Rep. Pete Sessions

Maddy summaryThe Pharmacists Fight Back Act (HR 9096) sets new rules for Pharmacy Benefits Managers (PBMs) working with federal health care programs like Medicare Part D and Medicaid. It requires PBMs to reimburse in-network pharmacies at a rate covering the drug's actual cost plus a small fee (capped at $25), and to reduce patient cost-sharing by at least 80% of rebates received from drug manufacturers. The bill bans PBMs from steering patients to specific pharmacies, charging patients more than pharmacies are paid, or using rebates to lower pharmacy payments after claims are processed. It also mandates public reporting of drug pricing data to improve transparency, ensuring patients and pharmacies receive fairer treatment under federal health programs.

Maddy summaryThe Blind Americans Return to Work Act of 2024 creates a 20-year demonstration project to help blind individuals receiving Social Security disability benefits return to work. It modifies how benefits are calculated for eligible participants - those with blindness-related disability benefits who earned income during the first 10 years of the program - by removing standard work-income limits. Specifically, benefits are reduced by $1 for every $2 earned above a threshold (including a set exempt amount and work-related expenses), but never below $0, and benefits won’t terminate due to earnings. Participants may also opt out after 10 years, and the program excludes standard trial work and termination rules.

Maddy summaryThe Preserving Seniors’ Access to Physicians Act of 2023 increases the Medicare payment adjustment rate for physicians from 1.25% to 4.62%, directly affecting doctors who treat Medicare patients (primarily seniors). It also reduces the funding for the Medicaid improvement fund from $5,796,117,810 to $3,973,117,810. These changes impact Medicare providers and Medicaid programs, with the Medicare adjustment aimed at supporting physicians adjusting to payment changes. The bill does not specify how the Medicaid funding reduction relates to its stated goal of preserving seniors' access to physicians.

Maddy summaryThis bill prohibits health insurance plans from charging healthcare providers fees for electronic payments (EFTs) and payment advice transactions. It directly affects doctors, hospitals, and clinics that receive electronic payments from health plans by banning any charges, including withholdings, for these transactions. The law, effective January 1, 2024, amends the Social Security Act to require health plans to cover these costs themselves, eliminating fees for providers.

Maddy summaryHR 6344, the Simon Crosier Act, requires Medicare and Medicaid providers to establish written policies for do-not-resuscitate (DNR) orders involving unemancipated minors (under 18 without legal independence). It mandates that providers must inform at least one parent or legal guardian in person or by phone (with 72 hours of effort) before considering a DNR, allow parents/guardians to refuse consent, and prohibit overriding parental objections to life-sustaining treatment. The bill also requires providers to continue life-sustaining care for 15 days if a parent requests a transfer and explicitly prohibits using disability as the sole basis for DNR decisions. These requirements apply to all Medicare/Medicaid-covered facilities and directly affect minors, their parents, and healthcare providers.

Maddy summaryThe Maximum Pressure Act (HR 6114) is a legislative proposal that would maintain and expand U.S. sanctions against Iran. The bill would codify existing sanctions, require Iran to meet 12 specific conditions before sanctions could be lifted (including ending support for terrorism, releasing hostages, and ending nuclear enrichment), and expand sanctions on Iran's Revolutionary Guard Corps and missile programs. It also establishes new reporting requirements for the U.S. government to monitor Iran's activities and the impact of sanctions. The legislation would require congressional review before any sanctions could be lifted or modified, preventing the executive branch from unilaterally easing restrictions.

Maddy summaryHR 5713, the Homeland Security Fentanyl Enforcement Act, authorizes Homeland Security Investigations (HSI) agents and designated state/local officers to enforce drug laws related to fentanyl trafficking under the Controlled Substances Act for five years. It requires the Government Accountability Office (GAO) to review and report on coordination between the Drug Enforcement Administration (DEA) and HSI in drug investigations within 18 months, including whether investigations followed established coordination policies. The bill mandates the Homeland Security Secretary and Attorney General to address any coordination failures found in the GAO report, prioritizing existing interagency task forces. This bill focuses on improving interagency coordination to combat fentanyl smuggling by transnational criminal organizations, without altering DEA's core authorities or creating new drug penalties.

Maddy summaryHR 5391 requires drug manufacturers to pay rebates to Medicare when the price of certain high-cost cancer drugs (called "selected drugs") exceeds a negotiated "maximum fair price" (MFP). This applies to Medicare Part B beneficiaries using these specific drugs, lowering their out-of-pocket costs. The bill mandates manufacturers to calculate rebates based on the difference between current Medicare payment rates (ASP+6) and the new MFP-based rates, reducing beneficiary coinsurance from ASP+6 to MFP+6. The rebates are deposited into Medicare's trust fund and apply to drugs already subject to MFP negotiations under existing law.

Maddy summaryThis bill creates an exemption for Medicare Advantage plan physicians who had at least 90% of their prior authorization requests approved for specific services in the previous year. These doctors would be exempt from needing pre-approval for those same services in subsequent plan years, reducing administrative delays for patients. The exemption continues until revoked (based on updated approval rates) or the physician opts out. It also requires plans to allow providers to discuss treatment plans with a qualifying physician during the authorization process.

Maddy summaryThis bill amends the Affordable Care Act and Medicaid/CHIP programs to deny health insurance subsidies, coverage, and related benefits to individuals with Deferred Action for Childhood Arrivals (DACA) status. Specifically, it excludes people lawfully present only due to the 2012 DHS memo granting deferred action from eligibility for ACA subsidies, Medicaid, and the State Children's Health Insurance Program (CHIP). The bill requires states to remove DACA recipients from enrollment in health plans and rescind any existing waivers that allowed such coverage. It directly affects approximately 800,000 DACA recipients who currently qualify for ACA subsidies and Medicaid/CHIP under existing rules.