UPDATED 11:55 a.m. ET Dec. 23
Winners and losers of CR bill
The continuing resolution will surely feel like an abject disappointment to many in healthcare.
Only telehealth extension advocates may feel a sense of relief over what provisions were included, and even then, they didn't receive all they bargained for once the ink settled. The funding bill extended Medicare telehealth flexibilities and CMS' acute hospital at home program for 90 days, instead of two years. Other provisions, like first dollar coverage of HDHP-HSAs, in-home cardiology rehab facilities, virtual diabetes program suppliers in the Medicare Diabetes Prevention Program and the SPEAK Act for telehealth flexibilities were not included in the CR at all, prompting the American Telemedicine Association (ATA) to call the legislation "far from an ideal outcome."
"Together, with future actions to come, we are on the brink of achieving landmark victories for patients, the healthcare system, and the future of care delivery," said Kyle Zebley, senior vice president of public policy at the ATA, in a statement.
Families USA Executive Director Anthony Wright said the bill was a "lump of coal" to Americans as Congress chose to cave to billionaires and special interests. Before the world's richest person, Elon Musk, posted in opposition to the CR due the size of the bill, it seemed the original legislation would pass with bipartisan support, which would've included a fuller healthcare package. That larger package included provisions to reduce most of a CMS-imposed pay cut to doctors, reform pharmacy benefit managers (PBMs), change drug patent practices and institute long-term funding of community health centers.
Some entrenched industry interests, like major PBMs, likely felt relieved over provisions that weren't included. The National Community Pharmacists Association called on the next Congress to take up PBM reform quickly.
"We encourage them to pass the health provisions as a standalone bill, so they don’t get buried under another mountain of spending provisions that can’t pass," said CEO Douglas Hoey. "They should do this as soon as possible in 2025. More small pharmacies will close, pharmacy deserts will grow, drug prices will continue to spiral upward, and more patients will lose access to the prescriptions their doctor prescribed and to their most accessible health care provider, the local pharmacist.”
Elsewhere, the American Medical Association lambasted Congress on doc pay. Physicians hoped to reverse a 2.83% payment cut to doctors at a time when the cost of delivering care, they say, has risen 3.5%. The original bill would have reversed the cut by 2.5%, still allowing for a marginal cut to doc pay.
"For the fifth consecutive year, Congress has adjourned and allowed Medicare cuts," scolded Bruce Scott, M.D., president of the AMA. "What will be the result? Patients struggling to access health care. With this new cut going into effect next year, Medicare payment rates have fallen by 33% over the past two decades, when adjusted for the costs of running a practice, leaving physicians struggling to figure out how they can continue to provide needed care to their elderly and chronically ill patients."
"Lawmakers are playing a dangerous game that will ultimately hurt patient access to physicians who can no longer deal with the chaos caused by congressional inaction to fix a reimbursement system that continues to destabilize the Medicare program," said Anders Gilberg, senior vice president of government affairs for MGMA. "Heading into the 119th Congress, while retroactively addressing the 2.83% cut to the conversion factor is of utmost importance, permanent reform to the Medicare payment system is needed to sustainably support medical groups and their ability to provide timely access to Medicare patients.”
The bill also did not include electronic prior auth standards that was broadly supported by all sectors, even some insurers, in healthcare, nor did it include provisions to prevent future pandemics and address the opioid crisis. The Senate did separately pass a cancer research bill that was included in the original bill, though other cancer-related provisions were left out.
Hospitals will be happy the bill, at the eleventh hour, eliminated disproportionate share hospital cuts set to go into effect.
UPDATED 8:00 a.m. ET Dec. 21
Government avoids shutdown
The Senate passed Mike Johnson's government funding bill just after midnight on Friday to avoid a government shutdown. The legislation funds the government through March 14, 2025 and extends expiring healthcare programs until March 31.
Medicare beneficiaries now face an April 1 cliff for telehealth services. A two-year telehealth extension was supported on a bipartisan and bicameral basis before the original funding deal was quashed by Elon Musk and President-elect Donald Trump on Wednesday.
Congressional staffers who worked on the healthcare deal said before the Trump-backed fiasco that Congress would not let telehealth flexibilities expire. Lawmakers will have to come together again before the end of March to give healthcare programs more runway.
The deadline for health programs is not tied to the government funding deadline, which gives lawmakers an additional two weeks to negotiate how to extend critical programs while offsetting the price tag with cost-saving reforms.
Pharmacy benefit manager (PBM) reform was a lynchpin offset in the original healthcare deal. PBM reform did not make it into the end-of-year package, but the proposals are likely to resurface when lawmakers negotiate offsets next year.
UPDATED 7:00 p.m. Dec. 20
House passes CR
The House passed a continuing resolution to fund the government on Friday night to avert a midnight shutdown. The funding bill extended Medicare telehealth flexibilities and CMS' acute hospital at home program for 90 days, through March 31, 2025.
The vote passed the House 366-34-1. All Democrats supported the bill, which pushed the Republican-drafted funding patch over the finish line.
The funding package will now move on to the Senate. Funding for the federal government runs out at midnight.
A broader healthcare package was axed earlier in the week, when President-elect Donald Trump and his allies voiced opposition to the large Christmas tree funding package.
The original healthcare deal included a two-year extension of Medicare telehealth flexibilities, a five-year hospital at home extension and pharmacy benefit manager reforms like a ban on spread pricing in Medicaid, delinking PBM compensation from Part D rebate size and mandating a 100% pass-through rate of rebates to sponsors.
UPDATED 8:25 a.m. ET, Dec. 20
House vote fails
The continuing resolution to fund the government failed a House vote, 235 to 174 on Thursday night. The government runs out of funding Friday, Dec. 20 at midnight.
President-elect Donald Trump encouraged a government shutdown in a post on Truth Social Friday morning. In another post, he pressed Republicans to extend the debt limit until 2029.
"If there is going to be a shutdown of government, let it begin now, under the Biden Administration, not after January 20th, under “TRUMP.” This is a Biden problem to solve, but if Republicans can help solve it, they will!" Trump wrote.
UPDATED 4:30 p.m. ET, Dec. 19
Trump-approved CR cuts healthcare package
House Speaker Mike Johnson has devised a new end-of-year government funding deal that rips apart a healthcare package that would have extended Medicare telehealth provisions for two years and mandated reforms for pharmacy benefit managers.
That deal is dead, a lobbyist told Fierce Healthcare. In its place is a package that cuts out PBM reform and only extends Medicare telehealth flexibilities and hospital at home waivers until March 31, 2025. The government will only be funded through Mar. 14.
PBM reform is not included in the new continuing resolution (C.R.), which is sure to be a massive disappointment for lawmakers close to the issue and reform advocates. There is also no mention of the 2.5% physician pay bump, an $8 billion cut to Medicaid disproportionate share hospital funding for safety net hospitals, drug patent reform, cancer research funding or opioid crisis and pandemic prevention reauthorizations that was included yesterday.
Some of these priorities will likely be revisited in the future, but there is no guarantee they will garner enough support to be enacted into law.
The new C.R. also nixes other telehealth wins like extending first-dollar coverage of telehealth for some high deductible health plans and Medicare coverage of virtual only diabetes prevention programs.
President-elect Trump denounced the first funding deal that Johnson put together as too big and costly. Trump and Vice President-elect JD Vance pressured Republicans to address the debt limit in the end of the year funding deal, which runs out in June.
Johnson went back to the drawing board on Wednesday night. Within 24 hours of Trump's public criticism, Johnson had a new C.R., which extends the debt limit through 2027. Trump approves of the new 'clean' C.R. to fund the government, he wrote in a post on Truth Social.
He said the agreement between Speaker Mike Johnson and the House is a "very good deal" and provides funding for disaster relief and farmers. The bill suspends the debt ceiling until January 2027.
Some provisions did not get scrapped. They include extensions for community health centers, the Medicare-dependent hospital program and special diabetes programs.
The House is expected to vote tonight under suspension of the rules. Democrats are urged by Trump to support the bill, but it's unclear if they will.
UPDATED 10:00 a.m. ET, Dec. 19
Trump's new CR demands
Telehealth advocates are gathering Thursday morning to discuss a plan to ensure Medicare telehealth flexibilities are extended in the end-of-year legislative package that is splitting at the seams.
A substantial healthcare package was set to pass along with the continuing resolution (C.R.) that needs to be passed to keep the government open beyond December 20. The package included a multitude of healthcare bills that did not get passed earlier this Congress, including pharmacy benefit manager reform and extension of pandemic-era telehealth flexibilities.
In the chaos that unfolded Wednesday, Elon Musk, president-elect Donald Trump and vice president-elect J.D. Vance began to pressure Republicans to cease support for the funding deal House Speaker Mike Johnson reached on Tuesday night.
President-elect Trump implied Congressional Republicans would have trouble getting re-elected if they voted for Johnson's continuing resolution (C.R.) saying they would be "primaried."
In the post, Trump implores Congress to address the debt limit in the end-of-year funding package. Trump decried the possibility of passing a clean continuing resolution, which would nix Democratic priorities, without raising the debt limit.
"Any Republican that would be so stupid as to do this should, and will, be Primaried. Everything should be done, and fully negotiated, prior to my taking Office on January 20th, 2025," Trump wrote on Truth Social.
Trump and vice president-elect Vance are pushing Congress to terminate or extend the debt limit now, before it comes to a vote in June under Trump's watch.
"Unless the Democrats terminate or substantially extend Debt Ceiling now, I will fight ‘till the end," Trump wrote on Truth Social. "This is a nasty TRAP set in place by the Radical Left Democrats! They are looking to embarrass us in June when it comes up for a Vote."
The Biden White House criticized Trump and Vance's involvement in the congressional funding effort.
“Republicans need to stop playing politics with this bipartisan agreement or they will hurt hard-working Americans and create instability across the country,” White House press secretary Karine Jean-Pierre said in a statement.
Republican Representative Buddy Carter, Louisiana, defended the funding deal, which includes reforms for pharmacy benefit managers and a two-year extension of telehealth flexibilities.
"The CR contains the most comprehensive #PBM reform we’ve ever seen and patients will see lower prices at the counter because of it. I will support this package on the floor and thank @SpeakerJohnson & @SteveScalise for standing up to the PBM lobby on behalf of patients," Carter wrote on X.
"The Telehealth Modernization Act extends Medicare telehealth flexibilities," Carter also wrote. "Telehealth is a vital tool for seniors and those in rural areas to access quality care, and we must ensure this flexibility is protected."
UPDATED 4:55 p.m. ET, Dec. 18
Trump, Vance oppose proposed CR
President-elect Trump and Vice President-elect JD Vance have weighed in on the continuing resolution–and it's not pretty for Mike Johnson.
Given the afternoon's disarray, sources say Congress will not vote on a continuing resolution to fund the government tonight. Funding runs out Dec. 20.
In a post on X, a Fox & Friends television anchor spoke to Trump and said he is "totally against" the currently proposed spending bill, though he appreciates the difficulty in pulling together a bill. Not long after, Vance implored Congress to pass a skinnier spending bill. He said he opposes any spending bill giving a pay bump to Congress and thinks the legislation should be pared down, blaming Democrats for the country's debt ceiling situation and for including "sweetheart" provisions.
"Republicans want to support our farmers, pay for disaster relief, and set our country up for success in 2025," said Vance. "The only way to do that is with a temporary funding bill WITHOUT DEMOCRAT GIVEAWAYS combined with an increase in the debt ceiling."
The spending bill fight is the first signal Elon Musk and Vivek Ramaswamy—co-leaders of the Department of Government Efficiency, an outside body working closely with Congressional leaders—have real power to shape the legislative agenda going forward. Earlier today, the duo declared their hardline opposition to the spending bill, setting off a firestorm of activity.
Johnson, meanwhile, appears to be bleeding support from House members and could face trouble holding together his party, leaving the future of the spending bill and healthcare package in question. Democrats are unlikely to support a new, streamlined bill as strongly as before after believing a deal was largely done.
"You break the bipartisan agreement, you own the consequences to follow," said House Minority Leader Hakeem Jeffries.
UPDATED 3:40 p.m. ET, Dec. 18
Healthcare deal in trouble
Congress’ end-of-year healthcare deal may be falling apart, lobbyists told Fierce Healthcare.
The bill text for the deal to extend expiring healthcare programs like Medicare telehealth flexibilities was finally finished Wednesday evening. By Thursday morning, there was blowback from Elon Musk, an incoming watchdog on federal spending, about the cost of the bill and the rush to pass it in the days before the government runs out of funding.
Elon Musk, who president-elect Donald Trump wants to advise the White House on federal spending through the Department of Government Efficiency, opposed the bill on his social media platform X on Thursday morning. He wrote that any lawmaker that votes to pass the C.R. “should not be reelected in 2 years.”
Three telehealth lobbyists confirmed they are worried Republicans might back out of the bill. The healthcare package as drafted was a sweeping win for telehealth advocates, as it extended Medicare telehealth flexibilities for two years, pre-deductible coverage of telehealth under high deductible health plans linked to health savings accounts for two years, and CMS’ hospital-at-home waiver for five years.
It is not yet clear what will happen with the proposed healthcare provisions.
According to one lobbyist, the House Republican Whip’s office says they need 100 solid Republican votes to be able to pass the continuing resolution. The lobbyist said it may be hard to garner that many Republican votes.
Also according to that lobbyist, the Congressional Doctor’s Caucus has doubts about the healthcare package because it does not completely fix the 2.8% Medicare physician pay cut finalized by the Biden administration in November. The healthcare package bumps physician pay by 2.5%, which leaves a fractional decrease in pay rates.
The current turmoil on Capitol Hill does not seem to be directly related to healthcare. But if other political fights get in the way of a bigger deal going through, healthcare could be impacted.
On Fox News this morning, Mike Johnson said he agrees with Vivek Ramaswamy and Elon Musk about needing to reduce the high levels of government spending.
But if Republican leadership begins to deconstruct the bill, they are likely to lose the vote of Democrats. Any changes would have to be a net gain in votes from the Republicans to be worth the change.
A fourth lobbyist close to the matter said they think the Republican opposition is mostly fanfare and that the so-called Christmas tree bill, which has been months in the making, will pass as drafted.
POLITICO reported Wednesday afternoon that House Speaker Mike Johnson is working on a Plan B for the C.R. that excludes $100 billion in disaster aid.
Healthcare orgs react to the bill
The 1,500-page continuing resolution to fund the government through Mar. 14 has finally dropped, and it includes a substantial number of healthcare priorities that have trade groups both cheering and jeering.
Government funding runs out Dec. 20, and Republicans are upset at the size and scope (PDF) of the bill’s spending given the backdrop of recent efforts to cut costs and streamline government efficiency. The House of Representatives will vote on the bill first, which will need Democrat votes to pass, before it heads to the Senate.
“The end of the year package shows how fundamentally broken the Congressional budgeting process has become,” said Brian Blase, Ph.D., president of conservative think tank Paragon Health Institute. “There is no way to have an open, honest debate about the policies—like the flow of money in the drug supply chain—in the CR as Congress scrambles to fund the government right before Christmas. Unfortunately, it is a sign of a lack of seriousness in Washington that has led the federal debt to now exceed the size of the economy.”
One surprise addition to the CR was how it will affect lawmakers. The drafted legislation would give a pay increase to Congress for the first time since 2009 and allow members to drop their Affordable Care Act (ACA) plans in favor of the Federal Employees Health Benefits Program, as first reported by Punchbowl News. Staffers cannot opt out of ACA plans under the bill.
Department of Government Efficiency commission co-leaders Elon Musk and Vivek Ramaswamy oppose the bill on principle.
“The bill could have easily been under 20 pages,” said Ramaswamy in a post on X. “It's indefensible to ram these measures through at the last second without debate.”
Musk was more blunt, saying that any member that votes for the spending bill "deserves to be voted out in two years" adding to increased uncertainty as to whether the bill will pass at all.
Many healthcare priorities included in the bill, however, have been discussed nonstop. It will extend Medicare telehealth flexibilities for two years, a provision supported by a broad coalition including America’s Essential Hospitals, MGMA, the Federation of American Hospitals, Telehealth Access for America (TAFA), the Alliance of Community Health Plans and the American Telemedicine Association.
“Our end goal is for telehealth flexibilities to become permanent policy,” said Alye Mlinar, executive director of TAFA, in a statement. “This two-year extension would help ensure that the millions of patients and providers who rely on virtual care can continue to do so and that innovations and investments in virtual care remain.”
Other telehealth provisions extend coverage of high-deductible health saving accounts and fund the Medicare Diabetes Prevention Program Expanded Model until 2030.
On the pharmacy benefit manager side, the bill bans spread pricing in Medicaid beginning in 2026, requires delinking PBM compensation from Part D rebate size by 2028 and mandates a 100% pass-through rate of rebates to sponsors. New benchmarks will dictate stronger Medicaid reimbursement to pharmacies through National Average Drug Acquisition Cost, again by 2028, said global strategy firm Capstone in an analyst note.
Pharmacy and pharma groups are happy at the legislation’s included provisions, as is Speaker of the House Mike Johnson.
“The provisions in this legislation will help ensure that pharmacies are reimbursed more fairly, and that their contracts with PBMs aren’t the completely one-sided, take-it-or-leave-it contracts currently offered by the PBMs and their big insurance plan owners,” said Douglas Hoey, CEO of the National Community Pharmacists Association. He added that pharmacies would be able to more easily contest contract violations by PBMs.
Other provisions include an increase of the Medicare physician fee schedule by 2.5%, extensions of hospital-at-home waivers and the SUPPORT Act for opioid treatment, blocking patent thickets, billing transparency, the elimination of a $8 billion cut to Medicaid disproportionate share hospital funding and reauthorization of the Pandemic and All Hazards Preparedness Act.
In value-based care, the National Association of ACOs celebrated the inclusion of an Advanced Alternative Payment Model (APM) incentive at 3.53%.
Veda Data Solutions CEO Meghan Gaffney shared with Fierce Healthcare that the bill's commitment to cleaning up provider directories will result in a better member experience for health plans. Sen. Ron Wyden, D-Oregon, praised that section and hoped it will cut down on inaccurate directories that frustrate patients.
“The legislation includes improvements to Medicare, especially cracking down on ghost networks in Medicare Advantage that prevented seniors from finding a physician or psychiatrist in their health plan,” he said. “There’s a lot more work to be done to improve mental health care for all Americans, but making sure you can find a doctor when you need care is step one.”
There’s also agitation over what’s not included in the CR. Site-neutral payments are not in the bill, and neither is the Improving Seniors’ Timely Access to Care Act. A group called the Regulatory Relief Coalition stated it is “outraged” the electronic prior auth bill was left out of the package despite a neutral scoring from the Congressional Budget Office and hundreds of endorsements.
“Congress had the opportunity to reach a deal that put patients over paperwork and would have protected more than 30 million Medicare enrollees,” the group said in a statement. “Despite being thoroughly vetted over the past seven years and receiving a zero-cost score from CBO, policymakers unnecessarily began revisiting bill language, seeking to water down this consensus-driven, bipartisan bill to merely codify rules recently finalized by the agency—stripping away essential transparency.”