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Winners and losers from health care deal

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Illustration: Sarah Grillo/Axios

After a busy weekend, Congress has settled on the health care pieces of this week's funding package.

  • While there could be an effort to revive some policies that didn't make the cut in time for the March 22 package, that push faces long odds. So it isn't too early to assess winners and losers so far.

Winners

PBMs dodged a bullet, for now at least. Nearly everyone in Congress wants to address what's widely viewed as unfair industry practices or skimming off the top. But getting an array of committees and lawmakers to agree on specifics proved too difficult this time around.

Hospitals also got a reprieve when negotiators omitted price transparency and Medicare site-neutral payment policies. That means hospital outpatient departments can continue to be paid more than independent physician offices for the same service.

  • Hospitals had lobbied hard against the site-neutral piece, arguing it would lead to damaging cuts, and the effort never got very far in the bicameral talks.

Anti-addiction advocates scored with a limited set of Medicaid provisions.

  • They may not be earth-shaking changes, and the non-Medicaid parts of the SUPPORT Act were left out, but it is still an accomplishment to get anything into a "skinny" health package.
  • Provisions include making permanent Medicaid coverage of medication assisted treatment and a state option to cover inpatient addiction treatment. States also will be required to suspend rather than terminate Medicaid coverage for people entering prison to ease re-enrollment upon release.

Community health centers won more funding (around 7-10%, depending on if you use Republicans' or Democrats' favored methodology).

  • "This level of funding represents the largest increase in many years," said Kyu Rhee, CEO of the National Association of Community Health Centers.
  • Teaching health centers also got more than a 50% increase.
  • The funding is only until the end of the year, though, and is also well short of what Sen. Bernie Sanders had pushed for in his sweeping bill to address a primary care shortage.

Losers

Key lawmakers across the health committees failed to get their priorities in the package. Casualties included House Energy and Commerce Chair Cathy McMorris Rodgers' price transparency and site neutral push and Senate Finance Chair Ron Wyden's PBM reform initiative.

  • Wyden said in a statement he is "extremely disappointed" that the package leaves out "major reforms that would lower prescription drug costs for America's seniors."

Pandemic preparedness advocates like the Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials unsuccessfully fought for inclusion of a reauthorization of the pandemic preparedness bill known as PAHPA.

Consumer and patient advocacy groups also went away disappointed after they advocated for hospital price transparency and site-neutral changes.

  • The group Power to the Patients is hosting a concert with Foo Fighters tomorrow night to try to keep the issues on lawmakers' and on everyone's radar.
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