Washington and Health Care News


Election 2016

According to FiveThirtyEight modeling based on current polling, support for Clinton has steadily increased after the first presidential debate. Clinton is projected to receive 341 electoral votes, with Trump receiving 197. The second presidential debate held in a town hall format in St. Louis, MO featured discussions of tax policy & the ongoing Syrian Civil War. The final presidential debate will be held on October 19th at 9:00 pm ET at the University of Nevada in Las Vegas, NV.

Lame Duck Appropriations Process

House and Senate negotiators have the giant task in the lame-duck session of trying to complete the 11 remaining fiscal 2017 appropriations bills — a task made more difficult by a $4 billion difference in the way the House and Senate draft bills squeeze in extra spending. Both sets of draft appropriations bills adhere to the $1.07 trillion budget cap. To accomplish that, the Senate bills make use of $20.1 billion in phantom mandatory cuts, compared with $16.3 billion of such cuts in the House bills.

The cuts are known as Changes in Mandatory Programs (CHIMPs) and generally allow appropriators to claim savings by capping mandatory spending that wasn’t expected to take place anyhow. Critics deride the practice as gimmickry. Last year, the House and Senate adopted a budget resolution limiting CHIMPs in the fiscal 2017 bills to $19.1 billion, meaning the Senate bills would technically be in violation of the rule. Conservatives originally had pushed for a $16 billion limit on CHIMPs this year.


The existing restriction can be waived by 60 votes in the Senate, something an omnibus spending bill would need in any case to win passage in that chamber. The biggest difference between the House and Senate is apparent in the Transportation-Housing and Urban Development bill, S. 2844, as demonstrated by an August list of CHIMPS from the Office of Management and Budget.

Half of Medicare Advantage Drug Plans Get High CMS Rating

Nearly half of all Medicare Advantage plans with prescription drug coverage (49 percent) received a four-star or higher ranking from the CMS for the 2017 plan year, according to data released today. MA plans with drug coverage on average made marginal gains in CMS’s quality rating system, but Part D drug-only plans made more significant gains.

The number of MA plans with drug coverage that garnered ratings of four or more stars (out of a total of five) for the 2017 plan year was roughly equal to the 2016 plan year numbers. Star ratings might harm the enrollment and revenue for MA plans that received low star ratings. Prominent Medicare plan issuer Humana saw its ratings drop, which the company said may have an impact on its enrollment and revenue.

The star ratings are designed to measure the quality of the MA plans and help beneficiaries make coverage decisions. The star ratings grade MA plans on a variety of metrics, including clinical quality and patient satisfaction. Medicare Advantage enrollment is expected to hit 18.5 million in 2017, a 60 percent increase from 2010, according to a blog post from Sean Cavanaugh, the CMS’s deputy administrator and director of the Center for Medicare.

Average star ratings for MA plans with prescription drug coverage have jumped from 3.86 for the 2014 plan year to the current 4.0 for the 2017 plan year, the CMS said. Star ratings for Medicare Part D plans were also released, with 49 percent of plans receiving four or more stars for the 2017 plan year. The average star rating for Part D plans increased from 3.05 in 2014 to 3.55 for 2017.

FDA Left Out of Zika Emergency Funds

The FDA is aiding the fight against the Zika virus without any dedicated Zika funding in the new fiscal year. The recently approved $1.1 billion package of federal funding to respond to the Zika outbreak is expected to generate more tests and vaccine candidates. However, that funding doesn’t cover the Food and Drug Administration’s costs in reviewing new policies and diagnostics and vaccines.

The agency already has spent millions of dollars on Zika work, an agency spokeswoman told Bloomberg BNA. In addition, an advocate of more FDA funding said there already is a “surge of work” on Zika at the agency. Congress provided $1.1 billion at the end of September to respond to the outbreak of the Zika virus as part of the continuing resolution (H.R. 5325) to keep the government running through early December. That funding, which came after months of fighting among Congress over provisions attached that funding, allows the National Institutes of Health to continue its pursuit of a Zika vaccine, and helps the Centers for Disease Control and Prevention with its public health response (14 PLIR 1374, 10/7/16).

As of late September, the FDA has spent $5 million in annual resources and “utilized” more than 400 staff members to respond to the Zika virus, according to FDA estimates. “Because additional funding to support Zika virus response activities was not provided to the FDA under H.R. 5325, the FDA will continue to leverage funding from its base resources to sustain response activities,” said FDA spokeswoman Tara Goodin. “Sustaining scaled-up Zika response activities using current base resources is a challenge and requires the FDA to reprioritize work in other important areas, as well as limiting the FDA’s ability to support highly targeted regulatory science research that is required for the efficient development and regulatory review of medical products for Zika virus disease.”

The FDA describes regulatory science as the science of developing new tools, standards, and approaches “to assess the safety, efficacy, quality, and performance of all FDA-regulated products.”

John Zang contributed to this report. 

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