Illustration: Sarah Grillo/Axios
Only a handful of health care provisions that mostly extend existing programs are likely to catch a ride on the next government funding package as the prospect of a shutdown looms, sources say.
Why it matters: While there is not a final deal and the outlook could still change, a skinny package would be a disappointment for advocates looking to address drug or hospital costs.
What we're hearing: Sources say that the health care package for the March 8 government funding deadline as of now will likely not include PBM reforms, price transparency measures or any site neutral Medicare payment policies for hospitals.
- It will almost exclusively focus on items with pressing deadlines, like community health center funding, reversing Medicaid DSH payment cuts to hospitals serving low-income patients, and partial relief for a Medicare pay cut for doctors that took effect Jan. 1.
- Punting virtually everything else that's in play would set up another health care package for a lame duck session.
Between the lines: One of the complications for including PBM measures has been an array of competing priorities across both chambers, including, as we wrote previously, disagreements between the House and Sen. Bill Cassidy over whether provisions would apply to the commercial market, as in the HELP Committee's legislation, not just Medicare.
- Even a modest site-neutral measure was widely seen as perhaps the hardest piece to get included, in the face of strong hospital opposition.
- Democrats have been pushing for higher community health center funding, and it is unclear what the final number will be. The House in December passed a 10% bump, to $4.4 billion per year.
- There have also been discussions about PAHPA and the SUPPORT Act being included in any rider package, but the details of what that could look like are not yet clear.
The big picture: It's also unclear exactly what legislative vehicle the health care riders could be attached to.
- It was expected that text for the first set of four appropriations bills with a March 1 deadline would be released over the weekend, but that hasn't happened.
- One of the main obstacles is that the House Freedom Caucus is insisting on including certain policy riders that are non-starters for Democrats.
- Those include some poison pill provisions such as prohibiting federal funds from going to gender-affirming care, Planned Parenthood and the Pentagon program that provides funds for people seeking an abortion to travel across state lines.
- Speaker Mike Johnson has such a slim House majority that he has to decide whether he will work with Democrats on a bipartisan funding deal with no policy riders, or side with the Freedom Caucus, which would likely result in a shutdown.
- There's also been talk that another continuing resolution could be in the works, which could extend the health programs at existing funding levels.
What we're watching: Friday is the first deadline for government funding to run out for programs covered by the fiscal 2024 Agriculture-FDA, Energy-Water, Military Construction-VA and Transportation-HUD spending bills.
