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What omnibus vs. CR means for health care

Illustration of the U.S. Capitol forming the top of a red cross symbol.

Illustration: Shoshana Gordon/Axios

Today we’re going to look at a question that’s on people’s minds all over town: What does it mean for health care if we end up with a year-long CR and not an omnibus?

  • The general consensus from our talks with aides and lobbyists is that health care riders definitely have a better chance on an omnibus — but don't rule out getting some items, like relief from provider cuts, with a CR.

The big picture: People angling to get their item in the package definitely are hoping for an omnibus, not a CR.

  • “A CR lasting through Sept. 30, 2023 will significantly reduce the size and scope of the year end health care package,” said Al Guida, president of the lobbying firm Guide Consulting Services.

Still, don’t give up all hope of getting your item attached even if it is a CR. No one knows exactly how this is going to play out, and at least in theory, health items can still ride on a CR.

  • Items with a firm deadline, like the provider cuts set to take effect on Jan. 1, are more likely to make it into a CR.
  • But the general thinking among lobbyists working on the provider cuts is that the 4.5 percent physician fee cut will not be entirely averted, and relief instead would be in the ballpark of 2-2.5 percent.
  • Bigger items like FDA reforms and mental health policy face a tougher path with a CR, but the door would not be fully closed on them.

Another wrinkle: There’s also a push for extra funding for health items in the underlying spending bills themselves, but the path there is an omnibus, not holding things constant with a CR.

  • Sen. Patty Murray, for example, said last week she wants more funding for local public health departments in the health spending bill.
  • Companies and academic medical centers that rely on NIH grants could be disproportionately affected, since issuing new grants or re-authorizing existing ones would be more limited under a CR than an omnibus, said Chris Meekins, a health care analyst at Raymond James.

What we're watching: There’s still a good chance of an omnibus, but the CR back-up option can’t be fully ruled out.

  • The clock is ticking, and there’s still no agreement on the overall funding level, with the ever-present debate about defense vs. non-defense spending levels unsolved.
  • Sen. Richard Shelby told reporters on Monday night after a meeting with President Biden that it is "doable" to get to an omnibus agreement, but the sides remain about $25 billion apart on spending levels. He noted that in the scheme of a roughly $1.6 trillion bill, that is not a huge amount, though.
  • "I hope we'll get to yes but we're not there yet," he said. "Our caucus is not going to just take anything."

And when is it safe to leave town? "Will we work something [out] before the 16th? I'd like to but probably not," Shelby said. (That could mean a one-week extension to Dec. 23.)

  • Rep. David Trone, a Maryland Democrat, said health care details in the package probably won’t come together until the week of Dec. 19.
  • “I don’t think it’ll be together until the week of the 19th, which means everything will be rushed. No one will have time to read it, no one will have time to understand it, and we’ll pass it. Great system, isn’t it?” Trone said. “Shame on us for that type of leadership.”

We’ll let you know when we hear more!

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