Health care winners and losers from the omnibus

With Tuesday’s release of the omnibus bill text (finally!), it’s time to talk about the winners and losers of this year’s health care appropriations season.

• And don't worry, Pro readers! You're all winners in our book.

Winners:

• Sens. Richard Burr and Patty Murray: They pushed through much of their pandemic preparedness bill.
• Academic medical centers: They blocked the VALID Act from being included, arguing it would have imposed burdensome regulations on them.
• Puerto Rico: The territory will have increased Medicaid funding and an FMAP of 76% for the next five years.
• Mothers and children: The bill makes permanent the ability of states to offer 12 months of Medicaid coverage postpartum. It also gives children on Medicaid one year of continuous coverage.
• Telehealth stakeholders (Medicare patients, providers and hospitals): Telehealth groups were pushing for as long of an extension of PHE flexibilities as possible. It seemed like a one-year extension was in play last week, but now it's become two years.
• PBMs (for now): A PBM transparency bill that had passed the House earlier this year was not included. But, as we’ve reported, it’s widely expected that PBM reform will be a focus of oversight in the next Congress.
• Reps. Paul Tonko and Mike Turner, and Sens. Maggie Hassan and Lisa Murkowski: They got their bill included to boost access to opioid treatment by removing a special DEA waiver that providers needed to prescribe the treatment.

Losers:

• Next-generation vaccines: Congress did not fulfill the White House request for COVID-19 funding, including for developing better vaccines that target an array of variants.
• Hospice providers: They're helping to pay for the package. The offsets include extending changes to the cap on how much hospice providers can recoup from Medicare.
• Medical device companies: They pushed for the VALID Act, arguing the current diagnostic test oversight system is outdated, but didn’t get it. AdvaMed CEO Scott Whitaker called the bill's absence "very disappointing," adding, "The last thing we need is more Theranos-type tests in our health care system.”

Somewhere in the middle:

• Health care providers: Congress gave physicians relief from some of their Medicare cuts, but physicians say it’s not enough.

• “The AMA is extremely disappointed and dismayed that Congress failed to prevent Medicare cuts next year, threatening the financial viability of physician practices and endangering access to care for Medicare beneficiaries,” American Medical Association president Jack Resneck said in a statement Monday.
• The bill made an effort to extend the bonus payment doctors get for participating in value-based care programs, but cut it down from 5% to 3.5% and continued it for only one more year.
• The package does include a two-year extension for the Hospital at Home program, which is a win for the industry.
• The home health industry: The bill doesn't freeze or remedy an impending Medicare payment cut for home health, but it does require CMS to release information on how it calculated the cut.

And regardless of where you fall, we all get a participation medal, at least according to Sen. Ron Wyden.

• "You can question was this change or that appropriate,” Wyden said in the Senate halls Monday night. “The reality is, this is significant headway compared to the status quo.”