Why the House Budget Committee needed a health-care task force

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Today’s edition: Why two key senators want to subpoena drug-industry CEOs. How political concerns slowed infectious-disease help for Gaza. But first …

Rep. Burgess wants his Health Care Task Force to be an ‘incubator’ for ideas

Forty-seven members of Congress have announced plans to retire, resign or run for other offices at the end of this term, setting the stage for major turnover in the next election. Among those departing are four members of the GOP Doctors Caucus, including its co-chair, Rep. Michael Burgess (Tex.). 

Eleven terms in, the obstetrician-gynecologist is the senior-most physician in Congress, where he leads the House Budget Committee’s Health Care Task Force. I caught up with Burgess this month to talk about some of the health policy issues he’ll focus on in his final year in the lower chamber. 

H202: What prompted you to help launch the Budget Committee’s Health Care Task Force last year?

Burgess: Because no matter where you are, health care is the key driver of debt, and national debt is a big headline at over $34 trillion and growing. But at the same time, as a doc, I know we’ve got to ensure patient access to care. I want to nail down access to those next-level cures that we all know are coming. So that’s the whole purpose in me spending energy in this realm. 

H202: What are some of your priorities for the task force this year? 

Burgess: My biggest concern in the pharmaceutical world is that when you get a big breakthrough drug, it’s going to be expensive right out of the box, but downstream it’s going to deliver significant savings. So how do we reconcile what the cost is today with what the overall savings are going to be? 

That’s where the Preventive Health Savings Act is going to begin to try to bridge that gap. We’ve had a hearing on the bill, we’ve put it through several iterations, and we’ve improved it. Watch this space, because we are going to be having a markup in the near future.  

There are a lot of other things we need to explore. One of the things that scares me to death is the Biden administration coming out and saying “You know what? For these new novel therapies that are very, very expensive, we are going to use our march-in rights and take the patents.” Oh my God. What are you going to do to the research in cell and gene therapies for these things, these breakthroughs that people are literally dying for?

This is not the right way to go. The task force is going to try to be an incubator for new ideas, which is a stark contrast to the Biden administration — they’re anti-innovation, anti-patient in so many ways. 

H202: One area that has gotten a lot of attention recently is prior authorization. As a physician, do you have any insights into how this impacts health-care spending and patient access?

Burgess: Prior authorization is a misapplication of your energy. You’ve identified as a doc how to remedy the problem that the patient has brought to you, and now prior authorization comes in and says, “Yeah, we know your diagnosis is right, we know your treatments are right, but we’re going to make you jump through all these hoops before the care is delivered.” Guess what? That doesn’t really save any money unless the poor person dies in the process and never gets the care. What a terrible way to approach fixing a problem that a patient has brought to you. 

I’ll share a secret with you: I’m on a Medicare Advantage plan —  it’s not the way I expected to end up, but because of some of the requirements of the Affordable Care Act, I’ve ended up here. So it’s personal to me. If there is a prior authorization requirement on something that I need, I don’t like the idea that someone’s going to hold me up for days, weeks, even months, before I get the answer that we all know is coming anyway. The only way that they’re saving money is by rationing and waiting lines. That’s not really good patient care. 

H202: I’m glad you brought up the ACA. Do you envision changes to Obamacare if a Republican wins the White House in November? 

Burgess: There are any number of things in the ACA that have been removed or repealed by executive orders or legislative action. 

When you really look back on the history of things, the cost to families was getting prohibitive. Anyone outside of the subsidy window in my district was coming to me and saying, “You’re killing us here with these premiums.” President Trump signed an executive order that allowed more competition in the insurance space with limited duration plans, and that immediately brought premiums back down to Earth. So we know there are things that can be done to the ACA that really seem like pretty minimal changes, but have a big budgetary impact. 

H202: You’ve announced that you won’t seek reelection at the end of this term, along with several other members of the GOP doctors caucus. How do you think that loss will impact Republicans’ ability to move their health-care agenda forward? 

Burgess: First off, I’m not going anywhere. Maybe they should have listened to me more before, but they have my phone number. This encyclopedic knowledge of health-care policy I have isn’t going to disappear, so if my counsel is needed it can certainly be sought. 

I can’t say anything about other people who are retiring, we all make our own individual decisions. In my case, my wife told me I was too old. And since she decided to stay married to me for 50 years, I thought maybe I ought to listen. 

Sanders, Markey build case to subpoena drug industry CEOs

Sens. Bernie Sanders (I-Vt.) and Ed Markey (D-Mass.) spoke to reporters yesterday ahead of next week’s vote on whether to compel two CEOs to testify in the Senate Health, Education, Labor and Pensions committee, The Post’s Dan Diamond writes for The Health 202. 

The panel’s Democrats in November demanded that Johnson & Johnson CEO Joaquin Duato, Merck CEO Robert Davis and Bristol Myers Squibb CEO Chris Boerner testify at a hearing — originally scheduled for yesterday — that would have probed the companies’ pricing practices and questioned why U.S. drug prices are much higher than those of other countries. 

Boerner agreed to testify if he is joined by another CEO, Sanders said, but Duato and Davis have so far refused.

“We have to demand that the CEOs explain to the American public why these prices are so high,” Markey said. “We can create a health care system worthy of the American people when pharmaceutical companies take a seat at the table and deliver innovative groundbreaking medications at a price that the American people can actually afford.”

Sanders, who chairs the panel, returned to a regular talking point: that the pharmaceutical lobby has too much sway in Washington and is not being reined in. 

• “They have enormous power over the United States Congress,” he said. “We’re gonna fight back.”

The vote is scheduled for next Wednesday. If successful, it would be the first time the panel has issued subpoenas since 1981.

Hear from Sanders and Markey:

LIVE: It is absolutely unacceptable that the CEOs of Johnson & Johnson and Merck have refused to appear before the HELP Committee to discuss the outrageously high price of prescription drugs.

The American people want answers. https://t.co/O2GPPbxYJR

— Bernie Sanders (@SenSanders) January 25, 2024

Political concerns slowed CDC help for Gaza

Political concerns within the World Health Organization about U.S support for Israel delayed the deployment of experts charged with preventing the spread of infectious disease from Gaza to neighboring regions, my colleague Lena H. Sun reports.

The Centers for Disease Control and Prevention plans to send an epidemiologist to the WHO’s Cairo office next week, nearly three months after it first offered support to the U.N. agency, which seeks to remain impartial in global conflicts. 

A closer look: The question was whether there would be “a perception of a lack of neutrality from WHO if we got support from CDC,” said Rick Brennan, emergency director of the WHO region headquartered in Cairo. Brennan downplayed the role political sensitivities played in the delay, saying logistics take time to work out, especially over the holidays. 

But the setback drew consternation within the CDC as outbreaks of disease began to ravage a displaced population. Agency employees have called on the CDC to take a greater and more public role in the conflict, arguing that its lack of visibility in Gaza contrasts sharply with its responses in other humanitarian crises, according to internal communications shared with The Post. 

Senators challenge assisted living industry over poor care

The U.S. assisted living industry faced scrutiny yesterday from a bipartisan group of lawmakers who pressed for answers about low staffing, high costs and a lack of transparency surrounding poor care and preventable deaths at the facilities, The Post’s Christopher Rowland and Douglas MacMillan report. 

The main question before the Senate Special Committee on Aging: Should the industry be subject to federal regulation, like nursing homes?

Sen. Elizabeth Warren (D-Mass.) sided with patient advocates in their push for stricter federal oversight, arguing that consumers can’t be assured they will get quality care without national standards. Across the aisle, the committee’s top Republican, Sen. Mike Braun (Ind.), said he favors state regulations but called for a stronger government role in promoting transparency about costs and quality in facilities.

Chairman Bob Casey (D-Pa.) didn’t commit to particular provisions that could be considered by Congress, but he asked the public to share their experiences to help inform future deliberations. Assisted-living operators have warned against pursuing uniform standards, arguing that they would damage the industry and drive up costs. 

The top Democrat and Republican on the Senate Finance Committee are taking on generic drug shortages in the United States. 

In a white paper published yesterday, Sens. Ron Wyden (D-Ore.) and Mike Crapo (R-Idaho) outlined policy options under Medicare and Medicaid that the committee is exploring to address factors contributing to the shortages. Their proposals include changes to the Medicaid Drug Rebate Program and reforms to stabilize the supply of generic sterile injectables. 

Sen. Mike Crapo (R-Idaho):

The recent surge in prescription drug shortages harms the health and finances of Americans in every state. We’re working to identify root causes and develop meaningful policy solutions for patients. pic.twitter.com/iuLOjBY622

— Senator Mike Crapo (@MikeCrapo) December 5, 2023

• The Centers for Medicare and Medicaid Services is seeking feedback from the public on how to increase transparency and improve data capabilities in the Medicare Advantage sector. 
• The Federal Trade Commission is suing to block a proposed hospital deal in North Carolina, alleging the acquisition threatens to raise consumer prices and reduce incentives to provide quality care. 
• The Association for Accessible Medicines is asking a court to stop Illinois from enforcing a new state law designed to prevent price gouging for certain generic drugs, Stat’s Ed Silverman reports. 

“Folks, this is what it looks like when the right to privacy is under attack.” — President Biden on federal abortion laws proposed by the GOP

Medicare certifies hospices in California despite state ban on new licenses (By Ava Kofman | ProPublica)

US pharmacy benefit lobby group ramps up spending as lawmakers close in (By Ahmed Aboulenein | Reuters)

Walgreens investors nix bid for clearer abortion drug policy (By Clara Hudson | Bloomberg Law)

Thanks for reading! We’ll see you on Monday. 

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