The expiring programs Congress needs to address

Here's a rundown of expired programs that will command attention as the session winds down, though passage likely depends on a large-scale health deal coming together:

PAHPA:

The Pandemic and All Hazards Preparedness Act's reauthorization expired over a year ago, at the end of September 2023, and there hasn't been much action since, except to keep provisions for essential activities authorized.

• While a PAHPA reauthorization package sailed through the Senate HELP Committee in 2023, House Republicans and Democrats have been split on whether to use it to expand the FDA's authority to address drug shortages.
• Several PAHPA measures addressing national health security were extended in the most recent CR and have been featured in the stopgap spending packages that have come up since last year.
• Those include mostly authorizing authorities for the HHS secretary to respond to national disasters, and FOIA and antitrust exemption provisions that allow medical companies to limit how much information they share due to intellectual property concerns.

One lobbyist who works on PAHPA told Axios that it seemed possible that those health security provisions would be extended for another two years in the next funding deal. But most everything else is likely to be deferred until after the election.

• There's also likely to be continued resistance from conservative members of the House GOP caucus, like Chip Roy, who have said they oppose a PAHPA reauthorization without revisions to the program such as cutting funding levels and establishing a vaccine liability commission.
• Roy's office didn't respond to a request for comment on whether he would hold up PAHPA's reauthorization.

SUPPORT Act

The reauthorization of the SUPPORT Act, which includes a range of programs aimed at fighting the opioid crisis, has bipartisan backing, but has been stalled since last year's deadline for renewal passed.

• While appropriators can still provide money, policy changes to update programs are on hold.
• One envisioned change would allow state opioid response grants to be used to treat other substance use disorders, such as alcohol addiction, that can co-exist with opioid addiction.
• Reauthorization is being held up not so much by disputes on the issues as by the lack of a legislative vehicle to ride on. If a big health package comes together in the lame duck, SUPPORT hop on.
• There is still disagreement over whether to attach separate legislation expanding the availability of methadone as an opioid addiction treatment. That faces resistance among some House Republicans, making it less likely to be included.

What we're watching: A related issue is whether DEA extends telehealth flexibilities for prescribing controlled substances, including buprenorphine, an addiction treatment.

• Sen. Mark Warner, who has been active on the issue, told Axios in a statement, he is "encouraged" that the DEA appears to be preparing another short-term extension. If it doesn't develop a "workable plan for actual telemedicine" in the long term, though, he's prepared to offer a "legislative fix."

PEPFAR

The President's Emergency Plan for AIDS Relief was authorized for one year when the FY24 funding deal came together this spring. It marked the first time the program wasn't reauthorized for a five-year period since its creation in 2003.

• This short-term authorization leaves the program expiring again in March 2025 if lawmakers don't take action at the end of this year or early in the new Congress, when they'll likely have many other issues on their plate.
• "There is some potential for Congress to consider a longer reauthorization during the lame duck, but it is unclear if that could happen. If it doesn't, the same dynamic would likely be at play early next year," said Jen Kates, senior vice president and director of global health and HIV policy at KFF. "Of course, the outcome of the election may shift this somewhat."

The program, which provides global HIV/AIDS support and was established under President George W. Bush, has traditionally had bipartisan backing.

• But, some congressional Republicans raised concerns last year that some of the program's funds were going toward abortions.
• If former President Trump wins the election, he will have more sway over whether and how the program is altered because of the short-term reauthorization.