Axios Pro: Health Care Policy

September 20, 2023

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Welcome back. Today we have a timely look at how House Republicans' 2024 budget resolution is reviving some conservative health policies just in time for the elections.

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1 big thing: House budget hits Medicaid again

House Budget Committee Chairman Jodey Arrington unveils a proposed budget for FY2024. Photo: Chip Somodevilla/Getty Images

Medicaid work requirements and other conservative health policy goals feature prominently in a 2024 budget blueprint that the House Budget Committee marked up today.

Why it matters: The document may be largely symbolic but could form the basis of a GOP health platform for next year's elections, Victoria reports.

Details: It proposes balancing the federal budget in 10 years while sparing Medicare benefits. But to make the numbers all work, it would implement Medicaid work requirements and per capita caps, roll back Affordable Care Act subsidy expansion and enact site-neutral hospital payment measures.

  • While Budget Committee Chairman Jodey Arrington says he doesn't want to cut Medicare benefits, he's proposing a bipartisan fiscal commission that would look at "drivers of U.S. debt, including entitlement spending such as Social Security and Medicare."
  • That could open the door to a host of provider payment changes that antagonize powerful health interests.
  • The document sets Medicaid work requirements at 80 hours per month, similar to a proposal in Speaker Kevin McCarthy's original debt ceiling bill that fell out in the final deal in the face of Democratic opposition.
  • It also envisions a Medicaid per capita cap for states rather than an open-ended federal match.

Outside of Medicare and Medicaid, the budget resolution calls for rolling back $57 billion of ACA subsidies which were expanded under the Inflation Reduction Act.

  • The resolution has a section devoted to returning to a "patient-centered health care system" with shout-outs to health policies that have already been gaining momentum in the House, including site-neutral payments, PBM reform, transparency for hospitals and insurers and 340B drug pricing reform.

The other side: Despite some bipartisan support for site-neutral measures, Budget Committee Democrats didn't hold back criticism in a report released Tuesday.

  • They predicted provider payment cuts would lead hospitals to pare unprofitable services, which would weigh heaviest on minority and low-income patients.

The intrigue: Arrington on Tuesday acknowledged the perils of reducing spending without touching Medicare benefits.

  • "No party is going to strike that balance on their own. It's just not practical. It's too politically sensitive," he said. "As soon as one party or the other comes out with their grand plan to save Social Security or Medicare, it will be used as a baseball bat against the other."

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