Dec 20, 2022 - Health

Congress saves big health care decisions for last

Illustration of the US Capitol forming the top of a red cross symbol.

Illustration: Shoshana Gordon/Axios

There's plenty for health care interest groups in Congress' year-end spending package, but some had to make significant concessions: There will be no pandemic commission, doctors will have to swallow some Medicare payment cuts and FDA oversight of diagnostic tests will not change.

Why it matters: The health care riders in the year-end spending package reflect which health care interests have clout, and which issues lawmakers want to punt into next year, when Congress will be divided and deals may be more elusive.

Here's where things stand:

Doctors cuts: The package will stave off 2.5 percentage points of a scheduled 4.5% cut to the Medicare physician fee schedule in 2023, and 1.25 percentage points of cuts in 2024.

  • Providers practicing in independent or small practices had said the cuts, combined with inflation and staffing pressures, could be economically devastating and prompt more mergers and buyouts.
  • American Medical Association president Jack Resneck expressed disappointment Congress didn't go all the way with relief on Monday and raised the prospect some practices will stop taking new Medicare patients.

Medicaid coverage: People could begin to be bumped from the safety net program if they don't meet eligibility requirements starting on April 1, but the process will occur over a one-year period so there is not a cliff where lots of people are kicked off at once.

  • The decision begins to unwind measures Congress put in pandemic relief legislation that increased the share of federal Medicaid spending if states offered continuous coverage to enrollees, suspending the program's usual churn.
  • The savings from that policy will in part be used on 12 months of Medicaid postpartum coverage, and continuous Medicaid eligibility for kids for one year. The advocacy group Protect Our Care said the steps would especially help families in communities of color and rural areas.
  • Puerto Rico also is getting a five-year funding deal for its Medicaid program through fiscal year 2027.

FDA oversight: Several FDA reforms which had bipartisan support in the House made it into the package. They include revamping a fast-track drug approval process that lets drugmakers sell their products based on preliminary evidence.

  • The year-end package also would give FDA added power to recall cosmetics that could cause harm and force manufacturers to disclose ingredients. And it would ensure more diversity in clinical trials, addressing a health equity issue that that was put into the spotlight during the pandemic.
  • But language aimed at modernizing a patchwork of diagnostic testing oversight at FDA was left out of the package.

Pandemic preparedness: Parts of a pandemic preparedness bill made it into the legislation, but the deal won't create a 9/11-style commission to examine the COVID response. It will, however, make the CDC director into a Senate-confirmed position, among other things.

  • Public health advocates have called for a much stronger legislative response, including more funding for next-generation vaccines and therapeutics.

Telehealth: Medicare telehealth flexibilities will also be extended for two years. The provisions have already been extended for 151 days after the end of the COVID-19 public health emergency.

Opioids: The omnibus also will include a bill to remove a requirement that health care providers get a special waiver from the Drug Enforcement Administration before being able to prescribe buprenorphine, a treatment for opioid addiction.

A version of this story was published first on Axios Pro. Get news like this by subscribing. Use code POLICY100 which gives you $100 off.

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