Illustration: Aïda Amer/Axios
Democrats and Republicans traded offers on a year-end health care package over the weekend and into Monday, with signs pointing to a deal that's at least somewhat narrower than originally envisioned.
Why it matters: The fate of Medicare hospital payment policies, changes to how PBMs are paid and community health center funding hang in the balance as Congress looks to finalize a package that could ride on a CR as soon as this week.
- Sources say a deal remains possible, though the clock is ticking and the overall package might end up somewhat smaller than when talks began.
- Here's a look at some of the main sticking points, based on conversations with lobbyists and congressional aides.
Community health center funding: Democrats are pushing for more funding for community health centers, which has been a particular priority of Senate HELP Chair Bernie Sanders, though the exact number they're asking for is not clear.
- Democrats want a fair balance between money to forestall scheduled Medicare physician payment cuts and community health centers.
Hospital billing: Republicans have proposed a provision from the bipartisan House transparency bill that would require off-campus hospital outpatient departments to have unique identifier numbers.
- This is to prevent what critics call "dishonest billing," when hospital outpatient departments bill at higher amounts associated with hospitals.
- Consumer groups like Families USA have pushed for the provision as a way to lower health care costs.
- Democrats have left the provision out of their offers, though. Senate Majority Leader Chuck Schumer has objected to it in the past because New York hospitals say it's burdensome.
- Schumer's office declined to comment when asked if the provision is a dealbreaker for him.
Nursing home rule: Republicans have proposed repeal (or more recently, delay) of the Biden administration's nursing home staffing rule as a payfor.
- Democrats have objected to this idea, and extending the length of the sequester is another possible way to get an offset.
- Democrats say the staffing standards ensure quality care for seniors in nursing homes, while Republicans say they can be impossible for nursing homes to meet because of workforce shortages.
Other updates on what's in and out: Republicans have rejected a Democratic proposal for a one-year extension of enhanced ACA subsidies.
- This is not a dealbreaker for Democrats, but a sign that action on the matter isn't happening this year.
- Democrats argue the extension is needed to prevent premium costs from jumping, while Republicans have questioned the cost.
- A Senate bill from John Cornyn and Richard Blumenthal to reduce drug prices by targeting "patent thickets" could make it in, along with PBM changes such as transparency and "delinking" of the price of a drug from PBM compensation in Medicare Part D.
