The House Energy and Commerce Committee on Thursday unanimously approved a medical cures bill shortly after reaching a bipartisan $13 billion deal to pay for the legislation.
The 21st Century Cures measure, which passed 51-0, is aimed at streamlining the Food and Drug Administration’s approval process for new drugs. It received bipartisan support in the Energy and Commerce Committee, easily passing a subpanel last week on a voice vote. The committee’s chairman, Rep. Fred Upton (R-Mich.), worked with Rep. Diana DeGette (D-Colo.) on the bill for over a year.
The major remaining question was how to pay for the bill’s cost, including more than $10 billion over five years in new funds for medical research at the National Institutes of Health (NIH). The bill also includes $550 million over five years for the FDA, a key point for Democrats, who pushed to have the funds added.
Members particularly praised the new NIH funds, which would fulfill a bipartisan priority and get around the spending caps known as the sequester because the funds come in mandatory spending, which are not subject to the same caps.
Committee leaders in both parties worked intensely over the past few days to come to an agreement.
The deal puts the bill on track to be a rare bipartisan achievement. Committee leaders hope to have a full House vote in June.
The atmosphere in the committee room Thursday was so jubilantly bipartisan that Rep. Bobby Rush (D-Ill.) joked it had become a “love-fest.”
Rep. Frank Pallone Jr. (D-N.J.), the top Democrat, told the committee’s chairman that “you really epitomize what it’s all about to be an outstanding member of Congress,” for working in a bipartisan way on the bill.
The offsets agreed to in negotiations culminating Wednesday night include selling 8 million barrels of oil each year for eight years from the Strategic Petroleum Reserve, which the Congressional Budget Office says will bring in $5.2 billion.
A second change modifies the timing of government payments to insurance companies under the Medicare Advantage program so that the government can keep interest earned on the funds rather than the insurer. This measure will bring in between $5 billion and 7 billion.
America’s Health Insurance Plans, the insurer trade group, objected to this loss of funds for its members, saying the provisions would use “seniors’ Medicare benefits to offset increased federal spending.”
A $2.8 billion change reduces Medicaid payments for certain medical equipment. It does this by lowering Medicaid payments to match the lower rates that Medicare pays for the same equipment. Medicare currently pays less because it uses a competitive bidding process.
The bill would also make $200 million by limiting payments for X-rays on film, incentivizing the switch to digital imaging.
The markup had been scheduled for Wednesday morning, but it was delayed for 24 hours at the last minute after Democrats asked for more time to review the offsets and work through changes.
Top Democrats on the committee had only seen the full offset proposals this week. Rep. Jan Schakowsky (D-Ill.) said Wednesday that the offsets had been “sprung” on Democrats.
A Democratic committee aide pointed out it would be more customary to work out offsets later in the process after the bill passed committee, but attributed the faster timeline to Republican leadership wanting the bill to be paid for early on.
Upton said Wednesday that leadership wants “us to get our ducks in line,” and that offsets had to be worked out so that the bill could be scored by the Congressional Budget Office.
In a positive signal from leadership, the bill was given the number H.R. 6. Bill numbers 1-10 are typically reserved for the Speaker.
The core of the bill aims to speed the approval of drugs through a number of measures, including by accepting broader evidence on a drug’s effects. It also encourages the use of “surrogate endpoints” in drug testing, which means tracking the progress of a biological measure instead of waiting for the full, definitive results, which can take much longer. It also creates a priority review program aimed at speeding the approval of breakthrough medical devices.
Committee leaders sent the proposal back and forth this week on the offsets, winnowing down a list of possible offsets.
Upton had a final meeting with the other leaders on the bill, Reps. Joe Pitts (R-Pa.), Pallone, Gene GreenGene GreenA guide to the committees: House Overnight Healthcare: Trump officials weigh fate of birth control mandate | House, DOJ seek delay in ObamaCare lawsuit Top lawmakers from both parties: 'Vaccines save lives' MORE (D-Texas) and DeGette on Wednesday before the group broke to brief the members in their respective parties.
Upton said Wednesday evening that committee Democrats had met at 5:30 p.m. that afternoon to go over the deal.
“We haven't heard any blowback, so I'm sensing that what we discussed earlier is going to hold,” he said. “So we're there.”
—This report was updated at 10:19 a.m.