Congress votes to keep government open, abandons health package

Modern Healthcare – Friday, December 20, 2024
By Michael McAuliff 

Congress overcame two failures in the House and advanced a last-minute measure to keep government funded into next year on Saturday, but abandoned a set of ambitious health policies promised just days ago.

The bill that debuted on the eve of a federal shutdown after a week of turmoil will have limited effects on the healthcare system. The health provisions mostly consist of short-term delays of Medicare and Medicaid payment cuts set to kick in Jan. 1 and brief extensions of several programs. President Joe Biden endorsed the measure.

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

Telehealth and hospital-at-home providers will remain eligible for Medicare reimbursement until March 31 under the bill. Those authorities would have extended for two years and five years, respectively, under the bipartisan deal House Speaker Mike Johnson (R-La.) announced Tuesday but scrapped after President-elect Donald Trump came out against it.

The new measure will postpone scheduled cuts to Medicaid disproportionate share payments for safety-net hospitals and extend special Medicare reimbursements for low-volume hospitals and Medicare-dependent hospitals until April 1. It sustains funding for community health centers and pandemic preparedness programs until March 31.

The House passed the bill 366-34 on Friday, with 34 Republicans voting nay and Rep. Jasmine Crockett (D-Texas) voting “present.” The Senate followed after midnight and approved the legislation on a 85-11 vote, with 10 Republicans and Sen. Bernie Sanders (I-Vt.) in opposition.

By slipping into Saturday, Congress technically permitted a fleeting shutdown. The bill funds federal operations until March 14.

“This was a necessary step to bridge the gap to put us in that moment where we can put our fingerprints on the final decisions on spending in 2025,” Johnson said after the vote. Republicans will control the White House, House and Senate next year, but Democrats still have a majority in the upper chamber for the time being.

“This is a good bill and I’m glad we’re passing it,” Senate Majority Leader Chuck Schumer (D-N.Y.) said ahead of the vote.

All of the health provisions would have been in force for all of 2025, at least, under the original bill. That now-dead legislation would have imposed significant new regulations on pharmacy benefit managers.

Also absent from the final bill is relief for physicians, who face a 2.9% cut to their Medicare reimbursements on Jan. 1, and an extension of Medicare bonus payments for accountable care organizations.

Johnson gave up on the legislation containing the healthcare package after Trump’s rejection provoked a revolt among House Republicans and anger among congressional Democrats who negotiated the agreement.

The speaker’s bid for a smaller bill Trump supported failed Thursday, in part because it would have raised the national debt ceiling, which Democrats viewed as a first step in Trump’s plans to cut taxes next year.

The third effort, which does not address the debt ceiling but is otherwise almost the same, is good enough for the White House.

“President Biden supports moving this legislation forward and ensuring that the vital services the government provides for hardworking Americans — from issuing Social Security checks to processing benefits for veterans — can continue, as well as to grant assistance for communities that were impacted by devastating hurricanes,” press secretary Karine Jean-Pierre said in a news release Friday.

Lawmakers who had worked on the abandoned healthcare provisions expressed dissatisfaction.

House Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) said Republicans complained that the bipartisan bill was 1,500 pages long, but said those pages contained many things they and their constituents wanted.

“They reduced the health for the American people,” Pallone said on the House floor before the vote. “That’s what the Republicans have done.”

Some House Republicans are eager to pick some of the healthcare policies back up when Congress reconvenes in January.

“Obviously disappointed that we’re not there on healthcare,” said Rep. Brett Guthrie (R-Ky.), who will chair the Energy and Commerce Committee next year. Guthrie specifically cited PBM and healthcare transparency legislation he supported as agenda items for 2025.

The PBM elements of the bipartisan bill should be revived as soon as possible, said Rep. Rick Allen (R-Ga.), a member of the Energy and Commerce Committee. “It’s going to be done very quickly,” he said.

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