First on the list is the normal appropriations for the rest of fiscal 2025, which starts Oct. 1, and which Congress has only funded until Dec. 20. That includes budgets for the Health and Human Services Department and other agencies. Under previous deals, which don't always hold, legislators had planned modest funding increases.
Next up are the big items that must be addressed. Congressional aides, who spoke on background to discuss still-unformed plans, said while it was hard to predict precisely how everything would turn out, there are several must-do priorities.
Those include erasing the $8 billion in cuts to Medicaid Disproportionate Share Hospital payments, funding community health centers, dealing with a 2.9% reduction in Medicare physician reimbursements next year, and renewing telehealth authorities. All of those were extended& until Dec. 31. under the current budget.
Those are likely to get done, but staffers said there would be some wrangling over the specifics, except in the case of DSH payments. Some of the of physician pay cuts are likely to be mitigated but, as Rep. Dr. Larry Bucshon (R-Ind.) recently predicted, the fix may only be partial, as it was for this year.
'Must-pass' bills
There is near-universal support for community health centers, but House and Senate members disagree over how much the funding should be. There is also virtually unanimous agreement that telehealth authorities first permitted during the COVID-19 pandemic should be extended for five years, but there is a dispute over how to pay for expected costs and whether there should be new restrictions, such as to limit fraud. Hospital-at-home rules are in a similar spot, with a two-year renewal likely.
There is a string of smaller programs lumped into the must-pass category that would likely ride along. Those include opioid abuse programs, graduate medical education, the Medicare Low-Volume Hospital Inpatient Payment Adjustment and Medicare-Dependent Hospitals programs, the National Health Service Corps, teaching health centers for primary care, diabetes programs and some public health preparedness initiatives.
Most of those issues get lumped into a category known in Capitol Hill speak as "extenders."
Then there are scores of health-related bills that have been introduced in committees all over the Hill. Aides said those are harder to predict, since lawmakers on the winning side of elections sometimes wait to advance their bills until their party has control and they may be able to craft legislation more to their liking.
Nevertheless, some measures have stronger chances of making it into a lame duck session, which one aide described as "the last-chance saloon for any bill this Congress."
Leading contenders include measures targeting pharmacy benefit managers, which proliferated in this Congress with strong bipartisan support. Some nearly made it into this year's funding deals. In addition to being popular, most of these bills have the benefit of saving the government money, which becomes highly valuable in closed-door negotiations when legislators are seeking "pay-fors" to finance new spending in other areas.
"The thing that PBM reform has going for it is it has money. That's sort of the golden ticket for getting things passed," one staffer said.
Other bills likely to come up are some of the many disease research bills that have moved forward in one chamber or another, although Congress often unanimously approves those if they don't carry large price tags.
Other more significant bills on deck include several dealing with prior authorizations, Those focusing on Medicare Advantage have garnered the most bipartisan support. In a similar category is so-called site-neutral payments legislation that would limit how much hospitals can charge for outpatient care, which has surfaced in a number of contexts in this Congress, most recently in a bill banning facility fees for telehealth appointments, attached to a telehealth extension as a pay-for.
The next Congress
Beyond that, there are several major areas in which lawmakers would like to advance bills, but less agreement has emerged. That makes it more likely they will get bumped into the 119th Congress, which convenes in January.
Those include overhauling the 340B Drug Discount Program, tightening healthcare cybersecurity standards, beefing up mental health parity requirements for health insurers and devising rules for artificial intelligence in healthcare.
Perhaps last on the list is extending enhanced health insurance exchange tax credits. Democrats made a push last week at a news conference led by Senate Majority Leader Chuck Schumer (D-N.Y.) and introduced the Health Care Affordability Act of 2024.
There has been no Republican support, but Democrats are taking a first stab at what would be a priority in early 2025, well ahead of when insurers announce their 2026 premiums in the summer.
Lead sponsor Sen. Jeanne Shaheen (D-N.H.) at least confirmed there would be a package of bills during the lame duck to which Democrats hope to add the subsidies extension.
"It would be important to bring it up this year because we don't know what's going to be moving next year," Shaheen said. "Hopefully, before the end of this session, after the election, we will see a package of tax extenders, or a tax package that will be included with the budget, and that would be an opportunity to include this," Shaheen said.
