Lame duck health outlook hinges on length of CR
Illustration: Sarah Grillo/Axios
Skepticism is building over the likelihood of a major health package before the end of the year as Congress weighs whether to dispense with unresolved health issues or opt for a bare-bones lame duck session.
Why it matters: The fate of PBM reforms, drug patent changes and prior authorization measures hinges on how ambitious lawmakers get.
Between the lines: Much of the immediate focus is on whether to pass a short-term government funding extension into early next year, which would decrease prospects for a major health package.
- A CR that extends to March, for example, would give the incoming Trump administration and the next Congress more options for shaping health policy.
- But if lawmakers instead decide to "clear the decks" for the incoming administration, there's a better chance for health riders.
- Senate Democrats will likely push for an omnibus package, seeing it as their last opportunity to influence policy for at least two years.
President-elect Trump is visiting the Capitol on Wednesday, which should help crystallize the GOP's views on next steps.
Don't discount that a number of retiring lawmakers will be pushing their health priorities, including retiring Energy and Commerce Chair Cathy McMorris Rodgers, who wants the Lower Costs, More Transparency Act to become law.
- Retiring physician Reps. Brad Wenstrup, Michael Burgess and Larry Bucshon also want to address a nearly 3% Medicare physician payment cut that takes effect in 2025.
State of play: A number of health extenders expire at the end of the year that will at least have to be addressed even in a minimalist session.
- They include community health center funding and Medicaid DSH payment cuts to hospitals.
- Also, programs including pandemic-era Medicare telehealth flexibilities and the Medicare hospital at-home program are also widely expected to be extended for several years.
- Prospects also are good for a limited "doc fix" partially addressing the Medicare physician payment cut.
The big picture: Items not facing must-do deadlines face a tougher path, even if they have the advantage of saving money that can be used to pay for other priorities.
- Those include PBM changes, site-neutral reforms to Medicare hospital payments and legislation addressing "patent thickets" that slow down generic drug competition.
- The Biosecure Act, meanwhile, could have a separate track in the National Defense Authorization Act, though its fate is not certain.
The bottom line: Much will depend on what Trump wants in a spending deal, since that will likely be the vehicle for add-ons other than the Biosecure Act.
- It's never a bad bet with Congress to assume things will be punted.
