Illustration: Aïda Amer/Axios
The collapse of the continuing resolution has seriously threatened an elaborately negotiated health care package that touches virtually every medical industry.
Why it matters: After weeks of intense bipartisan and bicameral talks, and months of laying the groundwork, the package's major reforms, reauthorizations of existing laws and extensions of funding streams could all be scrapped.
Driving the news: The sources we talked to Thursday do not see a clear path for the health care package with the collapse of the CR deal, though no one knows what's going to happen for sure.
- Casualties would include major changes to how PBMs are paid, a hospital billing provision, drug patent reforms and vouchers to streamline reviews of drugs for rare pediatric diseases.
- Congress would likely still have to pass at least short-term extensions of some must-pass expiring items affecting community health center funding and an extension of Medicare telehealth flexibilities.
- Another measure would have allowed lawmakers to opt out of their ACA marketplace insurance and return to the Federal Employee Health Benefits Program, along with a pay raise. Both could likely fall out if there's a deal on a skinny CR.
What they're saying: "Members got greedy and tried to hang too many ornaments on the tree; now it seems to have fallen over," Raymond James analyst Chris Meekins told Axios.
Between the lines: Without the original CR deal, the health package has no clear vehicle.
- Many House Republicans revolted in part over the length of the bill, so discussions are now centered on a smaller package.
- Still, it appears that the new CR will not be entirely "clean," given that President-elect Trump is demanding that it raise the debt ceiling.
- There are also other priorities like disaster aid and farmer relief that lawmakers are pushing.
Options for what happens next include a pared-down CR with some disaster relief for farmers and language raising the debt ceiling.
- Debt limit language could also be added to the existing CR, or lawmakers could opt for a clean CR that's silent on it. The possibility of a shutdown looms in any scenario.
Friction point: Don't discount that Democrats will likely still need to deliver some votes on the package, with the unruliness and potential defections of the House Republican conference and the 60-vote threshold in the Senate.
- But Democrats are pretty angry at Republicans for reneging on their bipartisan deal, so that may be a heavy lift for them.
If another bipartisan compromise emerges, that would leave some opportunity for health items to catch a ride.
- Rep. Nicole Malliotakis wrote on X that Congress should take a standalone vote on the health care package, pointing to the PBM reforms she said would lower drug costs and safeguard community pharmacies.
What's next: If the health package is dropped, another chance could arise in March if there is another government funding package then. But it's unclear whether the odds would be any better, or whether priorities will shift.
