Illustration: Maura Losch / Axios
The Senate Finance Committee's reconciliation title underscored a lack of appetite for making some major Medicare policy changes.
Why it matters: Almost every House Medicare policy proposal was discarded, including a "doc fix" and a provision that would have expanded the number of rare-disease drugs exempt from Medicare drug price negotiations.
- That helped avoid a reconciliation draft in conflict with President Trump's vow not to cut Medicare benefits.
What's (not) inside: The Medicare inflationary doc fix, which would have changed the physician fee schedule's conversion factor to increase payments to doctors.
- Expanding the "orphan" drug carveout to include orphan drugs approved for two or more rare diseases.
- Health savings accounts proposals that would have given Medicare beneficiaries more flexibility to contribute to HSAs, and would have expanded HSAs and increased the amount that can be contributed.
- Measures that would have cracked down on PBMs' practices in Medicare Part D, including "delinking" compensation and requiring more transparency.
Another casualty was Sen. Bill Cassidy's provision to address overbilling by Medicare Advantage insurers, which would have provided significant savings.
Between the lines: The proposed doc fix divided provider groups over whether it would stop incentivizing doctors to participate in value-based care models.
- That conflict and the Senate not wanting to touch Medicare in reconciliation, in general, doomed the policy, lobbyists said.
- But Rep. Greg Murphy, one of the chairs of the GOP Doctors Caucus, previously told Axios that not including a physician payment fix in reconciliation could cost GOP leaders his needed vote.
