Congress late Thursday approved legislation funding the government through Jan. 19. As they headed out of town for the holiday recess, however, lawmakers left a lot of unfinished healthcare issues on the table. Here's a look at 10 items that will need attention in 2018:
1. Children's Health Insurance Program: No question now that states are in deep trouble over the dwindling or already-dwindled funds in their programs. Some have already warned families that coverage for their kids may end.
The short-term budget patch adds $2.9 billion to CHIP in the hopes it will keep states in good shape through March.
Lawmakers on both sides are frustrated with one another, and have been for months, but still can't come together.
Sen. Orrin Hatch (R-Utah), an original author of the CHIP law, took to the Senate floor Thursday to condemn reports that Republicans have withheld the $15 billion five-year appropriation while happily passing a tax bill that costs about $1.5 trillion.
"No one should doubt my commitment to continuing the CHIP program," Hatch said. "For two decades now, I have been a supporter of CHIP and have worked with members of both parties to keep it moving forward and functioning properly—even in times when my Democratic colleagues have pursued a more divisive approach with the program."
But the divisive rhetoric shows no sign of abating.
Rep. Chris Collins (R-N.Y.), who sits on the House Energy and Commerce Committee that put forward the cost-offsets for the program that Democrats still staunchly oppose, said the House Republicans stand by their bill and won't budge.
2. Medicare extenders: Also once considered an easy must-pass, the programs were lost in the shuffle in the weeks leading up to the final spending deal of the year.
Hospitals with higher than average numbers of Medicare patients are especially dependent on the low-volume adjustment and the Medicare dependent hospital program.
3. Affordable Care Act taxes: House Ways and Means Committee Republicans released a set of bills that would delay the Cadillac tax, the employer mandate, the health insurance tax and the medical device tax.
Committee Democrats haven't come on board yet with the plan, but the panel's Ranking Member Richard Neal, a Massachusetts Democrat, said both sides are still talking about compromises to pay for them.
Ways and Means Chairman Kevin Brady (R-Texas) told reporters this week that he is ready to go with a delay package. With both sides amenable to most of items, it's up to leadership to decide whether to go ahead and pull the plug on them.
4. A continuous coverage provision: As Sen. Susan Collins (R-Maine) pointed out, the elimination of the individual mandate penalty on people who opt out of insurance coverage doesn't go into effect until 2019.
Congress needs to decide on a way to motivate people to buy insurance, provided they are willing to admit this is necessary to promote a healthy risk pool that should offset premiums.
The Trump administration's executive orders on short-duration plans and association health plans are essentially a counter-offer to the exchanges. Many Republicans who are vocal on healthcare want to promote catastrophic and short-term plans that don't offer much coverage. Coherent policy for how insurance should work may be the single most important issue lawmakers have to address before the other big one (see No. 5).
5. Individual market stabilization: Sen. Lamar Alexander (R-Tenn.) told reporters Thursday that House Speaker Paul Ryan (R-Wis.) has signaled House GOP interest in an invisible risk pool idea.
Alexander also said President Donald Trump called him Thursday morning with a supportive message on Alexander's deal with Sen. Patty Murray (D-Wash.) to fund cost-sharing reduction payments.
But House Republicans still don't like CSRs. And since the 2018 individual market will continue on without them, the point may be moot. However, the government is now paying out more in premium tax credits now that CSRs are gone; and the people getting squeezed are the unsubsidized enrollees. So lawmakers will have to work through the issue.
6. Opioid epidemic: The CDC's latest report that more Americans died of drug overdoses in 2016 than in any previous year on record came as Congress passed a continuing budget resolution in which funding for states to deal with the opioid epidemic was conspicuously absent.
Leading senators on both sides of the aisle want to give Trump's public health emergency declaration heft with funding. But so far they haven't agreed to a number.
Sen. Maggie Hassan (D-N.H.) is leading a charge to allocate $45 billion to states ravaged by overdose deaths.
7. Drug pricing: Alexander's Senate HELP committee and the House Energy & Commerce Committee have started to look at drug pricing.
Alexander said policymakers need to look at "anything we can do to create more competition for prescription drugs."
HHS Secretary-designate Alex Azar addressed the competition issue at length in his first Senate confirmation hearing.
Meanwhile, states are forging ahead on their own with pricing transparency measures and a recent Government Accountability Office report showed record pharma profits as consumers see their costs go up. Congress may have to step up their scrutiny this year.
"Higher spending on prescription medicine adds pressure to public healthcare programs, especially high-cost drugs that put even more pressure on healthcare spending," Sen. Chuck Grassley (R-Iowa) said in a statement Thursday.
8. Medicaid expansion: Virginia's election results and Maine's voter referendum once again brought Medicaid expansion to the fore. The 2017 health overhaul proposals would have halted expansion, but their failure—and the potential for more red states to go blue in 2018—may force congressional Republicans to deal with a future where it's here to stay.
While talk about block-granting Medicaid through capped, per-person payments has by no means gone away, the shape of the Medicaid debate may need to change and lawmakers should be ready for this.
9. Electronic health records: Alexander and his committee want to target the current EHR system that he calls a mess and "too burdensome for doctors."
Alexander has promised bipartisan meetings with Azar to discuss new processes. While it is a smaller issue among the big ones, providers are focused on it and lawmakers are listening.
10. Healthcare costs: The elephant in the room is the cost of care, Alexander said. He wants to address the issue through policies promoting wellness.
"We've been stuck arguing about 6% of the health insurance market while we really should be discussing healthcare costs," he said.
How this will translate into policy is yet to be seen.
And overshadowing these issues is the specter of Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) reviving their legislation to reallocate all federal ACA and Medicaid funding through a block-grant program -- even as Senate GOP leadership, including Senate Majority Leader Mitch McConnell (R-Ky.), insist that a comprehensive effort to repeal the rest of the ACA is over.
"I'm fully committed to repealing and replacing Obamacare in 2018 by block-granting the money back to the states and away from Washington bureaucrats who are completely unaccountable to the patients of America," Graham said Thursday in a rare public rebuke of McConnell."To be successful we will need presidential leadership with the same passion to replace Obamacare as President Obama demonstrated in passing Obamacare."
