Your Hill health care primer

With Robert King

MEDICARE, HOSPITAL STAFFING UNDER SCRUTINY — Congress, albeit the House without a permanent speaker, is in session this week. The lawmakers’ agenda includes considering a new NIH director and reviewing several Medicare enrollment and payment issues.

The most pressing concern: About five weeks remain for Congress to strike a funding deal before a government shutdown, but it’s unclear what that deal could look like ahead of a Nov. 17 deadline. The continuing resolution funding the government until then didn’t reauthorize key health programs.

What to expect in the Senate:

— The Finance Committee will hold a hearing on Medicare Advantage marketing practices Wednesday amid new, more stringent marketing rules for plans. Expected to testify are an Ohio health insurance regulator, a third-party broker for MA plans and a Wisconsin health plan that manages MA plans. The Biden administration has accused insurers of deceptive marketing tactics that confuse consumers about their plans.

— The HELP Committee will consider President Joe Biden’s pick to lead the National Institutes of Health on Wednesay. The hearing for Dr. Monica Bertagnolli, who heads the National Cancer Institute, has been on hold since May after chair Bernie Sanders (I-Vt.) demanded the White House act to more aggressively slash drug costs.

— The HELP Committee plans a hearing on hospital understaffing in New Jersey, where 1,700 nurses at Robert Wood Johnson University Hospital have been on strike. Ranking member Sen.Bill Cassidy (R-La.), however, has objected to the hearing, raising concerns that Sanders is using committee resources to support unions during a labor dispute, which Cassidy said in a letter Friday is a violation of Senate rules. Sanders’ office declined to comment.

What to expect in the House:

— The Energy and Commerce Health Subcommittee plans to review Medicare’s physician reimbursement policy at a hearing Thursday with witnesses from CMS, the Government Accountability Office and the Medicare Payment Advisory Commission. It comes as lawmakers and lobbyists have pushed for reforms to the way CMS pays doctors. As POLITICO previously reported, the GOP Doctors Caucus released a discussion draft of legislation that would have added more leeway for how much physicians are paid through Medicare.

— The Ways and Means Committee travels to North Carolina on Tuesday to hold a hearing on health care access in rural and underserved areas,

— The Select Subcommittee on the Coronavirus Pandemic holds a hearing Wednesday on tightening regulation of the U.S.-funded laboratories after the Covid-19 pandemic.

— The Energy and Commerce Committee holds a Wednesday hearing on EPA regulatory actions that leaders say limit materials for medical devices.

— The Veterans’ Affairs Committee holds a hearing Thursday on methods to combat veteran suicide.

WELCOME TO MONDAY PULSE. It’s now officially open enrollment season for Medicare, running through Dec. 7. Send your tips, scoops and feedback to [email protected] and [email protected] and follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Daniel Payne talks with POLITICO health care reporter Erin Schumaker about what to expect this week as the Senate HELP Committee considers the next NIH director — and what’s behind the monthslong delay of the confirmation hearing.

CHEVRON CASES LOOM The Supreme Court signaled Friday that it intends to grapple with a key question over the power of federal government agencies to interpret their own legal authority, POLITICO’s Josh Gerstein reports.

The high court had already said it would hear a case this term challenging a legal doctrine, known as Chevron deference, allowing agencies significant latitude to decide what power Congress gave them. On Friday, the high court added a second case on that issue to its docket and indicated that both will be argued in January.

The move to add the second case would allow the court’s newest member, Justice Ketanji Brown Jackson, to weigh in on the issue. Ending Chevron deference has been a top cause for conservative legal activists, who argue the doctrine empowers bureaucrats over judges.

Legal experts have said that restricting agency powers would likely send many health policy decisions to a tightly divided Congress. Dr. Mark McClellan, a former FDA commissioner under then-President George W. Bush, is among those warning that limiting the executive branch’s ability to make policy — especially health agencies making rules based on the latest science — would upend how government functions.

CMS SCRAPS ALZHEIMER SCAN LIMIT — CMS removed a policy that limited the number of PET scans Medicare would cover for a person with Alzheimer’s disease, Robert reports.

The agency said Friday it had scrapped a policy dating back to 2013 that limited the imaging scan, which can identify early indicators of the disease in the brain, to once in a patient’s lifetime. CMS reversed course because of new Alzheimer’s disease treatments, such as Biogen’s Aduhelm, that target amyloid plaques in the brain that are thought to contribute to the disease.

PET scans could “not only help select patients suitable for treatment, but also demonstrate treatment response,” according to a CMS memo. The decision drew plaudits from Alzheimer’s disease patient groups who’ve been clamoring for CMS to expand treatment coverage for the new and pricey treatments.

“This decision empowers millions of Alzheimer’s patients and their families to make more informed decisions about their health,” said George Vradenburg, chairman and co-founder of the group UsAgainstAlzheimer’s in a statement.

Patient groups have been pressuring CMS to improve coverage of Aduhelm after the agency granted Medicare coverage to only patients in a qualifying clinical trial in April 2022. The agency had been concerned about the drug’s hefty price tag — $28,000 a year per treatment.

In June, CMS said it would cover new Alzheimer’s treatments when they received the FDA’s traditional approval and the prescribing doctor agrees to collect information on how the drugs work. Aduhelm reached the market through the FDA’s accelerated approval process, which expedites the review of new treatments, and got traditional approval in July.

THE END OF HHS PAXLOVID SUPPLY — HHS and Pfizer said Friday they had reached an agreement to discontinue federal purchases of Covid-19 antiviral Paxlovid, POLITICO’s Katherine Ellen Foley reports.

The federal government has purchased nearly 24 million courses of Paxlovid. At the end of the year, HHS will return about 7.9 million courses of the drug to Pfizer for a credit of around $4.2 billion, according to the company.

The credit will be used for future therapies HHS may buy. It will also be used to establish free courses of the drug for patients without insurance through 2028 and for those on Medicaid or Medicare through 2024. The company didn’t immediately respond to inquiries about Paxlovid’s commercial price but plans to work with commercial insurers starting next year.

Providers can still order Paxlovid through the federal government through Dec. 15. Paxlovid will be fully available on the commercial market beginning Jan. 1.

NEW CA HEALTH WORKER WAGE — California Gov. Gavin Newsom signed a bill that will raise the minimum wage for the state’s health care workers, POLITICO’s Rachel Bluth reports.

The proposal would gradually raise hourly wages to $25 an hour in most settings. It had been unclear whether Newsom would sign the bill. The governor often cites cost pressures in vetoes, and an analysis of a previous version of the bill put the estimated cost to the state at $1 billion.

Labor groups applauded the decision. In the final days of the year’s legislative session, hospitals, dialysis centers and community clinics got on board with the raised wage.

YOUNGKIN SEES WINDOW FOR GOP ON ABORTION — Glenn Youngkin thinks he has a way forward for Republicans on abortion, POLITICO’s Zach Montellaro reports.

The issue has dogged Republicans since the Dobbs decision, and Virginia Republicans are trying to change that.

After Republicans had largely avoided the issue, Youngkin is going after Democrats as extremists who don’t support any restrictions. Republicans, the new campaign says, are the reasonable ones who back a ban after 15 weeks with exceptions for cases of rape, incest and life of the mother.

Republicans have recently launched a major $1.4 million ad buy to make that case in the final stretch of the campaign for control of the state Legislature.

The Associated Press reports on Kaiser Permanente and unions reaching a tentative deal.

MedPage Today reports on UNC Health’s threats to cancel UnitedHealthcare contracts.

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