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Big health questions remain after spending deal

Jan 8, 2024
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Illustration: Lindsey Bailey/Axios

The topline spending deal that congressional leaders announced on Sunday should accelerate a series of key health policy decisions that will shape the year ahead on the Hill.

  • Speaker Mike Johnson maintained that he will "fight for the important policy riders included in our House FY24 bills," while Senate Majority Leader Chuck Schumer has said "Democrats will not support including poison pill policy changes in any of the twelve appropriations bills."

What we're watching: As details of the funding deal are hammered out, there are at least four things that must be answered:

What's the status of toplines for individual spending bills?

  • This will determine if funding levels for HHS, the FDA, NIH and other health agencies remain flat or face program cuts.

What happens to the poison pills?

  • The House's Agriculture-FDA and the Labor-HHS bills, along with others, are laden with contentious riders on issues like abortion and gender-affirming care. Will they stay or go? (Here's a breakdown of what's on the table.)

What is being targeted by the COVID rescissions?

  • The framework outlined on Sunday includes $6.1 billion in COVID rescissions, but it's not clear yet what that all includes.
  • House Appropriations Ranking Member Rosa DeLauro slammed the rescissions, stating that she was "infuriated that it includes cuts to the Internal Revenue Service that only benefit tax cheats and cuts to COVID and public health funds — cuts I opposed."
  • When Republicans targeted COVID rescissions last year during the debt ceiling debate, Democrats told us they were worried that it could affect public health initiatives which have already allocated funds.

What other health provisions might tag along on a funding deal?

  • It's likely that community health centers, Medicaid DSH cuts to safety net hospitals and some type of fix to the doctor Medicare payment cuts (see above) will all be addressed.
  • But as we wrote last week, it's still up in the air whether transparency provisions for PBMs, hospitals and insurers, or any site-neutral measures will catch a ride on a spending package.
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