Axios Pro tracker: Health care bills to watch
We're back with a fresh bill tracker for the new Congress.
Why it matters: Other than reconciliation and possible Medicaid changes, not a lot is moving on health care front at the moment after the demise of December's health package.
Here's what is still on the table:
Medicaid cuts
The issue: Medicaid cut proposals include per capita caps on spending, lowering the federal share of costs (FMAP) for the expansion population, and imposing work requirements and doing stricter eligibility checks.
Status: Republicans are divided over how far to go, with the most consensus on work requirements.
Cost estimate: Hundreds of billions in savings, depending on what is implemented.
What's next: Given their divisions, it's unclear where Republicans will end up in reconciliation on changes to the safety net program.
PBM Overhaul
The issue: Options include a ban on spread pricing in Medicaid, delinking PBM compensation from a drug's price, instituting assorted transparency requirements and passing rebates fully along to the plan sponsor.
Status: The December health package contained PBM measures, and there's been some bipartisan interest in bringing it back.
- PBM overhaul bills that fall into the jurisdiction of House Ways and Means, House Energy and Commerce, and the Senate Finance Committee have all been reintroduced this session.
Cost estimate: A range, with some totaling roughly $1 billion in savings.
What's next: Democrats have pushed to revive the December health package, but GOP leaders are not going along.
- That leaves the path unclear, despite the bipartisan support.
Doc fix
The issue: Physicians in January were hit with a 2.8% reduction in their Medicare payment rate. Doctors in Congress have been pushing for a patch and increased payments the rest of this year to make up for the lost revenue.
Status: House leadership and Greg Murphy, the GOP Doctors Caucus co-chair, have said that the "doc fix" will be included in reconciliation.
Cost estimate: $1.9 billion for averting 2.5 percentage points of the 2.8% cut.
What's next: Seeing whether the doc fix actually makes it into reconciliation, when there are already concerns about the cost of the bill.
Medicare hospital pricing
The issue: Full site-neutral payment changes would equalize Medicare payments between hospital outpatient departments and independent physician offices for the same services.
- A narrower measure would require off-campus outpatient departments to have unique billing identifier numbers to crack down on "dishonest billing."
Status: The larger site-neutral effort hasn't gained traction in the Senate, but the billing identifiers did make it into the December package.
Cost estimate: Full site-neutral could save over $100 billion, but a more realistic narrower effort focused only on physician-administered drugs would save $3.8 billion.
Drug patent bills
The issue: Cracking down on "patent thickets," in which drugmakers file multiple patents around a product to make it harder for generics to compete.
- Also "product hopping," in which manufacturers make small changes to a drug to try to extend its period of market exclusivity.
Status: The Senate Judiciary Committee advanced the bills with nearly unanimous bipartisan support at the beginning of April.
- The patent thickets measure made it into the December health package.
Cost estimate: Last year the CBO said the changes would save $3 billion over a decade.
What's next: Similar patent bills have advanced out of committee in previous Congresses and gone nowhere.
- There's no sign yet that this year is different.
