Remember this cheat sheet we assembled at the start of August recess for big-ticket policy items that are grinding through the mill? It's back and updated.
Why it matters: The latest government funding deal punted decisions on a host of big health policy issues past Dec. 20, setting up a prospective year-end package with huge implications for hospitals, PBMs, telehealth and other industries.
- Congress has struggled to get anything substantive over the finish line, but year-end deadlines and powerful lobbying could break that pattern.
Driving the news: At the very least, lawmakers will need to deal with expiring programs like pandemic-era telehealth flexibilities and community health center funding. Scheduled cuts to Medicaid DSH hospital payments and Medicare physician reimbursements also are on the radar.
- The Medicare telehealth flexibilities will likely be renewed for two years, with bipartisan support across the board and an extension package already passed out of the Ways and Means and Energy and Commerce committees.
- There's also the hospital price transparency package that passed the House last year and remains a priority for departing Energy and Commerce Chair Cathy McMorris Rodgers, who's pushing senators to act.
- A flurry of proposed PBM changes or limited site-neutral payments for hospitals could emerge as payfors, to help cover the cost of the telehealth extension or delaying provider payment cuts.
Yes, but: There's disagreement over whether PBM changes should also apply to the commercial market, and concern in the Senate over site-neutral's impact on rural hospitals, plus strong opposition from the PBM and hospital lobbies.
- Another potential payfor is bipartisan drug pricing legislation to crack down on "patent thickets" that can delay competition. Sen. John Cornyn expressed confidence this week in that measure's chances in the lame duck.
The big picture: The election results will influence lawmakers' willingness to deal. If Republicans win a trifecta, they'll likely delay major action until next year.
- But it's rarely unwise to bet on Congress punting big agenda items. Many of these same provisions were in play for March.
- Still, pressure has been building for action on PBM changes, with members in both parties calling for moves like "delinking" PBM compensation from the price of a drug, or improving transparency in the drug supply chain.
- Final FY25 funding levels for individual health agencies also are in limbo after the House and Senate approved very different appropriations bills. The betting is that levels will remain relatively flat, but election results could still determine if HHS or the FDA takes a hit in a year-end spending deal.
