Congress passes telehealth, hospital-at-home in funding bill

Congress completed work on a government funding bill Friday that modestly trims spending, gives President Donald Trump greater flexibility to cut programs and extends expiring healthcare priorities.

In a 54-46 vote, the Senate approved legislation the House passed Tuesday that prevents the partial government shutdown that would have commenced at midnight EDT. Sens. Maggie Hassan (D-N.H.) and Angus King (Maine), an independent who caucuses with Democrats, broke with the minority party to vote in favor and Sen. Rand Paul (Ky.) was the lone Republican to vote nay. Trump intends to sign the bill.

Related: House passes funding bill and health programs but strands doctors

The "continuing resolution," or CR, funds government operations through fiscal 2025, which ends Sept. 30, and extends and finances key healthcare programs for the same duration.

Those include reauthorizing Medicare reimbursements for telehealth and hospital-at-home services, originally authorized during the COVID-19 pandemic; funding community health centers, the National Health Service Corps and the teaching health center graduate medical education program; delaying Medicaid disproportionate share hospital payment cuts for safety-net facilities; extending the Medicare low-volume hospital payment adjustment, the Medicare-dependent hospital program and add-on Medicare payments for ambulance services; and funding for state health insurance assistance programs.

"Today we're trying to finish up last year's work so that we can begin this year's work," Senate Majority Leader John Thune (R-S.D.) said on the Senate floor ahead of the vote Friday. Thune blamed Democrats for not passing the 12 annual appropriations bills last year when they held the majority.

"To be clear, Republicans aren't thrilled about another CR, but it is our best option to make sure that last year's failure by Democrats doesn't interfere with this year's appropriations process," Thune said. Congress has only passed all 12 spending bills on time on four occasions since adopting the current procedure in 1977, most recently in 1997, according to the Pew Research Center.

The bill's passage became assured earlier Friday, when the Senate voted 62-38 to forestall a filibuster and advance to final action after Minority Leader Chuck Schumer (D-N.Y) said he would join Republicans to avoid a shutdown. Nine Democrats and King voted with the Republican majority while Paul opposed his party.

The fiscal 2025 measure notably does not erase a cut to Medicare physician pay rates that took effect in January, though it does renew a boost to the Medicare work geographic practice cost index, which raises pay for doctors in rural areas.

The American Medical Association and other physician groups pressured lawmakers to undo or mitigate the reimbursement cut but were unable to persuade Republican allies to oppose a spending bill without a rate increase. Their next opportunity for relief will come as the congressional GOP continues a partisan effort to assemble legislation that renews expiring tax cuts enacted during Trump's first term and slashes government spending, including up to $880 billion from Medicaid.

Most Democrats opposed the spending bill, arguing it disregards the spending levels lawmakers previously approved. The bill also grants unusual flexibility for the Trump administration to continue its cost-cutting efforts by removing restrictions and instructions on funding included in fiscal 2024 spending bills. It also prohibits Congress from altering Trump's tariffs.

Democrats such as Senate Appropriations Committee ranking member Patty Murray (Wash.) said that Trump and Elon Musk's efforts to cut spending through the White House "Department of Government Efficiency" are already shutting down government services, and that the spending bill will worsen matters.

"The yearlong CR House Republicans sent our way hands a blank check to Elon Musk and Donad Trump to decide how our constituents' taxpayer dollars get spent, all while cutting the funding working people count on each and every day," Murray said on the Senate floor before the vote. "In this case, 'CR' stands for 'complete resignation,' because what Republicans are doing here is ceding more discretion to two billionaires to decide what does and does not get funded in their states. It is a power grab."

Democratic leaders briefly vowed to oppose the funding bill in a bid to force Republicans to negotiate. But Schumer reversed himself Thursday when he announced he would vote to keep the government open. A shutdown, he argued on the Senate floor, would benefit Trump.

"It is the best way to minimize the harm that the Trump administration will do the American people," Schumer said before the vote Friday. "The CR is a bad bill. But as bad as the CR is, I believe allowing Donald Trump to take even much more power via a government shutdown is a far worse option. A shutdown would allow DOGE to shift into overdrive."