Medical cures bill hits setback

The House Energy and Commerce Committee on Wednesday abruptly delayed a markup of its bipartisan medical cures bill for 24 hours over the question of how to pay for the legislation.

The 21st Century Cures measure, aimed at streamlining the Food and Drug Administration (FDA) approval process for new cures, was scheduled for a markup Wednesday morning, but the committee delayed it until Thursday with less than two hours’ notice.

{mosads}The committee’s chairman, Rep. Fred Upton (R-Mich.), told reporters Wednesday that members are still in talks about cuts to mandatory spending programs in order to offset the cost of the bill.

“We could simply just raise the authorization level but there’s no guarantee the appropriators will ever spend it,” Upton said. “So what we have to do is create a fund in essence from mandatory spending cuts.”

The details of what the offsets will be have been closely held. Asked if the debate is over how much of the money will come from drug companies, Upton replied, “No, not really.”

Democrats have asked for another 24 hours to review the proposed offsets.

”My partner in this effort for the past year, Diana DeGette, asked for one more day so members can digest these policies further, and we respect that request,” Upton said in a statement earlier Wednesday. “We will reconvene bright and early tomorrow.”

A spokesman for DeGette confirmed that she and the other leading Democrats on the bill — Rep. Frank Pallone (N.J.), ranking member of the committee, and Gene Green (Texas) — had needed more time to review the offsets.

Upton reiterated that the mark-up will go forward on Thursday at 8:30 a.m.

The bill includes more than $10 billion over five years in new funding for the National Institutes of Health, which lawmakers must find an offset for, since they have said the bill would be fully paid for. There are also talks to include about $550 million in new funding for the FDA, according to a Democratic committee aide, but the number could change depending on the Congressional Budget Office score.

Democrats have expressed concern that the bill could increase burdens on the FDA, but does not provide it with any increased funding.

Rep. Jan Schakowsky (Ill), a Democratic member of the committee, said Wednesday that the short notice on the proposed offsets had caused problems.

“We’ve been having discussions all day, last night and today,” Schakowsky said. “These offsets have been kind of sprung on us, so there’s a lot of discussion right now.”

She said she would not vote for any bill that cut Medicare or Medicaid, but that the latest round of offsets she saw did not include cuts to those programs.

Democrats involved with the bill have taken issue with Upton’s push to find ways to pay for the bill before passing it through committee, which one aide said was likely an attempt to eliminate complications later on.

“Our understanding is that Upton has been told by his leadership to produce the bill with pay-fors,” the aide said. “Normally you get the bill out of committee, then you’re hashing out with leadership and other committee chairs on how to pay for it.”

The aide said it’s clear the bill has been given high priority by the leadership because it was introduced in the House on Tuesday with the number HR 6 — a number that is typically reserved for the Speaker.

Upton said Wednesday that the offsets could not wait because he wants the bill to be scored by the Congressional Budget Office.

Healthcare lobbyists and advocates also say they have been kept out of the loop about how the bill would be paid for.

“They are keeping it really close to the chest. We haven’t heard a peep,” said Nancy Hughes, the vice president for communications at the National Health Council.

Drug companies have also heard next to nothing about the proposals, according to one lobbyist for a major pharmaceutical company.

At a separate committee session for opening statements on the bill on Tuesday, members vaguely referred to disagreement over offsets.

Rep. Michael Burgess (R-Texas) said that he had been working with committee leaders to ease his concerns about changes that would affect a public hospital in his state that treats many of the uninsured.

“I hope that the changes we’re making to some of the programs will not … place them at a disadvantage,” he said.

One change that was considered and largely dropped was to the 340B Drug Discount Program, which requires drug companies to provide discounts to providers that serve low-income people.

The committee circulated an overhaul of the program to narrow its breadth and increase oversight last week, but has dropped most of the changes after pushback from outside groups, including America’s Essential Hospitals, which represents hospitals that serve many low-income people.

“It was expected that stakeholder feedback would help flag … the areas of agreement and disagreement amongst stakeholders,” according to a committee memo sent Tuesday night and obtained by The Hill. “In many ways, while the feedback has been very robust, that process has worked. As a result, the more challenging, harder-to-solve issues that generated the most serious stakeholder concerns have been set aside.”

This story was updated at 2:39 p.m.