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House ’Cures’ Package Could Hit Potholes in Senate

Questions over funding, disclosure of gifts to doctors

Iowa Sen. Charles E. Grassley objects to a provision in the ‘Cures’ package and says he will object to an expected request for unanimous consent to take up the House bill in the Senate unless this provision is removed. (Bill Clark/CQ Roll Call file photo)
Iowa Sen. Charles E. Grassley objects to a provision in the ‘Cures’ package and says he will object to an expected request for unanimous consent to take up the House bill in the Senate unless this provision is removed. (Bill Clark/CQ Roll Call file photo)

An expansive plan to spur the development of new medical treatments that’s on the fast track in the House could encounter resistance on the other side of the Capitol over disclosure requirements and the way the legislation is funded.

Lawmakers late last week released an updated version of a long-stalled package known as the 21st Century Cures Act. While many provisions remain from the version the House passed last year, additions include language designed to improve the nation’s mental health system and $1 billion over two years to help combat misuse of prescription opioids.

The 996-page measure now also includes changes to policies on foster care, as well as several Medicare-related bills. It would allow federal reimbursement for services to keep children out of foster care when their parents undergo mental health or drug use disorder treatment.

The updated package would direct $4.8 billion in funding over a decade to the National Institutes of Health. The bill would include $1.4 billion for President Barack Obama’s Precision Medicine Initiative, $1.8 billion for Vice President Joseph R. Biden Jr.’s cancer “moonshot” program and $1.6 billion for a program focused on enhanced understanding of brain-related diseases like Alzheimer’s.

The bill would be paid for mostly through sales of the U.S. strategic petroleum reserve and a fund created in the 2010 health care overhaul  intended to promote disease prevention and public health.

[‘Cures’ Package Not Unanimously Backed by Democrats, Pelosi Says]

While the earlier version would have provided $8.75 billion in mandatory funding for the NIH, the new text would instead create several “innovation” funds. Each year, appropriators would need to endorse any withdrawals from those accounts. The switch has caused some concern among liberals such as Democratic Sen. Elizabeth Warren of Massachusetts.

House Energy and Commerce Chairman Fred Upton of Michigan and Senate Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee, the two main sponsors of the package, touted the bill as beneficial to virtually every American family.

“What we have in the 21st Century Cures Act is an innovation game changer, a transformational bill to bring our health infrastructure light years ahead to best match the incredible breakthroughs that are happening by the day,” the lawmakers said in a joint statement.

A Wednesday House vote on the package will be held under suspension of the rules, preventing amendments. While it is expected to pass with strong bipartisan support — the previous version passed 344-77 — some barriers remain.

The Senate has also not agreed to a final version of the legislation.

On Monday, Senate Judiciary Chairman Charles E. Grassley blasted a plan to reduce public disclosure of companies’ gifts to doctors that was tucked into the package, potentially complicating efforts to quickly clear the measure.

The Iowa Republican said he will object to an expected request for unanimous consent to take up the House bill in the Senate unless this provision is removed. Senate Majority Leader Mitch McConnell has expressed support for completing the measure before the end of the year.

[Finally, House Action on Opioids?]

Grassley said the changes proposed in the bill would undermine standards that he has long championed for revealing to the public financial connections between doctors and makers of medical products, particularly drugs.

Republicans in both chambers may also raise concerns about the levels of funding in the bill. Along with the additional money for NIH, foster care and other provisions, the package also includes $500 million over nine years for the Food and Drug Administration. Several budget-conscious House lawmakers voted “no” on the package last year.

A spokesman for the conservative group Heritage Action for America, which opposed the original bill, did not respond to a request for comment. He previously told Roll Call that the group would “evaluate any funding mechanism once details become publicly available.”

Kerry Young contributed to this report.

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