Lame duck health care forecast

We hope you had a good Thanksgiving break! Congress is heading back in with just three weeks until the government runs out of money.

• We caught up with senators, aides and lobbyists Monday to get an update on our lame duck preview. Here’s our sense of the outlook so far.

A newsy comment from Sen. Richard Burr: He told Peter on Monday that there is "no" chance of action on reforming FDA oversight of dietary supplements before the end of the year.

• A senior Republican HELP Committee aide later added that there is a chance of reforming FDA oversight of cosmetics, and that it is "linked" to the VALID Act reforming diagnostic test oversight, a measure pushed by Burr, where changes are being discussed.
• "If we reach consensus on VALID then cosmetics can flow with it," the aide said.
• Another candidate is the PREVENT Pandemics Act, which Burr introduced with Sen. Patty Murray.
• "Everything's in conversations right now, hopefully in the next week to 10 days we should get some read on that," Burr said. "I think VALID's currently on the table, so is the PREVENT Act."

The outlook is better for items with a firm deadline, like averting Medicare PAYGO cuts and at least partly averting a 4.5 percent cut to physician payments.

• As Burr's comments suggest, dietary supplement reform is looking very unlikely, but there is some chance for other FDA items like cosmetics, VALID, and accelerated-approval reform.
• Public health policies (like the PREVENT Pandemics Act) will be easier to pass and quicker to negotiate than policies that require extensive pay-fors, one former Democratic aide added.
• An extension of the telehealth flexibilities seems very likely, though the specifics on how long the extension will be — and whether permanency is on the table — are still up in the air.
• A House Republican aide said bipartisan negotiations on the FMAP rate and number of years to to extend Medicaid funding for Puerto Rico are a lame duck priority. The starting point is a bipartisan 2021 Energy and Commerce bill that extended increased funding at the FMAP rate of 76% for five years.
• Two health care proposals that Republicans oppose — vaccine mandates and paying for abortion travel — could also hold up the annual defense spending bill, which needs to pass in December.

What’s really looking tough: COVID-19 funding. The White House announced another request of about $10 billion for COVID needs, including development of next-generation vaccines that better target new variants.

• But Republicans have been resisting new COVID-19 funds for months, and there’s no sign they are changing their minds.
• We’re also hearing more and more that the $16 billion price-tag associated with Medicare Advantage prior authorization reforms that passed the House earlier this year is likely to mean it won’t end up in an end-of-year package.

The big picture: There’s definitely uncertainty about what’s going to happen. Negotiations are not very intense yet, and a lot is still to be decided. One big unknown: How much money there even is to spend on the health-related items.

• It’s always a safe bet to say Congress is going to kick the can down the road, at least a little bit, and we’re hearing the funding deadline could be extended from Dec. 16 to Dec. 23. (So don’t book your flights home for the holidays too soon!)
• "I don't know if we'll get [the package] done by the 16th. The 16th is the day I'd like to get it done, but we might be here 'til Christmas," Sen. Richard Shelby told reporters Monday evening.