, the funds can only be used for these purposes and every dollar must be used in the next 10 years.
There are significant inclusions and some noticeable absences including:
The revised draft also includes bipartisan, House-passed legislation, the Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273), that contains several provisions related to socioeconomic status (SES) adjustment and off-campus hospital outpatient department (HOPD) site-neutral payment policy.
To pay for this effort, the bill includes some of the offsets originally included in H.R. 6, including:
President-elect Donald Trump is nominating Betsy DeVos for Education Secretary. A billionaire GOP donor, she also once served as head of the Michigan Republican Party.
DeVos is a vocal advocate of allowing parents to use school vouchers to seek alternative schools and other policies strongly opposed by teachers unions. She is the current chairwoman of the American Federation for Children, an education advocacy group pushing school-choice-friendly policies.