Members of Congress headed home for the summer over the weekend, leaving the healthcare community in an all-too-familiar position: Wondering how key priorities will turn out after lawmakers failed to address them in the first part off the year.
At the top of the list is money, with billions of dollars in cuts to physician pay and safety net hospitals funding set to begin in January, as well as appropriations for expiring programs such as community health centers.
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Close behind are several major legislative efforts that lawmakers have tried to advance for more than a year.
Congress has not completed its work on bills that would impose restrictions on pharmacy benefit managers, mandate transparency in multiple realms of healthcare, enact site-neutral payments for certain outpatient services, regulate artificial intelligence and cybersecurity, overhaul the 340B drug discount program, and extend COVID-19 pandemic-era authorizations for telehealth and hospital-at-home care.
With Congress not scheduled to reconvene until Sept. 9, when, how and whether these various pieces of unfinished business will move forward are open questions.
While funding measures are all but certain to reach President Joe Biden eventually, the timing became exceptionally unclear in July.
Two week ago, the majority-GOP House quit work on appropriations and left town because Republicans were unable to agree on their own bills. And while the Democrat-led Senate finally began moving its 12 spending bills through committee, the upper chamber recessed Thursday before getting anywhere close to starting difficult bicameral negotiations.
And there won't be much time left before government funding expires at the end of September, just three weeks after lawmakers return to Washington.
Campaign season
What Congress normally does when time runs short is pass what's known as a continuing resolution, or CR, to keep the government open. Members have begun talking about resorting to a CR, but even that fallback plan is complicated by the looming election.
Before Biden abandoned his reelection bid last month, some Republicans — feeling confident about winning Congress and former President Donald Trump reclaiming the White House — had floated the idea of a longer-term bill that would last until after a new Congress and president take office in January.
With the shift in political winds caused by Biden's withdrawal and Vice President Kamala Harris' ascension to presumptive Democratic presidential nominee, both parties seem more in the mood to wait and see.
Sen. Dr. Bill Cassidy (R-La.), who would likely chair the Health, Education, Labor and Pensions Committee if the GOP takes the upper chamber, acknowledged last week that work on several bills he supports is unlikely to be finished before Election Day on Nov. 5.
"If you look at our number of legislative days between now and the election, and we've still got to do [the National Defense Authorization Act], just as an example, and that'll take some time. I can imagine it being difficult to get all that done before the election," Cassidy said.
Senate Majority Leader Chuck Schumer (D-N.Y.) offered no clues on when the spending bills would advance. "As for the timing, let's wait for the negotiations to occur," he said at a news conference Thursday.
There is some good news for the healthcare sector, in that key funding issues that lingered over multiple stopgap bills for this year were extended from the end of the fiscal year on Sept. 30 until Dec. 31.
The big-ticket items that need to be addressed before the end of the year are:
- Halting an $8 billion reduction in Medicaid disproportionate share hospital payments to safety-net facilities.
- Addressing a 2.9% cut in Medicare physicians reimbursements.
- Reauthorizing and funding community health centers.
- Extending telehealth and hospital-at-home authorities for five years.
- Extending Medicare programs that support rural providers, such as low-volume hospital and Medicare-dependent hospital payment add-ons and geographic adjustments to Medicare pay for doctors.
PBMs and more
Besides simply keeping the dollars flowing, Congress has also been debating legislation to address several large issues. While many bills enjoy bipartisan support in both chambers, their fate is even more uncertain than the appropriations measures'.
Perhaps the highest-profile example is legislation to tackle PBMs and drug costs.
House and Senate committees have advanced a slew of bipartisan bills that would govern PBM transparency and pricing practices, with the Lower Costs, More Transparency Act of 2023 even overwhelmingly passing the House in December. Yet repeated attempts last year and this year to send these bills to Biden failed.
Other high-profile areas where broad agreement hasn't translated into passage include reining in prior authorizations under Medicare Advantage, instituting site-neutral payments for outpatient care and approving privacy legislation that is seen as the first step to regulating artificial intelligence in healthcare.
Congressional aides said on background that these priorities are likely to land in a healthcare package alongside must-pass funding measures during a lame duck session after the elections.
But that was also the plan a the end of 2023, and even bipartisan, bicameral support for some of these matters wasn't enough to make that happen.
Asked whether a 340B bill might find room in a broad year-end bill, Sen. Jerry Moran (R-Kan.) chuckled and said, "I've been waiting on a healthcare package for a while now."
One lobbyist who spoke of background to offer a frank opinion on the fate of PBM legislation figuratively threw up their hands: "Do I see a path forward? I mean, who the heck knows what's gonna happen at the end of the year?"
