Part of the mission of Arnold Ventures focuses on a very long game: legislative change that maximizes opportunity and minimizes injustice. Here are some of our legislative wins on the federal and state levels across our portfolios.
In Heath Care:
Important Gains in Site-Neutral Payment Reforms
In December, the U.S. House of Representatives passed the Lower Costs, More Transparency Act (H.R. 5378) by a sweeping, bipartisan margin of 320 to 71 votes. The legislation is comprised of a comprehensive package of health care policies aimed at improving transparency and addressing health care costs. This includes a provision to implement site-neutral payments for certain services, a policy that ensures patients pay the same price whether the service is provided at hospital-owned outpatient facilities and independent physicians’ offices. The site-neutral payment reforms included in the legislation would lower health care costs for patients, employers, and taxpayers.
Implementation of the IRA
This summer, the Centers for Medicare and Medicaid Services (CMS) published the list of the 10 drugs selected for the first round of Medicare drug price negotiations. The list, which is comprised of high-expenditure, single source drugs with no generic or biosimilar competition is a result of the Medicare drug price negotiation program that passed in the Inflation Reduction Act (IRA) in late 2022. The law addresses drug price affordability in part by allowing — for the first time — Medicare to directly negotiate prices for certain drugs. The 10 drugs announced will be covered under Medicare Part D and subject to the negotiated price starting in 2026.
Increased Focus on Integration
Recently momentum has picked up to promote integration between Medicare and Medicaid and improve care for the population enrolled in both insurance programs. Today, these so-called “dual-eligible” individuals, which includes low-income, older adults and people with disabilities must navigate care in a complicated and uncoordinated system. The Biden administration has recently released proposed rules to maximize the impact of integrated models and a bipartisan working group in the Senate dedicated to addressing this problem is expected to release legislation soon.
Related: Arnold Ventures Responds to Bipartisan Senators Seeing Advice on Improving Care for 12 Million+ Americans
Medicare Advantage Regulations
In February, CMS proposed changes to the way the Medicare program determines payments to Medicare Advantage (MA) plans. This came after clear evidence from researchers and federal lawsuits, audits, and investigations determined that many insurance companies systematically overcharge beneficiaries and taxpayers by billions of dollars each year through practices like upcoding. Upcoding is where MA plans intensively code beneficiary diagnoses to make them appear less healthy and increase the government’s payments to plans. In March, CMS finalized these changes, which are an important step to address plan upcoding and overpayments, but in a disappointing move, decided to phase them in over a three-year period.
In Criminal Justice:
Amendments to Federal Sentencing Guidelines
In November, a series of amendments to federal sentencing guidelines went into effect, having been approved by the United States Sentencing Commission earlier in the year. These amendments are the most significant reforms to federal sentencing laws since the First Step Act five years ago. “Even at a time when issues of community safety feel like they are being politicized again, we can still make progress,” said Kevin Ring, vice president of criminal justice advocacy at Arnold Ventures, at the time. “The truth is that these are just smart policy changes.”
Changing SBA Rules for People with Criminal Records
In September, the Small Business Administration (SBA) announced a proposed rule that would improve access to loans for people with a criminal record. The SBA is an important source of funding for entrepreneurs and small businesses, particularly those in disadvantaged areas. However, prior to the proposed rule change people with prior justice system involvement faced numerous barriers to accessing SBA support. “We believe that a criminal record should not result in a life of poverty, and that finding solutions that work to advance second chances will strengthen our communities,” said Carson Whitelemons, director of criminal justice at Arnold Ventures. “As the SBA implements these changes, we look forward to following implementation and supporting research on the role of reintegration reforms in promoting economic mobility for people with criminal records, along with their families and their communities.”
Overhauling Public Defense
In June, Oregon Governor Tina Kotek signed legislation passed by the Oregon legislature that reforms the way the state fulfills the constitutional requirement to provide defense services to indigent defendants. Specifically, the law strengthens independence and oversight of the public defense system. It also establishes a hybrid model of in-house public defenders and contracted private attorneys in an attempt to increase the number of public defenders and reduce caseloads. “What’s so exciting about the bill in Oregon is the comprehensiveness and size of the reform, including funding and restructuring the system,” said Rebecca Silber, director of criminal justice at Arnold Ventures. While Oregon’s reforms stood out for their comprehensiveness, the state was just one of several that made needed changes to their public defense systems in 2023.
An Omnibus of Reform Measures
In May, Minnesota Governor Tim Walz signed a large-scale criminal justice omnibus package that had passed the state senate the previous month. The legislation included limited the use no-knock warrants, eliminated the practice of sentencing juveniles to life without parole, restricted probation terms to five years or less, funded a study of pretrial release and bail, established prosecutor-led resentencing, appropriated funding for free prison phone calls, and created an Office of Restorative Practices and an Office for Missing and Murdered Black Women and Girls. “Minnesota has been laying the groundwork for justice reform for years, with many of these policies being researched and debated for multiple sessions,” says Alyson Clements, director of criminal justice advocacy at AV. “With their passage, it is clear that Minnesota is stepping up as a leader committed to a justice system that is fair, effective, and just.”
Progress in the Land of Enchantment
In 2023, New Mexico Governor Michelle Lujan Grisham signed a series of laws aimed at improving the state’s criminal justice system. This included eliminating the practice of suspending people’s drivers licenses due to court debt or failure to pay/appear, ending fees for convictions and bench warrants, banning juvenile life without parole, creating parole opportunities for people serving long sentences for crimes they committed as children, reforming the state’s compassionate release process for elderly people, and strengthening law enforcement licensing standards. “It’s encouraging to see the state being intentional about how much it wants its system to impact people, what the appropriate measures of justice and accountability are, and how it can make sure that justice-involved people have an opportunity to learn from their mistakes and re-engage in society,” said Destiny Carter, advocacy manager for criminal justice at Arnold Ventures.
In Higher Education:
Gainful Employment Rules Finalized
In September, the Biden administration released final Gainful Employment regulations that will hold career-training programs accountable for demonstrating they lead to an adequate return on investment for students. As Arnold Ventures Vice President of Higher Education Kelly McManus said at the time: “These accountability regulations, which set the strongest standard for student outcomes of any rule to date, will provide students and borrowers with critical protections and ensure taxpayer dollars aren’t wasted on educational programs that don’t produce real value.”
There is still more work to be done in setting rules for accrediting agencies, state authorization and other accountability topics, but this was a major and long-awaited move in the right direction.
Stronger Oversight of High-Risk Colleges
The U.S. Department of Education released final rules in October strengthening accountability for colleges and consumer protection for students. These rules are aimed at predatory colleges that defraud students, take their federal aid dollars, and then shutter entirely – leaving students and taxpayers holding the bag. The new rules empower regulators to take action when schools sit on the edge of collapse, lie to students, or abuse the financial aid system.
Lawmakers and Voters Promote Ranked Choice Voting
Ranked choice voting racked up considerable wins over the past year. The Oregon legislature agreed to put the matter up for voter approval on the 2024 ballot, making it the first state where lawmakers referred ranked choice voting to the ballot rather than relying on a citizen-led effort. Meanwhile, cities in Minnesota and Michigan approved the voting method for their local elections.
In Contraceptive Choice and Access:
OPill Gets FDA Approval for Over-The-Counter Use
The FDA made history this year by approving the first contraceptive pill available over the counter in stores and online – no need for a prescription. The Opill, a progestin-only oral hormonal contraception by HRA Pharma, promises to help millions of people overcome barriers in accessing prescription birth control, particularly the 19 million low-income women who live in “contraceptive deserts” where reproductive health care is not readily available.
Related: Removing the Prescription Barrier
In Organ Donation Reform:
Congress Passed Organ Donation Reform
An average of 33 people on the organ transplant waiting list die every day, and yet taxpayer-funded Organ Procurement Organizations have a track record of unaccountable spending while leaving thousands of organs unrecovered every year. That’s why, after years of advocacy from experts and impacted families, we were so excited for Congress to finally pass a much-needed overhaul of the nation’s organ transplant system. With unanimous bipartisan support in both chambers of Congress, the “Securing the U.S. Organ Procurement and Transplantation Network Act” strengthens oversight of the contracting process for managing the nation’s organ transplant system, breaking up the national organ monopoly, and opening its functions to competitive bidding for the first time.