Last week on July 19, the House Energy and Commerce full committee met to markup 15 pieces of legislation recently passed by the Subcommittee on Health in a hearing titled, “Full Committee Markup of Health Bills.” Included on the docket were bills to reauthorize key preparedness and opioids programs, as well as other related legislation. For more on the earlier subcommittee consideration of these bills, see our blog.
Key preparedness legislation, the Pandemic and All-Hazards Preparedness Act, must be reauthorized by September 30, 2023. As part of that process, the Committee considered two bills that comprise the core of the existing law: H.R. 4421, the Preparing for All Hazards and Pathogens Reauthorization Act, which would reauthorize provisions related to ASPR and Biomedical Advanced Research and Development Authority (BARDA) and H.R. 4420, to reauthorize certain programs under the Public Health Service Act with respect to public health security and all-hazards preparedness and response related to the CDC. There is much disagreement over the scope of these bills and whether they should address drug shortages, a priority of Committee Democrats. Republicans said they are working on a separate, more comprehensive measure to address the issue, but that it is not relevant to include in the preparedness bill. In addition, Democrats voiced concerns about the funding levels authorized in the bill, which cap many programs at the current authorization or appropriations amount—whichever is lower—as well as provisions in the bills to require the BARDA to engage in contracts lasting at least five years when procuring vaccines, treatments, and other items in response to a public health emergency, as well as the creation of an industry advisory panel.
Additional preparedness-related bills were also considered. H.R. 4381, the Public Health Emergency Congressional Review Act, introduced by Rep. Murphy (R-NC) and Rep. Guthrie (R-KY), would establish a Congressional review process to vote on whether to terminate a Public Health Emergency. Currently, the power to declare or sunset a declaration rests with the Secretary of Health and Human Services. Rep. Cardenas (D-CA) voiced his concerns about this bill permitting political perspectives to interfere and make decisions regarding public health threats, a concern shared by NACCHO and other public health stakeholders. A final vote along the party line of 28 to 21 allowed this bill to be forwarded to the House floor. H.R. 3813, the CDC Leadership Accountability Act of 2023, introduced by Rep. Guthrie (R-KY), would require Senate confirmation of any Director of the CDC appointed on or after June 1, 2023. In December 2022, Congress passed a law to make the CDC Director role subject to Senate Confirmation starting January 1, 2025. Rep. Guthrie stated that his bill would ensure CDC is better prepared to combat a future pandemic. Ranking member of the committee, Rep. Frank Pallone (D-NJ) stated he opposed this bill because he believes it undermines the Biden administration and would further strain CDC who would be forced to continue to operate without a permanent director. This bill was forwarded to the House floor with a vote along party lines of 27-20. H.R. 4529, the Public Health Guidance Transparency and Accountability Act of 2023, introduced by Chair Rodgers (R-WA), would add additional oversight and public participation requirements for guidance issued by the CDC. The bill received a party-line vote of 25-21 and was forwarded to the House floor. NACCHO has concerns about the potential negative impacts this bill would have on the timeliness and scientific basis of CDC guidance, especially during an emergency, if implemented.
Next stop for any of these bills will be the House floor, but efforts to address differences in the House and Senate version will still be needed before it can become law.
During the same event, the committee also voted unanimously to reauthorize the SUPPORT Act, a major law providing treatment for opioid use disorder as the nation’s rate of fatal overdoses remains near record highs. The bill would renew programs that will otherwise run out of funding by September 30, such as opioid recovery centers and training for providers who treat people with substance use disorder. The bipartisan push for this bill came after both parties came to a compromise on provisions each side wanted to add. The reauthorization would remove a 1965 rule that bars states from using Medicaid funds to pay for addiction treatment in large mental health institutions. The act would also improve Medicaid coverage for some people in prison. Pregnant people in pretrial detention would not lose their Medicaid coverage anymore and the bill would also prohibit states from disenrolling people from Medicaid when they are incarcerated, and their coverage would automatically resume upon release. The bill would also schedule xylazine, also known as Tranq, as a Schedule III substance under the Controlled Substance Act, subjecting it to Drug Enforcement Administration oversight.