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Spending debate tees up potential lame-duck health bill

Newly set December deadline for health priorities gives lawmakers another opportunity to take on big-ticket health policy priorities

The coming retirement of House Energy and Commerce Committee Chair Cathy McMorris Rodgers, R-Wash., is among the factors that could impact the future of health policy priorities during a lame duck session.
The coming retirement of House Energy and Commerce Committee Chair Cathy McMorris Rodgers, R-Wash., is among the factors that could impact the future of health policy priorities during a lame duck session. (Bill Clark/CQ Roll Call file photo)

A collection of year-end health policy deadlines are increasing the chances that Congress will face another must-pass bill come December, after lawmakers punted a number of bipartisan health riders from the most recent spending package.

Lawmakers are looking to extend a number of health reauthorizations beyond the fiscal year that ends Sept. 30 as part of a six-bill fiscal 2024 appropriations package on deck this week. But other major policies were dropped amid ongoing disputes.

While the bulk of the spending bill expires Sept. 30, the health reauthorizations, which include critical funding for community health centers, would run through the end of December.

But the Dec. 31 cliff also gives lawmakers another swing at big-ticket overhauls on health industry transparency, pharmacy benefit managers and a pandemic response reauthorization that weren’t agreed upon in time for the current bill. 

The upcoming Labor-HHS-Education funding bill that faces a March 22 deadline is the next closest target for the remaining health priorities. But there has been little outward progress in resolving the disputes. 

Lawmakers are also exhausting the Medicare and Medicaid Improvement Funds to offset the batch of extenders included in the spending package being considered this week, which means they’ll likely need the savings from some of the more controversial items in December. That includes parity in Medicare drug administration payments between hospital outpatient departments and independent physicians, or “site-neutral” payments.

“By draining each fund down to $0 lawmakers have ensured they will have no easy offsets available to pay for the panoply of reforms and fixes that must be addressed at year-end,” Veda Partners Healthcare Policy Research Director Spencer Perlman wrote in an investor report. “Thus, we think that lawmakers must incorporate both PBM reforms and site neutral adjustments into whatever legislative package emerges at year-end.”

The House passed the six-bill package Wednesday on a 339-85 vote. The package included funding for the Food and Drug Administration, Department of Veterans Affairs and the Indian Health Service. The Senate is expected to take it up in the coming days.

Any lame-duck health measure would also likely have to address the expiration of pandemic-era telehealth flexibilities under Medicare at the end of the year. Advocates have pushed Congress to make them permanent.

“You can literally see that next bill starting to come together,” said Rodney Whitlock, vice president of McDermott+Consulting and a former GOP Senate Finance Committee aide.

But a number of factors could impact the lame-duck session, including the coming retirement of Energy and Commerce Chair Cathy McMorris Rodgers, R-Wash., the rematch between President Joe Biden and former President Donald Trump and whether the majority flips in the House or Senate.

“That chaos could be severe,” Whitlock said.

Senate Health, Education, Labor and Pensions Chairman Bernie Sanders, I-Vt., said Tuesday that discussions were still happening, but declined to speculate on when a deal might come together. 

Rodgers also said she was still pushing to get price transparency into the Labor-HHS spending bill.

“Nothing is over till it’s over,” she said.

But Energy and Commerce Health Subcommittee Chair Brett Guthrie, R-Ky., predicted the provisions are more likely to pass separately from the upcoming spending package, though he said he hoped it would be sooner than the lame duck. “There’s still time,” he said Tuesday. “But my guess is probably a separate bill.”

Calls for action

Lobbyists, advocates and academics are already calling on Congress to address the policies left on the cutting-room floor. 

One major to-do item is the broader reauthorization of a pandemic and emergency response law, which supports programs within the Administration for Strategic Preparedness and Response and the Biomedical Advanced Research and Development Authority.

Seven smaller pandemic-related provisions were included in the six-bill spending package, but that’s hardly sufficient after the “tragic and searing experience” of COVID-19, argued Johns Hopkins Center for Health Security Director and former Biden administration COVID-19 testing czar Tom Inglesby.

Various bills in the House and Senate include new policies, like contracting and staffing authorities for ASPR, improved screening around gene synthesis and funding research into treatments for potential pandemic pathogens. A straight reauthorization is not enough, Inglesby argued.

“We should also be moving in new directions based on what we learned from COVID,” he said. 

Unlike most policy disputes in Congress, the bills in question are largely bipartisan. But a series of smaller disagreements is pitting the House against the Senate, Democrats against Republicans and members of the same party against each other.

“Members from both sides of the aisle have previously championed and worked in bipartisan fashion on policies to improve price transparency and end payment and pricing abuses that lead to unaffordable and inequitable health care,” Families USA Interim Executive Director Yael Lehmann said in a statement. “We urge Congress to rise above partisan politics and build on this momentum to get the job done for families now.”

Senate Finance Chair Ron Wyden, D-Ore., nodded to the likely lame-duck time frame in a statement issued after the first six spending bills were unveiled without the additional rider language. But on Tuesday he kept up the drumbeat to overhaul PBM tactics as soon as possible.

“The last time I looked, the lame duck was a long way away,” he said. “So why not pull out all the stops to do it now and respond to people’s concerns, understandably, about middlemen in American health care?”  

The spelling of Tom Inglesby’s name was corrected in this report.

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