Congress is poised to get a lot less done on healthcare this year than it seemed only weeks ago.
Lawmakers are eyeing a significantly narrower package of healthcare legislation in the coming weeks that would jettison major bipartisan proposals such as stricter regulation of pharmacy benefit managers and a site-neutral Medicare payment policy, according to Capitol Hill and K Street sources.
Related: Congress eyes endgame for PBM legislation
Instead, Congress may consider a "skinny" healthcare bill that would address a Medicare cut to physician payments, delay $16 billion in reductions to Medicaid disproportionate share hospital payments for safety-net facilities and fund federally qualified health centers. That measure would ride along with broader government spending legislation Congress may consider this week.
Despite broad-based, bipartisan support in general, lawmakers negotiating the health package failed to come to agreement on specifics and tanked sought-after initiatives, said multiple sources who spoke on condition of anonymity to discuss non-public information.
Four sources summed up the situation the same way: "It's a mess." Some added expletives.
Congress more or less must reveal its plans this week with two potential partial government shutdowns on the horizon.
By Friday, lawmakers will need to approve funding for four of its 12 appropriations bills, including money for veterans' health programs and the Food and Drug Administration. By March 8, they must agree on legislation to fund the rest of the government, including the Health and Human Services Department except for the FDA.
Some popular health measures could be included in those measures as so-called "extenders," including funding for graduate medical education, the National Health Service Corps, special diabetes programs and a slew of smaller programs.
PBM legislation
A major casualty, though, appears to be long-sought actions aimed at pharmacy benefit managers, which Democrats and Republicans alike pitched as key to reducing prescription drug prices.
Numerous bills targeting PBMs cleared House and Senate committees with strong bipartisan support during the current Congress, and one overwhelmingly passed the House. But those measures differ in the parts of the market they target and in the specific new restrictions they envision.
Most sought increased transparency and would limit how PBMs could compensate themselves. The House-passed Lower Costs More Transparency Act of 2023 focused on PBM interactions with Medicare and Medicaid. A bill the Senate Health, Education, Labor and Pensions Committee approved targeted the broader market.
Also seemingly dead is a House-passed site-neutrality measure to bar hospitals from charging the same for injections at outpatient locations as they do in inpatient settings. The measure was expected to save taxpayers—and cost hospitals—$4 billion.
Also on the cutting room floor are an extension of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018, also known as the SUPPORT Act, to counter the opioid crisis and Senate Finance Committee efforts to crack down on "ghost networks" for Medicare Advantage plans that list providers who are not actually in-network.
The failure to craft a larger package doesn't have a single cause, sources said, but negotiators on both sides of the aisle and both chambers of Congress have been unable to bridge disagreements on details. The broader turmoil around government funding further complicated talks.
As of Monday, it seemed unlikely the larger measures would be revived soon. Still, some sources suggested talks would continue, regardless of how the current spending debate plays out, and that Congress may revisit these healthcare priorities during a lame duck session following the November elections.
