Trump-backed funding bill fails with health measures in limbo

Congressional Republican leaders failed to advance a slimmed down year-end funding bill endorsed by President-elect Donald Trump after they scrapped a larger package he opposed that included major bipartisan healthcare legislation.

The Trump-favored bill dropped major provisions imposing new restrictions on pharmacy benefit managers, partially reversing Medicare reimbursement cuts for doctors, and extending Medicare telehealth authorities. It failed in a hastily called vote in the GOP-led House Thursday night.

Related: Telehealth and doctors win, PBMs lose as government funding deal nears

Government funding expires when the clock strikes midnight on Saturday.

House Speaker Mike Johnson (R-La.) unveiled the larger package just two days ago. It all fell apart Wednesday after billionaire Trump adviser Elon Musk began attacking the agreement on his social media platform X, culminating in Trump himself opposing the measure.

On Thursday, Trump backed the skinny bill on his own platform, Truth Social, and urged swift action.

"Speaker Mike Johnson and the House have come to a very good deal for the American people," Trump wrote.

The legislation fell on a 174-235 vote. Thirty-eight Republicans voted to kill the measure while two Democrats voted yes and another voted present. The bill reached the floor under fast-track rules that required a two-thirds majority to pass.

After the unsuccessful vote on the smaller bill, it was not immediately clear what the path forward would be.

If Congress cannot advance that measure, the previously agreed bill or some other short-term alternative, the government would shut down just four days before Christmas.

Senate Majority Leader Chuck Schumer (D-N.Y.) issued a brief statement after the House vote advising the House Republican leaders to revert to the original agreement.

“It’s a good thing the bill failed in the House," Schumer said. "Now it’s time to go back to the bipartisan agreement we came to.”

If the Republicans' new version of the bill is used as a new starting point, the original two-year extension of Medicare reimbursements for telehealth services and a 5-year extension of the Medicare hospital-at-home program would be scrapped and extensions would last only until March 31.

The GOP's newer measure would have also renewed several healthcare programs, including funding for community health centers, until March 31. Special reimbursements for low-volume hospitals and Medicare-dependent hospitals would have extended to April 1.

Physicians, hospitals and accountable care organizations were among the losers under the GOP bill.

The deal Johnson struck with Democrats would have mitigated the reimbursement cut facing doctors in 13 days. The legislation also would have canceled $8 billion in cuts to Medicaid disproportionate share payments for safety-net hospitals and extended bonus Medicare reimbursements for ACOs.

The newer package included one large, new ask Trump made: a suspension of the nation's debt limit into 2027.

A shutdown would set off a cascade of uncertainty, but major healthcare programs such as Medicare and Medicaid would continue to operate because they are financed with mandatory spending not subject to congressional appropriations. However, disruptions could arise if the impasse were to linger.

Democrats declined to help Johnson smooth things over with Trump and his allies. "Democrats are opposed to this legislation because you're trying to jam working-class Americans again," House Minority Leader Hakeem Jeffries (D-N.Y.) said on the House floor prior to the vote.

"We negotiated in a bipartisan, bicameral way real progress for working-class Americans, for middle-class Americans, for everyday Americans who aspire to be part of the middle class. That has been cut out of this legislation," Jeffries said. "Why would you do that? Why would you eliminate funding for community health centers? That impacts the heartland of America."