Illustration: Sarah Grillo / Axios
The Senate Finance Committee is likely to squeeze more savings from Medicaid than the House while discarding a Medicare Advantage overhaul and some other ambitious policy changes when it releases its portion of the reconciliation bill Monday.
Why it matters: Senate GOP leadership seems to be trying to strike a balance between putting its mark on the health provisions while retaining some House-passed Medicaid provisions to avoid tanking the bill when it goes back to the lower chamber.
What we're hearing: Although the situation remains fluid, here is what lobbyists are expecting from the Finance text, which is expected to arrive Monday evening:
- Further savings from the taxes that states levy on providers, going beyond the freeze in the House bill. Changes under discussion include lowering the safe harbor from 6% of a provider's net patient revenue to 3.5%. That may be limited to Medicaid expansion states, however.
- There are concerns over the Medicare physician payment inflationary fix, and whether it would stop encouraging doctors to use value-based care payment models. Lobbyist sources say the Senate wants to drop it from the package but that the House is pushing back.
- An overhaul of Medicare Advantage is expected to be dropped, scuttling for now efforts to crack down on upcoding by insurers, to avoid adding contentious provisions.
- Another discussion centers around getting more savings by tweaking some of the state-directed payment measures. The House version caps new SDPs at the rate Medicare pays providers.
- Senate Finance Committee Republicans didn't respond to a request for comment.
Between the lines: Moderate GOP senators haven't expressed major concerns with the House's Medicaid work requirements, leaving the House-passed provisions broadly intact.
- That means for the first time ever, a federal work requirement of 80 hours per month would apply to able-bodied people ages 19 to 64.
- Numerous provisions that tighten requirements to enroll in the Affordable Care Act marketplaces also seem likely to remain intact.
- Absent any further Senate action, these would likely result in millions of people losing their insurance coverage.
What we're watching: Whether further provider tax changes raise alarm among some more moderate Republicans, who had already expressed reservations with the House bill's freeze.
- There was also concern from Sen. Josh Hawley about the cost-sharing provision that would require a doctor visit copay of up to $35 for Medicaid expansion enrollees.
