Awesome, thank you. Thank you everybody for having me. I'm on with my colleague, Michael Paccaro, Director of Government Relations here at Lobbyit. I'll let him introduce himself real quick and then we'll jump in. As Kay mentioned, my name is Michael Paccaro and I've worked here at Lobbyit for just about a year now. Prior to that, I have extensive experience on Capitol Hill and I've been excited to work with AOE these last couple of months and excited to hit the road in the next Congress. Awesome, thank you. And let me pull up my slides because I forgot I wasn't doing that. All right, is that sharing my screen? You're good. Perfect. Well, great. Let me get everything started here. So I'm here to talk to you today about the 2025 Healthcare Legislative Outlook. And awesome. So yeah, just Michael and I, we work with Lobbyit. I've been here about two years now and I've worked with AOE the whole time. Really enjoyed getting to work with everybody and really excited to see what this Congress brings for us. So I'll just dive in here. Great, so first I'll start off talking about AOE's priorities in the 119th. Some of you have been in meetings with me already this year and I've heard a little bit from staff on kind of what Congress is working on. So I'll go through some of it. Some of the bills might, just as a headline, some of the bills that we talked about last Congress might not be the same ones that'll be introduced this Congress, but the ideas will most likely remain the same. We're talking about the same ideas. So on telehealth, AOE has previously supported the Connect for Health Act. It was a permanent fix for telehealth. We're still looking at a permanent telehealth fix. However, now that we have the two-year extension, it gives Congress a little bit more time to kind of ensure that they're passing something that is effective and efficient and long lasting. Congress is certainly concerned still with some of the, excuse me, potential improper prescribing of drugs or improper use of telehealth services. So they're just trying to make sure that they're crossing their T's and dotting their I's as they're passing telehealth bills. But it's certainly something that is very bipartisanly supported. So it is certainly gaining traction in this Congress again, awaiting introduction, which I'll discuss later on. On the physician fee schedule, AOE has previously supported the Strengthening Medicare for Patients and Providers Act. We haven't seen that bill reintroduced yet. It is still very early in this Congress, but the idea behind fixing the physician fee schedule and tying it to inflation, which is what the Strengthening Medicare for Patients and Providers Act would do, very much still exists. So one of the conversations around the physician fee schedule is using site-neutral payments as a pay-for for tying the physician fee schedule to inflationary measures. The current and leading proposal is very targeted and specific for site-neutral payments. We met with the Senate Finance Committee earlier this week and had a very, very long, thorough discussion with them on exactly where they wanna take site-neutral payments. They're really focused on making it not punitive. They don't wanna punish any hospital systems, take money away from anyone. And so they are separating out different types of hospitals, whether you're rural, critical access, you've been affected by natural disasters in the past or are prone to being hit by natural disasters. So they're really trying to make sure it's this big cohesive package. And so they, the Senate Finance, excuse me, Senator Cassidy's Senate Finance Health Staff assured us that Congress isn't looking for site-neutral payments as any way to like prevent anything else from happening. They really want to try and use it as a stepping stone to try and reinvest money back into the healthcare system. So they wanna take any of the savings and really put them back into the system. They're trying to figure out an exact date for introduction. I think with some of the reconciliation bills and the appropriations package being worked on, they're trying to figure out exactly where this slots in exactly, but definitely pre-summer is what I was told. So definitely keep an eye out for that and we'll keep a, we post it as it, as we get closer to those dates. On the physician fee schedule or on the physician-owned hospitals, sorry, AOE has supported the Patient Access to Higher Quality Healthcare Act, which would repeal the Affordable Care Act's ban on new physician-owned hospitals. So again, that one hasn't been reintroduced yet, but at the end of last Congress, a bill allowing specifically focused on rural physician-owned hospitals was gaining significant traction and it's likely to see the same support and traction this Congress. It's likely going to be reintroduced as part of that site neutral payments package, which I will discuss in the next slide, kind of talking about larger picture of what's moving. The House and Senate health leaders have reaffirmed their support for the measure, specifically on rural physician-owned hospitals. They kind of wanna use that as a test case for this, the Affordable Care Act's, the repeal and the ban. So it'll determine how it functions for a larger conversation around physician-owned hospitals. And then lastly, on prior authorization reform. So every office we've met so far, met with so far this year, has agreed with AOE members and expressed support for prior author reforms, but there has not been a specific legislative fix or vehicle really identified yet this Congress. I think this is a really awesome opportunity for AOE members, those that have already been involved, those that would like to get involved, to continue to work with these offices to make sure that your voice is heard and make sure they understand that, prior auth is a great way forward and it can help sometimes alleviate some of that administrative burden that we've talked about. And we had a really great meeting a couple of weeks ago with Representative Neil Dunn, who's the Vice Chair of the House Energy and Commerce Health Subcommittee, who definitely reaffirmed their support and their efforts to tackle all these issues this Congress. There is certainly an appetite to help fix the healthcare industry, not just to help patients, but to help providers. And so I really think AOE is in a fantastic position to really advocate for and push for some of these measures this Congress. So I will, okay, awesome. So the 119th Healthcare Preview, I'm just gonna kind of talk a little bit about everything that's going on in the 119th Congress, some things that'll impact healthcare, other things that just determine some of the timeline around some of these healthcare pieces moving. So first is appropriations. So the current continuing resolution that was passed in December expires in March, on March 14th specifically. And that basically just pushed the existing funding levels from FY24 until March 14th. And so the negotiations on the FY25 appropriations package is really just starting. I know congressional leaders have just officially granted Appropriations Committee leaders permission to begin negotiating a top line spending deal for the final fiscal year 2025 spending. The members have really, what is it, six weeks from today really, to reach an agreement to draft and finalize all 12 overdue spending bills or risk a government shutdown again. Honestly, the chances of us having a government shutdown are very low. There's certainly a lot of movement that has already taken place. And with the green light from the leadership, the Appropriations Committee leaders, excuse me, so on the Senate side, you have the Senate Appropriations Chair, Susan Collins from Maine and the ranking member, Patty Murray from Washington. And then on the House side, you have the Appropriations Chair, Tom Cole from Oklahoma and the ranking member, Rosa DeLaura are really gonna take a first step towards reaching a final spending agreement. We'll probably see the FY25 bill kind of take shape over the next couple of weeks, but it's really likely that we'll see a lot of flat spending in the FY25 package. There was kind of the agreement before the continuing resolution on some of these top line numbers. So hopefully we'll see some of these members go back to what they had previously discussed as a baseline for these negotiations. We know that the Republicans are looking to make some spending cuts this year. So I think we're gonna, between appropriations and reconciliation process, we'll see some of that take place, but I really think they'll probably focus mostly on trying to just make sure those programs stay as they are for FY25, since we're already four months in and then address some of the spending cuts in the reconciliation package after that. So secondly, that brings me to reauthorizations and extenders. So at the end of last Congress, this kind of, this and the next part of the continuing resolution package are all one and the same. So there are a number of healthcare programs that were not reauthorized or extended at the end of last Congress. They were all attached to the first continuing resolution that was introduced and then ultimately thrown out. And they were attached onto that package and that package very much still exists. It's very much being still supported on the House side, but for specific reauthorizations, the substance use disorder prevention that promotes opioid recovery and treatment or the support act and the pandemic and all hazards preparedness act were not reauthorized. And there seems to be some pretty heavy bipartisan support coalescing around that package at the moment. And as this continuing resolution expires on March 14th, so do a number of other healthcare extenders that did remain in the package like the community health center funding and the special diabetes program funding. So some of the programs didn't get the full year long funding they would have seen. They got just this temporary four month one. So it's very likely that we'll see individual movements on things like PAPA and the support act, but the rest of the extenders will likely be added on to the FY25 appropriations package. That's kind of been the plan all along. So it's encouraging to see that Buddy Carter on the House side, he's the chair of the health subcommittee this Congress is really pushing to make sure that this package is reintroduced and it is passed, which brings me to describing the rest of the actual package. So the continuing resolution package, it's the, I don't really wanna call it leftovers because that makes it sound somehow negative, but it is really the package that wasn't passed at the end of last Congress. So House Republicans are considering incorporating parts of the bipartisan healthcare package aimed at lowering prescription drug costs, regulating pharmacy benefit managers into their reconciliation bill or into the appropriations. It's kind of an either or, or both at the same time. Democrats really just want to pass those as their own standalone bill, kind of like what they're pushing for support, the support act and PAPA, but the healthcare package had like immense bipartisan support in the previous Congress. I think out of the members of the House, something like 390 members were in favor of it, but it was unfortunately excluded from the final continuing resolution. And Republicans really view this package as a potential way to offset the costs of some of their ambitious reconciliation work. So a lot of these programs will see change a little bit in their direction of their funding, but Democrats are really concerned that they don't wanna combine the package. They think that that could take bipartisan support away from some of these programs and tack on some of the more partisan, yeah, partisan pills along the way. And so they really think that, they really wanna try and do them separately. So, and procedural rules around reconciliation add on further uncertainty as to what parts of the healthcare package could be included. Key lawmakers on both sides are divided and no final decision has been made yet. We haven't really even gotten to their discussions around reconciliation yet. They, as I'll talk about at the end, there's a little bit of conversation from the House retreat this past weekend in Miami, where they kind of mentioned a little bit about reconciliation, but there wasn't anything fully ironed out yet. But this is, this package, this healthcare package is really where we'll see the Medicare physician fee schedule adjustment to offset the cuts. There was the proposed 2.5% offset. It's still included in the package and the action will likely come on, come later with the permanent fix as I've previously discussed, but really tracking and pushing for that to be reintroduced sooner versus later. I know we'd all love to see action on the physician fee schedule as soon as possible. So I think pushing at least for the 2.5% offset for now would be great. And then onto new business. So, excuse me, really leading new business this Congress is PBMs, PBM reform. I'm gonna keep saying it, PBMs, PBMs, PBMs. It's a really hot topic. The FTC came out with a report that said that pharmacy benefit managers were artificially inflating the cost of drugs for serious illnesses like cancer medication. So I think that has really spurned lawmakers into taking action around it. And I think that last Congress, telehealth was kind of pushing the way, pushing or pulling, however you wanna look at it, everything else in healthcare. This Congress is certainly PBMs. It hasn't gone anywhere. It's been a conversation the past two years and it's still a conversation. The past two years and it's still a conversation now with more plans kind of being ironed out. So, onto more talk about the next 100 days. So House Republicans faced tough internal debates at their Florida retreat yesterday and Monday and Sunday. They were there for like four days over how to fund President Donald Trump's legislative agenda through a sweeping reconciliation package. Speaker Mike Johnson emphasized that the spending cuts for the package focused largely on the border energy and tax policy will be shaped by what committees find feasible. So, however, divisions have emerged with hardliners demanding deeper federal cuts and moderates cautioning against reducing social safety net programs. So Johnson outlined a really ambitious timeline for the package targeting committee discussions this week and a House floor vote soon after. He further went on to say that he wants a draft of the bill like the middle of February. So I think his really aggressive timeline to get that done will help shape things over the next week or so. I certainly know that top Senate Republicans aim to pass their agenda through budget reconciliation. And just to kind of explain a little bit more about it, reconciliation is a process that bypasses the democratic filibuster and requires only a simple majority. Experts, unfortunately, warn that even one reconciliation bill is a difficult task, let alone two, due to some of the procedural challenges with narrow Republican majorities and political risks. So some of the key challenges to trying to pass this reconciliation bill is agreeing on a unified budget resolution between the House and the Senate, managing resistance within their own party over the debt ceiling, increasing spending and spending cuts. Kind of an interesting thing to throw together is the cuts, but then increasing in other ways. So it's trying to figure out exactly how to agree to that. And then navigating the Byrd rule, which limits policies that increase deficits beyond 10 years, restricting Republicans' abilities to make the 2017 tax cuts permanent. And then Republicans are considering signing tax and budget changes, including reducing the corporate tax rate. Excuse me. Repealing certain Democratic tax measures and cutting spending programs. So they may split their agenda into two bills, if necessary, with pressure mounting to address the expiring 2017 tax cuts. I know procedural obstacles like the Voterama where Democrats propose politically charged amendments add further difficulty. And former president, excuse me, current president, Donald Trump, suggesting seeking Democratic support for tax cuts. But top Democrats have really said that they're not really looking to engage on that. So the Republicans are gonna have to go at it alone. I know Speaker Mike Johnson aims to pass a budget resolution by late February, but the path forward remains unclear. But the path forward remains uncertain and fraught with internal and external resistance. Certainly part of that is just trying to figure out exactly what they would like to tackle and trying to get everybody on board with one idea. And after the House Republican retreat, they are struggling to figure out if they're gonna do two reconciliation bills or just one really big one. So until the committees meet and kind of iron out some of these details, we're not really gonna see much action on it yet. So we still have some time to make sure that we're prepping for anything that's coming out and then advocating for things along the way. So lastly, on confirmations, I know RFK Jr. is on the Hill right now testifying for his nomination to head HHS. So we will see how that shakes out. I think there's been a lot of recent pushback from senators and stakeholders regarding justice conflict of interest disclosure form and some of his more conflicting viewpoints on certain issues. I would say I can't really predict how this will turn out, but I think both RFK and Dr. Oz have a 50-50 shot. I think Dr. Oz, at least, I haven't heard a lot about his confirmation recently and sometimes no news is good news. So we'll certainly see how both of those shake out. And I think that wraps it up. If anybody has any questions. Cameron, we did have one question and it's how do I figure out how to get in contact with my representatives? Yeah, absolutely. So after the call, I can share a link to find your local representative. It should have your district office contact address, everything like that. And it's really, really easy to get involved. I mean, these district offices are used to people coming in, businesses coming in and wanting something from them. So just having you drop in to share information with them, advocate for your personal positions, your company, your workforce positions, anything like that is certainly always welcome. They're always looking to meet new people and hear from their constituents. I'll make sure I share that around. I'm gonna share around a link as well to all of the bills that I talked about from last Congress and then a couple other resources after this meeting so that everybody can dig in a little and reach out to your local representative. Sorry, I can't see the question. Nope, did anybody else have any other questions? I'll give people a minute to drop them in the chat. Here we are. I found where the chat was hiding, so. All right, well, thank you so much, Cameron, for coming to joining us today. It was a great presentation. We really appreciate you being here and Michael, you as well. If you guys, if anybody does have any questions, please feel free to reach out. We can get you in touch with Cameron or Michael They're fantastic resources that we use here and they attend all of our advocacy council calls and they're just, they're a wonderful resource that we're super fortunate to have on our team. So thank everybody for joining us and everybody enjoy the rest of your day. Awesome, thank you very much. Have a good one.

Healthcare Legislative Outlook

telehealth

physician fee schedule

prior authorization reform

PBM reform

healthcare advocacy