Clock starts ticking on a year-end health package
Illustration: Shoshana Gordon/Axios
The fate of a year-end health care package hangs on a messy appropriations process and may not come into sharp focus until December — which makes this week's deliberations over a CR the undercard to the main event
Why it matters: The disarray in the House is already taking away bandwidth from health add-ons, making prospects for a grand bargain addressing issues like PBM reforms and Medicare hospital payments somewhat less likely.
- But there will be significant pressure to extend health programs with funding that expires at the end of December.
State of play: The House is starting off with a conservative play: a CR stretching into March that's going to the Rules Committee today with a voting proof-of-citizenship measure attached. It contains no health extenders.
- House Democrats are lined up in opposition, with Appropriations ranking member Rosa DeLauro stating "A half-year continuing resolution that includes Trump's Project 2025 policies is no way to govern."
- Senate Democrats also won't support the bill, and the general consensus is that an eventual compromise will extend government funding into December and could set up some kind of year-end health package.
State of play: There are a range of health programs that expire at the end of the year which will need to be addressed.
- Those include Medicare telehealth flexibilities implemented during the pandemic to increase access to virtual care and scrap certain geographic requirements and originating site restrictions.
- The Medicare hospital-at-home program for acute services is also up for a five-year extension.
- And there's the issue of renewing community health center funding and delaying Medicaid DSH payment cuts to safety net hospitals.
Between the lines: Paying for these priorities is an issue — which is where policies that generate savings could come into play, like PBM overhauls or modest site-neutral Medicare payments for hospitals.
- In March, when the FY24 government funding deal was coming together, there were disagreements about which PBM policies to select from a variety of delinking, transparency, and spread pricing measures that have already seen action.
- Several key members are retiring, though, and will be looking to leave an imprint before they leave, notably House E&C Chair Cathy McMorris Rodgers. And physician-lawmakers will seek rollbacks to Medicare physician payment cuts and are pushing for the extension of the hospital-at-home program.
The bottom line: Lawmakers' track record agreeing to bigger-ticket health care items has not been great this Congress, so there's plenty of skepticism about whether a larger deal can come together.
- Even bipartisan priorities like telehealth could get hung up on cost concerns and caught between competing priorities, making a two-year extension a win.
- Election results will play a big role too, especially if either party sweeps and wants to wait for full control of the government next year.
