Ways & Means strikes first

Yesterday, leaders of the House Ways & Means Committee passed a two-year extension of expiring Medicare telehealth provisions with a major, unanimous 41-0 vote. And importantly for the health care industry, my colleague Mario Aguilar and I wrote, they're looking to PBM regulations to pay for the extension.

There was a telling exchange during the markup when ranking Democrat Richard Neal (Mass.) questioned whether the bill was truly offset and Chair Jason Smith (R-Mo.) said that lawmakers don't have official numbers, but according to his office's projections, it's paid for. We'll all find out when CBO releases its estimates, now that it's passed out of committee.

A couple notes: Keep in mind that it's May, and these telehealth policies don't expire until December. Also remember that there are several other committees with jurisdiction in this area that will have their own ideas.

public health

The CDC just opened up a fight with the military over man's best friend

The CDC had some very strong words for members of the U.S. military yesterday, my colleague Nick Florko reports. CDC officials finalized a proposal that would require people importing dogs from foreign countries to abide by a slew of new requirements, including requiring certain dogs imported from countries with high rabies rates undergo lengthy quarantines.

When the CDC first proposed the idea last July, members of the military and Foreign Service urged regulators to exempt their pets from the requirements. But the CDC, it turns out, is having none of that.

"CDC has no data to support the proposition that dogs owned by [government] employees or members of the U.S. military are better cared for than other dogs or that individuals in these groups are less likely to attempt to import dogs with falsified documents or fraudulent or insufficient titers," the officials wrote, adding that the agency has found "multiple instances of falsified documents ... submitted by U.S. government employees and military service members" in order to import their pets.

But fear not, animal lovers, not all is lost. The CDC also made clear it does not hate dogs – in the most bureaucratic way possible.

"CDC supports the human-animal bond and recognizes the important role these animals play in the lives of government employees and service members stationed overseas," the CDC writes. "However, the employment status of the importer does not affect the dog's potential risk of carrying [rabies]."

covid-19

A new round of long Covid trials

Last year, Betsy Ladyzhets of The Sick Times and I wrote about how the NIH had repeatedly pushed back its timeline to start clinical trials for treatments for long Covid, and how patients were dissatisfied with the amount of funding going to trials compared with broader observational research.

This week, the NIH announced new clinical trials shortly after receiving another cash infusion. This round of trials will be focused on patients with sleep disruption, inability to tolerate exercise, and exhaustion after completing tasks. The interventions include medications for people who have problems staying awake during the day, melatonin, light therapy, exercise rehab programs, and a program to help patients pace their daily activities.

In response to criticism that its exercise study could harm patients with post-exertional malaise, meaning they don't recover after exercise, NIH said patients with the condition would be screened out and not subject to exercise programs.

providers

Austin hospital district's day in court

Advocates challenging Austin's hospital district are scheduled for a court hearing today related to their lawsuit alleging that the district should have been using taxpayer dollars to provide care for the poor instead of paying for overhead costs at the University of Texas' medical school. I wrote about the conflict earlier this year.

Advocates argue that the hospital district had no legal right to spend taxpayer money on costs unrelated to care for indigent patients because it was funneled through the local government entity, which is charged with caring for the poor. Central Health filed a motion to dismiss the lawsuit altogether.

The case has dragged on for years and is a test that could determine how local health care funding could be used across the state, which has one of the highest uninsured rates in the country. Stay tuned for updates.

drug shortages

When inspections lead to shortages

FDA's drug center chief wants agency inspectors to know when shutting down a facility will cause a drug shortage, my colleague John Wilkerson reports.

Speaking at an Alliance for a Stronger FDA event, Patrizia Cavazzoni, the director of the Center for Drug Evaluation and Research, praised FDA inspectors and emphasized their independence. She stopped short of saying that inspectors are expected to go easier on facilities when shutting them down would cause a shortage. But she also said the FDA's drug shortage team will begin briefing inspectors on the ramifications of their actions.

"We have now a situation where we have so many single-source drugs, or essential medicines, that are made by maybe only two manufacturers," she said. "It's becoming increasingly important, because of that increased complexity, that we spend more time to brief and sort of educate investigators about, you know, the facility and the essential medicines that we expect to have in that facility."

politics

Progressives latch onto canceling medical debt

Senate health committee chairman Bernie Sanders (I-Vt.) introduced a bill to eliminate all medical debt yesterday, tapping into a sleeper grassroots issue that affects millions. The shift could be a signal that progressives are pivoting to pay attention to the issue this election cycle, which is particularly notable given that Medicare for All has fallen off of House progressives' to-do list.

The proposal, introduced with Sen. Jeff Merkley (D-Ore.) and Reps. Ro Khanna (D-Calif.) and Rashida Tlaib (D-Mich.), would make it illegal to collect medical debt incurred before the bill passes, prohibits medical debt from being included in considerations of patients' credit scores, creates a program at HHS to cancel medical debt, and places more requirements on providers related to charity care programs.

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What we're reading

First Opinion: H5N1 communication has been strictly for the birds. Didn't the federal government learn anything from Covid? STAT
R.F.K. Jr. says doctors found a dead worm in his brain, The New York Times
Apple pushes into clinical trials with new FDA nod for Apple Watch, STAT
Biosecure Act revisions to target Medicare, Medicaid, VA reimbursement, Biocentury