Please review the following below and provide , one-pagereaction to this budget proposal. 1. Budget

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Please review the following below and provide , one-pagereaction to this budget proposal.
1. Budget
The President’s Budget and Health Care While the president’s budget is not likely to be acted upon byCongress, it does signal what the administration’s prioritiesare—as well as what policy initiatives they might push.
Repeal the Affordable Care Act: The administration’sbudget includes a plan that is based upon the plan put forward bySens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) last fall whichrelies on block grants for state-based programs. It also would haveplaced a per-person spending cap in Medicaid. The Graham-Cassidyplan was projected to save $215 billion in federal health spendingover 10 years and would have led to 20 million fewer individuals’having health insurance in 2026 than under the Affordable Care Act.The administration’s proposal creates deeper cuts for Medicaid byusing the Consumer Price Index instead of the medical CPI for theblock grants. In the president’s budget the result is a spendingcut of $675 billion by 2028.   Ironically, the proposed HHS budget would spend $812 million infiscal 2019 to fully fund the risk corridors, which has drawncriticism from conservative members of Congress. Some believe thatthis proposal likely reflects the costs of exempting the programfrom sequestration.
Medicaid Cuts: The budget contains substantial Medicaidcuts including: ·         Denybenefits to people who cannot prove their immigration status ($2.2billion in cuts over 10 years) ·         Increasebeneficiaries’ copayments for improper use of the emergency room($1.3 billion in cuts over 10 years) ·         Allowasset testing, which adds up all the value of a person’s propertyand belongings, in addition to income as a test of Medicaideligibility ($2 billion in cuts over 10 years) Overall, the budget reduces federal Medicaid spending by 22percent.
Drug Prices and Federal Programs: The budget containsseveral proposals on lowering drug prices. Some have been proposedbefore. However, there are a few new proposals. Medicaid programs would be allowed to establish drugformularies. Massachusetts has a waiver pending before CMS toestablish a formulary. However, Congress would need to act topermit such a change.   The budget proposes changes in Medicare Part D that include: ·         Create anout-of-pocket maximum; above a certain threshold, seniors would nothave to pay any more of their drug costs ·         Requireprivate Medicare Part D plans to share the rebates they receivefrom manufacturers with beneficiaries ·         GiveMedicare Part D plans more flexibility to set their formularies,which should give them more negotiating leverage with drugmakers ·         Allow forcertain drugs to be moved from Medicare Part B, where there is aset formula for drug payments, to Medicare Part D, where there aresome negotiations between private Part D plans and drugcompanies ·         Movedrugs from Part B to Part D ·         Createmore expansive Part D formularies These proposals save approximately $6 billion. There are an additional $266 billion in Medicare cuts proposedthough they are largely cuts in provider payments rather than cutsin eligibility or benefits.   The president’s budget also proposes $16 million in user fees tohelp the Health Resources and Services Administration administerthe 340B drug discount program. The budget proposes to tie Part Bpayment for 340B drugs to charity care. Nonprofit hospitals andother facilities that purchase 340B drugs would pay the user feesunder the proposal, which amount to 0.1 percent of each 340B drugpurchase. User fees would more than double HRSA’s budget for theprogram.
Opioids: The budget provides $10 billion for efforts toprevent opioid abuse and expand treatment, however there is notmuch detail in the budget.
Reducing Key Parts of the Health Care Establishment:The budget would reduce the size of the Department of Health andHuman Services and key programs, saying they are duplicative ofother functions or programs of the governmentincluding:   ·         Agencyfor Healthcare Research and Quality, which is tasked withevaluating best health care practices ·         CommunityServices Block Grant, $700 million in annual grants for healthcare, food and workforce programs ·         Healthcare workforce programs, which help train medical students and fundtheir education, etc.
FDA: Should the president’s budget increase for FDA getratified, FDA would spend the extra $400 million on: ·         CreatingCenters of Excellence for compounding and digital health, ·         Researchingcontinuous manufacturing, ·         Standingup third-party certification of medical device quality, ·         Advancingnear-real-time evaluation of real-world evidence, ·         Expandingthe digital health precertification program, ·         Conductingnatural history studies for rare disease, and ·         Creatingnew internal agency systems for knowledge management and genericdrug submission.
2. Congress
House
Ways and Means Committee Holds Hearing onBudget   On Feb. 14, HHS Secretary Alex Azar testified before the HouseWays and Means Committee concerning the president’s budget.Democratic members of the committee attacked HHS Secretary AlexAzar for the administration’s nearly $2 trillion in proposed budgetcuts to Medicare and Medicaid, while Republicans promoted increasedfunding to fight opioid addiction and cuts to regulations. Thelawmakers also discussed predictive modeling, the ban on newdoctor-owned hospitals, telehealth, durable medical equipmentreimbursement, biosimilars and Idaho’s plan to allow exchange plansthat violate federal insurance rules. The hearing was Azar’s first appearance before Congress as HHSsecretary. The secretary also defended the administration’s proposal to usebids to determine pay rates for durable medical equipment in ruralparts of the country. Rep. Adrian Smith (R-NE) said the proposalworries him and asked if CMS is prepared to sufficiently pay thehigher cost of delivering medical equipment in rural areas. Azarpromised to make the program work in rural areas and said hesupports paying equipment suppliers what they bid, instead ofpaying the median price, which can cause problems when the medianprice is lower than prices that suppliers bid. To view the hearing, click here. The House Energy and Commerce Committee also held a hearing onFeb. 15 with Secretary Azaar as the sole witness.   At the hearing HHS Secretary Alex Azar seemed to open the doorto expanding federal gun violence research. Azar said that aprovision passed two decades ago limiting the CDC’s work on gunviolence only prevents it from taking an advocacy position—not fromdoing research. The CDC’s ability to study gun violence has been limited by a1996 amendment that prevented the agency from collecting data toadvocate for gun control. President Barack Obama signed an order in2013 directing the CDC to resume its research, but its work hasremained limited. “My understanding is that the rider does not in any way impedeour ability to conduct our research mission,” he said. “We’re inthe science business and the evidence-generating business, and so Iwill have our agency certainly working in this field, as they doacross the broad spectrum of disease control and prevention.” Azar committed to encouraging the study of gun violence withinthe department, when pressed by Rep. Kathy Castor (D-FL). To view the Energy and Commerce hearing, click here.
Senate
Azar Goes Before Senate Finance Hearing Senate Finance Committee held a hearing on the president’shealth care budget on Feb. 15. At the hearing—as in others—Azar wasasked about the governor of Idaho’s permitting plans to be soldthat are not compliant with the Affordable Care Act. Secretary Alex Azar agreed to look into the legality of Idaho’splan to significantly change the Affordable Care Act’s marketplaceafter Democratic lawmakers pushed the secretary on the issue. WhileAzar said he did not want to take enforcement action beforeofficially receiving notice of Blue Cross of Idaho’s non-ACAcompliant plans, he pledged to closely monitor the situation andreport back to the Finance Committee in 30 days. Azar’s comments came one day after he was questioned by Rep.Sander Levin (D-MI) about the issue at the Ways and Means budgethearing, and Azar signaled there has been little HHS oversight ofthe state’s policy, since the state had not made a request. ButDemocrats continued to press the question in the HHS budgethearings. During the Senate Finance hearing, ranking Democrat Ron Wyden(OR) asked Azar if he would approve Blue Cross of Idaho’s recentlyannounced (Feb. 14) five new state-based plan options in responseto GOP Gov. Butch Otter’s controversial executive order. Wydennoted that numerous health care experts and organizations say thismove would be a violation of federal law and puts the company atrisk of federal penalties. He encouraged Azar to crack down on suchactivity and requested Azar to report back to the committee in 10days with a plan. Wyden and Azar eventually agreed to a 30-day time frame for thesecretary to get back to the Finance Committee about his plans todeal with Idaho’s marketplaces. In contrast, Idaho Sen. Mike Crapo(R) defended Blue Cross Idaho’s move and the governor’s executiveorder, arguing that the plan deviations allowed for state autonomyand consumer choice. Azar agreed with Crapo, noting that the rising cost of premiumshas led states to explore all options. “I think what we are seeing here is a cry for help,” Azar said.“It’s saying that where we are right now with our individual marketbecause of the structure we have is not serving enough of ourcitizens. There are too many Americans who simply cannot afford theinsurance packages we have in our program because of the way thestatute is designed and the way it has been implemented.”
Finance and Judiciary Chairs Ask IRS About Oversight ofNonprofit Hospitals On Feb. 15, Senate Finance Committee Chairman Orrin Hatch (R-UT)and Chairman Chuck Grassley (R-IA) sent Acting IRS CommissionerDavid Kautter a letter today asking, among other things, how theIRS reviews information hospitals submit on their charitable givingand what guidance the IRS has given hospitals on their obligationto aid their communities. The senators cite reports from Politicoto raise questions about whether the hospitals are fulfilling theirrequirements as a nonprofit. “Given the importance of these institutions to theircommunities, and the forgone federal revenue associated with theirtax-exempt status, it is important that both Congress and the IRSconduct oversight to ensure their activities are in line with thebenefits they enjoy under the Internal Revenue Code,” the senatorswrote. These issues have been longstanding ones for Grassley who hassince 2005 been reviewing the charitable giving of the nation’snonprofit hospitals. . . .

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