RNS Advocacy: Capitol Update – January 2024

In January, Congress enacted another continuing resolution (CR) to extend government funding through March 1 for one set of agencies and March 8 for another. The physician community had conducted extensive outreach asking Congress to reverse the -3.4% reduction to the Medicare Physician Fee Schedule, which took effect on January 1, 2024. However, the CR did not include a provision to reverse that cut. Even so, Congress is negotiating a package of health policies with an eye toward the March 8 deadline. That set of policies may include a Fee Schedule fix for the remainder of the year. Additionally, pharmacy benefit manager reform and the Safe Step Act are on the shortlist of policies that may be included in that March package, if bipartisan consensus can be reached. Whether these substantive reforms will be included depends on whether consensus can be reached among committees of jurisdiction in both chambers as well as party leadership. RNS supports both of these priorities.

January also brought positive news on the copay accumulator front. As a reminder, last year a court struck down the 2021 regulation that allowed insurers to use copay accumulators in the Affordable Care Act exchanges. Although that was a victory for patients, the Administration quickly filed a notice of its intent to appeal. Patient and provider groups–including RNS–as well as a bipartisan group of Members of Congress quickly mobilized to urge the Administration to let the lower court ruling stand. On January 16, the Administration signaled that it had heard the message by announcing that it no longer plans to appeal the recent ruling. The regulatory paradigm now reverts back to the 2020 regulation that allowed use of copay accumulator programs only for branded medications that have low-cost therapeutic alternatives, and only in states that do not have a state law banning the use of these programs.

Although patients and providers welcomed that news, it also underscores the need for enactment of the HELP Copays Act (H.R.830/S.1375). That bill would codify into federal law a prohibition on the use of copay accumulators in the exchanges, so that the current or any future Administration cannot revive its now-defunct policy. As of the time of this writing, that bill has 108 cosponsors in the House and 17 in the Senate. Last year, RNS ran a grassroots campaign on that legislation to drum up co-sponsorship and discussed the bill on Capitol Hill during our Advocacy Day in March.

Finally, on January 24, the Senate passed the Train More Nurses Act (S.2853), a bipartisan bill requiring the Department of Labor and the Department of Health and Human Services to conduct a review of all grant programs supporting the nursing workforce. Based on that review, the Departments would make recommendations to Congress for changes to these grant programs that would help achieve one or more of the following three goals: (1) increase nurse faculty, especially in underserved areas, (2) provide pathways for nurses with over ten years of clinical experience to become faculty at nursing schools, and (3) increase the nursing pipeline through pathways for licensed practical nurses to become registered nurses. The bill has a companion in the House, but that has not advanced beyond the standard referral to the committee of jurisdiction.