December 4, 2024

Congress must pass a stopgap Continuing Budget Resolution (CBR) by year’s end to keep the federal government ‘open’ past December 31, 2024. Given the time crunch (of course it is now commonplace for Congress to take this down to the wire every year after failing to pass a new fiscal year budget) we could once again be left with a spending plan that freezes spending at current levels) until something changes. Here’s a look at the fight that is materializing on the Hill.

Republicans send Democrats a year-end health care offer
Lobbyists expect the GOP’s plan will be a hard sell.

By Ben Leonard, David Lim | 12/04/2024 02:18 PM EST

Senate Finance Chair Ron Wyden wants to see pharmacy benefit managers overhauled. | Mariam Zuhaib/AP
Lawmakers on Capitol Hill are weighing attaching a health care package to a stopgap end-of-year government funding bill, according to five lobbyists granted anonymity to discuss the ongoing talks.

Republicans sent a proposal Tuesday to Democrats that, if they agree, could be attached to a three-month continuing resolution that would keep the government funded until late March.

The GOP has leverage in the talks because Republicans are set to gain control of the White House and Senate to go with their current House majority next year, giving them greater power to shape funding legislation.

But Republicans are weighing their advantage against their desire to move quickly in 2025 on President-elect Donald Trump’s agenda. Enacting a year-end package this month could pave the way for that agenda.

The health care proposal includes a three-year extension of rules that would allow Medicare to cover telehealth for all patients and permit hospital care in patients’ homes. It includes one year of extensions for expiring Medicare and Medicaid programs, a 2.5 percent bump to doctor Medicare payments for 2025, a Medicare cancer screening bill, full reauthorizations of the opioid-fighting SUPPORT Act and the Pandemic and All-Hazards Preparedness Act and a handful of bipartisan Medicaid policies.

The package would also provide flat funding for federally qualified health centers and extend expanded telehealth coverage for high-deductible health plans that’s set to expire at the end of the year.

Republicans propose to pay for it by repealing a Biden-era rule to increase nursing home staffing, a move they had already planned for next year. The repeal could save tens of billions of dollars, according to the Congressional Budget Office, the nonpartisan scorekeeper on the financial effects of legislation, likely because it would reduce Medicare and Medicaid costs.

It’s unclear whether the proposed pay-fors would cover the costs of the Republicans’ priorities.

The GOP offer also would boost transparency around the business practices of pharmacy benefit managers, the middlemen who negotiate drug prices for insurers and employers, and includes provisions “delinking” the payments PBMs get from the list price of drugs. That would apply to Medicare but not the private market.

The GOP proposal also includes a policy from the House-passed Lower Costs, More Transparency Act that would require a unique national provider identifier for Medicare hospital claims to make clear where care is being delivered.

All that could still be difficult for Democrats to stomach, especially on a short timeline. One person granted anonymity to discuss the negotiations told POLITICO that Republicans gave Democrats a Friday deadline.

“Both sides are still pretty far apart,” one of the lobbyists said. “Flat funding for [community health centers] will be a nonstarter for Dems.”

Senate Finance Committee Chair Ron Wyden (D-Ore.) said he is familiar with the idea of using the nursing home rule to pay for the package and pushed PBM legislation.

“Rumors are like tailbones, everybody’s got one,” Wyden said of the contents of the health care package. “We feel very strongly: If you want to be serious about health care costs, you’ve got to go after middlemen.”

Lawmakers are making a significant push to overhaul PBMs by the end of this Congress to clear the way for Trump’s agenda.

“This is an issue that we need to resolve,” said Sen. James Lankford (R-Okla.). “We don’t need to tell rural pharmacies and patients to wait another two years and maybe we’ll get into it in the next session.”

But Rep. Buddy Carter (R-Ga.), a pharmacist before he came to Congress, acknowledged that PBM legislation could get stymied by other issues.

“That’s a problem that we have in Congress,” Carter said. “We need to make reform one bite at a time.”