Healthcare Provisions in Congress’s Latest Spending Package: What’s in, What’s out

The initial email I saw this morning when I got on my computer welcomed me back with a headline that read simply, “happy shutdown week!”

If you’ve been tracking Congress recently, you likely know that over the weekend the House Speaker published a proposed funding bill — known as a continuing resolution, or CR, which has been blessed by President Trump. The proposal would fund the federal government through the end of the current fiscal year, and push Congress’s next funding deadline to Sept. 30.

A vote in the House to consider the bill is also tentatively scheduled for this week.

This comes as federal government operations are funded through this Friday, at which point the government would technically shut down, without some sort of funding extension. Indications suggest that House Republicans likely have sufficient votes to advance this current measure without Democrat support.

With much uncertainty over the past several weeks surrounding which healthcare-related provisions would make it into Congress’s next large spending bill, here’s a quick update on some of the key provisions that made it, and a few that didn’t.

Broadly, the CR extends funding for community health centers, the National Health Service Corps, teaching health centers that operate graduate medical education (GME) programs, special diabetes programs, and national health-related security provisions.

Under the Medicare program, the CR extends the following:

1. Increased inpatient hospital payment adjustments;
2. The Medicare-dependent hospital program;
3. Add-on payments for ambulance services; and
4. Financing for quality measure endorsement, input, and selection.

The bill also extends Medicare telehealth flexibilities – for example, removal of geographic requirements and expansion of originating sites for telehealth services and allowing for the furnishing of audio-only telehealth services.

This should delight healthcare organizations across the country, over 300 of which recently sent a letter to congressional leaders urging them to extend the flexibilities permanently.

However, the CR does not include a highly touted Medicare pay bump for doctors, who have been operating under a 2.8-percent reimbursement reduction since January.

This is a major blow to providers, as prior drafts of a shorter stopgap funding measure contained a physician reimbursement increase that the Trump Administration assured industry leaders would be included in any funding package.

Physician groups maintain that leaving the cuts as is will cause patients to struggle accessing care and cause doctors to close or sell private practices, while others opt to leave the profession.

Under Medicaid, the bill delays Disproportionate Share Hospital, or DSH, payment reductions, eliminating them in the 2025 fiscal year (FY) and providing for reductions in FY 2028.

This appears to be a big win for Democrats who, in recent weeks, have strongly opposed the idea of “slashing” the Medicaid program as a way to generate cost savings. In fact, just a few weeks ago, the House passed a budget blueprint that would have tasked a House Committee with finding at least $880 billion in cuts from the programs it oversees – namely, Medicare and Medicaid.

Deep Medicaid cuts have been criticized of late for their potential to bring about significant negative impacts on states and enrollees, mainly in terms of inflating spending gaps and pushing beneficiaries off the rolls entirely, triggering expanded uninsurance rates. These cuts may also create potential political problems for members of Congress who represent large numbers of enrollees back home.

Even with a couple perceived wins for Democrats built in, the Speaker’s CR is said to be “wholly unimpressive” for swing-state Dems, who oppose the bill’s increased funding for deportations and the military.

So, stay tuned during this crucial shutdown week, because lawmakers must fund the government or risk it shutting down – something political news outlets warn is the last thing the U.S. economy needs right now.

The healthcare industry will be affected, so make sure you know how and in what ways.

Reference Material

1. Major Medicaid cuts are looming. Here’s a look at the impacts
2. POLITICO Playbook – POLITICO
3. Biden signs funding bill extending telehealth flexibilities, but no relief for doctors — or PBM reform | Healthcare Dive
4. Republicans once maligned Medicaid. Now some see a program too big to touch | AP News
5. CR text