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Congress confronts a lengthy health care to-do list

an illustration of a health plus made from dollar bills surrounded by ballot imagery

Illustration: Tiffany Herring/Axios

The holidays are over and Congress is coming back to reality, including the realization there's a lot of unfinished health business that needs to be addressed.

Let's dive in to what's still on the table for the 118th Congress' second session.

The big picture: The looming government funding deadlines could be the last chance for major health policy until a post-election lame duck session. But so far, there haven't been any decisions on which health care riders could be attached to a spending package ahead of the first deadline, on Jan. 19.

  • Delays to Medicaid DSH funding cuts for hospitals and money for community health centers expire on Jan. 19 and are perhaps the likeliest agenda items to be extended through a funding package.
  • Lobbyists also expect partial relief for Medicare physician payment cuts that took effect on Jan. 1.
  • PBM changes and the House's modest site-neutral payment reforms are also in the mix, but could be harder to pull off by Jan. 19. Some items could be punted to the lame duck.

Where things stand: The first of the House's "laddered" continuing resolutions expires on Jan. 19 and includes Agriculture-FDA spending.

  • No progress appears to have been made on addressing conflict around reversing current FDA rules on distributing the abortion pill mifepristone, as well as deep cuts to agriculture programs.
  • And a topline appropriations number has not been decided on yet, a Democratic Senate aide confirmed.
  • The Senate seems likely to want to stick to funding levels close to what was agreed to during the Fiscal Responsibility Act, while the House hasn't yet reached a consensus. On Friday, the House Freedom Caucus put out a press release urging for funding to be below FY 2023 levels.
  • The Labor-HHS bill is a part of the package of bills covered by the second CR that expires Feb. 2.

Zooming in on key issues:

Medicare doctor payment cuts

  • The CR ensured that the 3.4% Medicare payment cut rates for providers were pushed off only until Jan. 1, not Jan. 19.
  • There is precedent to extend the cuts and retroactively reimburse providers, but that can complicate negotiations.
  • "Should the reduction go into effect on Jan. 1, 2024, and then later be remedied, medical groups will face administrative turmoil if CMS pays out claims prior to the enactment of a fix and later has to reprocess them," said the Medical Group Management Association in a December letter to congressional leaders.
  • The group also noted that commercial insurance plans sometimes set their reimbursement rates based on Medicare rates, and then don't always revise them to reflect higher rates if Congress enacts a fix.

Medicaid DSH cuts and community health centers

Averting cuts to safety net hospitals is a top priority. And community health centers also need a funding extension. The clear deadlines and bipartisan support on both these fronts give them a good chance of being addressed in some fashion.

Health price transparency

  • Now that the House has passed a transparency package, the ball is in the Senate's court, and it's been slow going.
  • Sens. Bernie Sanders and Mike Braun introduced transparency legislation in the Senate in December that has some similar provisions requiring hospitals to disclose standard charges.
  • Analysts like Raymond James' Chris Meekins believe that the stars are aligning and that transparency provisions will be attached to government funding legislation.

PBMs

The House transparency bill included some new PBM reporting requirements. The Senate has some even more sweeping proposals, including changes in the commercial market, not just Medicare.

  • Working out the differences there could take some time, though there is clearly lots of bipartisan interest in the subject.

Site-neutral payment reforms

The House's modest site-neutral measure, which only applies to physician-administered drugs, has still alarmed hospitals.

  • It will certainly be discussed, but health system opposition might make it less likely to make the final cut, especially given unclear interest in the Senate.
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