Rep. Lizzie Fletcher

Maddy summaryThis bill amends Medicare, Medicaid, and private insurance rules to improve coverage for drugs treating rare diseases (defined as conditions affecting 200,000 or fewer people in the U.S.). It requires coverage for rare disease drug uses supported by peer-reviewed medical literature and not listed as contraindicated in FDA labeling or medical reference guides. Private insurers must provide expedited review processes for denials of such drugs. The changes apply 30 days after enactment, affecting insurers and patients seeking coverage for rare disease treatments.

Maddy summaryHR 5819, the COMPLETE Care Act, incentivizes Medicare primary care providers to integrate behavioral health services by increasing payments for specific services (like mental health and substance use disorder support) during 2025-2027. Providers using designated HCPCS codes for integrated care would receive 125-175% of standard payment rates, with the percentage declining annually. The bill also requires these providers to report on integration quality measures and mandates technical assistance for practices adopting integrated models, funded through new appropriations for 2024-2027. It directly affects Medicare-participating primary care practices serving beneficiaries needing mental health or substance use services.

Maddy summaryThe Lowering Drug Costs for American Families Act expands Medicare's drug price negotiation program from 20 to 50 drugs, allowing the government to negotiate lower prices for these medications. It requires private health insurance plans and group health coverage to apply these negotiated prices to their members' cost-sharing for covered drugs, with plans able to opt out while publicly disclosing their decision. The bill also extends these negotiated prices to drugs covered by commercial insurance markets, not just Medicare. This would directly affect Medicare beneficiaries and people with private health insurance who take the negotiated drugs.

Maddy summaryThe 9-8-8 Implementation Act of 2023 establishes a national mental health crisis response system centered around the 9-8-8 suicide prevention hotline. It provides $441 million for call center technology, staffing, and operations, and requires Medicare, Medicaid, and private health plans to cover crisis response services including mobile crisis teams and crisis stabilization facilities. The bill also mandates a national suicide prevention media campaign and creates protocols for 9-1-1 dispatchers to better respond to mental health crises. These provisions aim to improve access to mental health crisis care across the United States.

Maddy summaryThis bill mandates an interagency review by the Department of Health and Human Services (with Defense and Veterans Affairs) to address lung cancer disparities affecting women. It requires a report evaluating research gaps, improving access to lung cancer screening (especially for underserved groups), and developing public awareness campaigns about early detection. The review will focus on factors like environmental exposures, genomic differences, and treatment responses specific to women, particularly those who never smoked. The report must be submitted to Congress within one year of enactment. This directly affects women at risk of lung cancer, including those with non-smoking-related cases.

Maddy summaryThe PrEP Access and Coverage Act of 2023 requires private health insurance plans, Medicare, Medicaid, and other public health programs to cover pre-exposure prophylaxis (PrEP) for HIV prevention without cost-sharing, including the medication, related lab tests, and follow-up care. The bill also prohibits life, disability, and long-term care insurance companies from denying coverage or charging higher premiums to people taking PrEP. It establishes public education campaigns to increase awareness of PrEP and PEP (post-exposure prophylaxis) and creates funding for state and community programs to expand access to HIV prevention services, particularly for populations disproportionately affected by HIV including Black, Hispanic/Latinx, and transgender individuals. The legislation specifically addresses current disparities in PrEP access, as data shows only 11% of Black/African American and 21% of Hispanic/Latinx individuals eligible for PrEP received prescriptions in 2022 compared to 82% of White individuals. Coverage requirements for most plans will take effect on January 1, 2025.

Maddy summaryThis bill, the Public Servants Protection and Fairness Act of 2023, amends Social Security to better protect public servants who work in jobs not covered by Social Security (such as certain government positions). It creates a new formula for calculating retirement benefits that combines both covered and noncovered earnings, ensuring public servants receive the higher of two benefit calculations. The bill also provides an additional $150 monthly payment for certain public servants whose benefits were previously reduced by the windfall elimination provision. It improves Social Security account statements to clearly show noncovered earnings and requires a study of how state retirement plans handle these benefits. These changes will apply to benefits starting in 2025.

Maddy summaryHR 3561, the PATIENT Act of 2023, requires hospitals, health insurance plans, and pharmacy benefit managers to publicly disclose detailed pricing information for healthcare services and drugs. Hospitals must publish standard charges for 300+ shoppable services, including gross charges, payer-specific negotiated rates, and discounted cash prices, with updates required annually. Health plans must provide real-time information on in-network rates, cost sharing, deductibles, and prior authorization requirements for covered services. The bill establishes enforcement mechanisms, including civil monetary penalties for non-compliance, with fines ranging from $300 per day for small hospitals to $5 million for large hospitals that fail to comply with the transparency requirements.

Maddy summary# Summary of Proposed Immigration Legislation This comprehensive immigration bill proposes sweeping reforms across multiple areas of U.S. immigration policy. The key provisions can be categorized as follows: ## Family Immigration Reforms - Expands eligibility for family-based visas - Creates new pathways for family reunification - Reforms the "child out" rule for H-4 visa holders who age out - Establishes new procedures for sponsors of unaccompanied children ## Employment-Based Immigration - Increases diversity visas from 55,000 to 80,000 - Creates new categories for doctoral STEM graduates - Eliminates per-country limits for employment-based visas - Addresses visa backlogs by creating new categories for beneficiaries with priority dates over 10 years old - Increases visa numbers for certain employment-based categories (e.g., 23.55% instead of 28.6% for certain categories) - Creates a Regional Economic Development Immigrant Visa Pilot Program (10,000 visas annually) ## Diversity and Integration Programs - Creates a United States Citizenship and Integration Foundation to promote citizenship preparation - Establishes pilot programs for immigrant integration at state and local levels - Creates English as a Gateway to Integration grant program ($100 million for 2024-2025) - Creates Workforce Development and Shared Prosperity grant program ($100 million for 2024-2025) - Requires in-state tuition rates for refugees, asylees, and certain special immigrants - Waives English requirements for seniors applying for naturalization ## Immigration Court Reforms - Increases immigration judge numbers by 55 annually through 2028 - Creates a right to counsel for vulnerable individuals (children, victims of abuse, etc.) - Establishes an Immigration Counsel Fund with a $25 surcharge on immigration fees - Requires all noncitizens to receive legal orientation programs - Modernizes court technology for improved efficiency - Creates procedures for ensuring court appearance compliance ## Refugee and Asylum Processing - Expands alternatives to detention for family units - Improves processing for asylum seekers - Creates programs to facilitate safe and efficient repatriation - Establishes reintegration support for repatriated individuals ## Naturalization and Citizenship - Creates citizenship pathways for U.S. high school graduates - Waives English requirements for seniors - Creates a National Citizenship Promotion Program - Establishes naturalization ceremonies at historic locations The bill aims to create a more efficient immigration system, address backlogs in immigration courts, promote immigrant integration, create clearer pathways to citizenship, and reform both family-based and employment-based immigration systems. It represents a comprehensive approach to modernizing U.S. immigration policy.

Maddy summaryThe ACCESS Act (HR 3004) temporarily expands health insurance premium tax credits for low-income individuals and creates a federal Medicaid program to close coverage gaps in states that haven't expanded Medicaid. For 2024-2026, the bill removes income limits for premium tax credits and allows credits for low-income employees with household incomes up to 138% of the poverty line. It establishes a Federal Medicaid program that would provide health coverage to individuals in non-Medicaid-expansion states who earn up to 138% of the poverty line, administered through contracts with Medicaid managed care organizations or third-party administrators. The program would transition individuals from Marketplace plans to this federal coverage and includes provisions for income verification and coordination with state Medicaid programs.