Illustration: Natalie Peeples / Axios
Congress is back next week with a full plate of unfinished health care business. The question is how much can get done if lawmakers get tied up with bigger fights, like avoiding another government shutdown.
- Here's our loose ranking of what could still get enacted by year's end.
Most likely
Health extenders
Health extenders covering continued funding for community health centers or to avert cuts to Medicaid DSH payments to hospitals are routinely addressed in year-end packages, so the underlying programs aren't likely to totally lapse.
- A typical backup is the use of short-term extensions. For example, if there is a continuing resolution on government funding into December, health extenders could be punted to last the same length of time.
On the fence
PBM overhaul
Members of both parties have wanted to target PBM business practices for years, but haven't found a legislative vehicle that can get through both chambers.
- This year could be different. The question is less about the policy than the broader congressional dynamics.
- "You're talking about a series of reforms that had 350 votes in the House," Rep. Jake Auchincloss, a major backer of PBM changes, told Axios.
- "But then, you also are talking about Republican leadership that backed down because of a single tweet," he added, referencing Elon Musk's broadsides last year.
- A major funding package could provide a vehicle for health policies affecting PBMs. But if Congress just opts for a stripped-down CR or if there's a shutdown, it would be much harder to accommodate extraneous items.
Least likely
ACA premium tax credits
Congress is facing a major cliff at the end of the year with the expiration of enhanced Affordable Care Act subsidies that help people afford premiums.
- There's still a chance that lawmakers will agree to a short-term extension, especially if it would phase down subsidies for some higher-income earners.
- But extending an expansion of the ACA still seems like a tall order with complete GOP control of Washington. Some Republicans argue that Democrats created this problem themselves by making the enhanced subsidies expire in the Inflation Reduction Act.
- Many health providers will try to build political pressure for an extension ahead of the midterms.
Medicare Advantage overhaul
There has been increasing scrutiny of Medicare Advantage practices like "upcoding," in which insurers classify patients as sicker to secure higher payments from the government.
- Sens. Bill Cassidy and Jeff Merkley's bipartisan bill to crack down on the practice has received interest from other lawmakers.
- Any effort would face strong opposition from the insurance industry and the possibility of attack ads.
- After taking heat for Medicaid cuts, changing Medicare could be a bridge too far for vulnerable Republicans.
- Medicare Advantage still could resurface after the midterms, given the billions in savings that could be used to offset other priorities.
