Updated: March 14 at 4:48 p.m. ET
A last-ditch effort to pass a bipartisan healthcare package pushed aside at the end of 2024 that includes telehealth extensions and pharmacy benefit manager reform, reverses doc pay cuts and addresses the opioid crisis has failed.
That legislation was brought to the floor by Senators Ron Wyden, D-Oregon and Bernie Sanders, I-Vermont, March 14 ahead of a key procedural vote. The senators' bill required unanimous consent or it would not advance. Sen. Rick Scott, R-Florida, quickly rejected the bill.
"I object," he said, offering no further rationale.
"Is that it?" Sanders was heard saying before it was his turn to speak again.
"We have a healthcare crisis," Sanders added. "85 million uninsured or underinsured people dying because they can't afford healthcare. We've been the highest prices in the world for prescription drugs and we have reached a bipartisan conclusion to go forward—in a modest way, but it would have some impact in improving health care in America—and my Republican colleague objects. That's about it."
It was a last-ditch effort that seemed almost destined to fail, with all focus on the Senate's attempts to pass a government funding stopgap bill.
"Another swing and a miss," said a spokesperson for the National Community Pharmacists Association (NCPA) March 10 after the bill was not brought to the floor Monday. The NCPA advocates for PBM reform.
The provisions in the 482-page Bipartisan Healthcare Act, which were included in an end-of-the-year package, seemed likely to pass last year until Elon Musk led a charge on social media site X among Republicans to oppose the spending bill for reasons unrelated to healthcare, despite the bipartisan support toward the health policy items.
Dems tried passing the healthcare provisions that never quite materialized during the 118th Congress. They intended to pass the bill by unanimous consent to bypass procedural hoops, which would require each member of the Senate to vote in favor of the bill, reported The Hill. With this method, opponents of the package outside of Congress would only have to convince one Senator to knock the fast-tracked process off the rails.
Though many of its provisions are widely supported on both sides of the aisle and are regarded as top priorities for lawmakers, one lobbyist told Fierce Healthcare the package was a “long shot” to pass. Republicans may want to save some of the cost offsets for budget reconciliation, they said.
But if Senate Republicans refuse to pass the bill, they may miss an opportunity to get key healthcare reforms through Congress.
Congress is simultaneously attempting to fund the government with a stopgap bill through September and agree on a budget resolution that is so far expected to slash Medicaid by $880 billion over 10 years. Notably, the healthcare package is budget-neutral; program spending is offset by cost savings achieved by the reforms.
The Senate is continuing to vote on President Donald Trump’s political appointees, with agency heads within the Department of Health and Human Services still needing to earn confirmation.
Telehealth
House Speaker Mike Johnson’s “clean” C.R, which he put forward March 6, is expected to extend expiring Medicare telehealth flexibilities until Sept. 30, the end of the fiscal year, along with the rest of the stop-gap government funding.
Johnson’s move would only punt the flexibilities down the road by six months—months that are sure to pass by quickly with the speed at which the Trump administration has pursued its priorities in the last six weeks. Six months also isn’t much time for patients and providers to feel at ease continuing to use the services and invest in the technology.
The Senate Democrats’ package would give lawmakers room to breathe on telehealth, moving the expiration date of pandemic-era flexibilities to Dec. 31, 2026, securing the two-year extension lobbyists were aiming for in 2024.
The package also revives a private insurance telehealth provision that Congress let lapse at the end of 2024, the ability for patients with high-deductible health plans linked to health savings account to receive telehealth services pre-deductible.
The Acute Hospital Care at Home program, which allows hospitals to apply to the Centers for Medicare & Medicaid Services to provide acute-level hospital care in the home, would be extended by five years in the Democrats’ package.
The package would continue to allow the use of telehealth for hospice eligibility recertification, requires guidance on providing telehealth to patients with limited English proficiency and includes virtual-only suppliers of the Medicare diabetes prevention program. The package also calls for a report on wearable medical devices.
In a recent letter to Congress, telehealth advocates pushed for an extension of the flexibilities that is “as long as possible,” leaving behind an explicit push for a two-year extension, a virtual care lobbyist told Fierce Healthcare.
Pharmacy benefit managers
PBM reform has become the great white whale of healthcare reform. This bill would take the first steps to rein in what lawmakers see as abusive practices, using PBM items as an offset to accomplish other measures.
The legislation calls for eliminating spread pricing in Medicaid and requires a survey of pharmacy drug prices to determine national average drug acquisition cost benchmarks. There would also be stricter punishments for PBMs that violate contracts.
Included in the package is the Modernizing and Ensuring PBM Accountability Act. It outlaws linking PBM compensation with drug prices and is designed to improve transparency.
Doc pay, Medicare
Under the Bipartisan Healthcare Act, payments under the Medicare Physician Fee Schedule (PFS) would increase by 3.5% for services from March 15 to Jan. 1, 2026, approximately in line with the Medicare Economic Index (PDF). The previous end-of-year package included a 2.5% fix for 2025, and the higher percentage is designed to alleviate the lack of relief across the entire year so far. This would help offset a 2.83% reduction to the PFS in effect as of January.
In Medicare, there would be an extension of inpatient hospital payments for some low-volume hospitals and payment extensions for rural hospitals. It includes a 3.5% payment extension to the Advanced Alternative Payment Model through the end of 2025.
The bill includes extensions to certain ambulance services and low-income assistance programs.
Medicare would be required to cover certain cancer detection screening tests and home infusion drugs. Part D would cover certain oral antiviral drugs.
The addition of a virtual diabetes prevention program under the Medicare Diabetes Prevention Program is likely a welcome inclusion for some telehealth companies.
Medicaid
The bill streamlines the enrollment process for out-of-state providers in Medicaid and the Children’s Health Insurance Program, modifies coverage of community-based services in Medicaid, eliminates age restrictions on Medicaid eligibility for working seniors with disabilities and removes or delays disproportionate share hospital allotments
State Medicaid programs will be required to conduct studies on the cost of maternity, labor and delivery services in rural hospitals.
Other measures tighten program integrity requirements around durable medical equipment and more accurate provider directories.
Opioids, public health
Community health centers would also receive an extension through 2026 in this bill, while the SUPPORT Act for opioid treatment and prevention would also get reauthorized for five years.
The Teaching Health Center Graduate Medical Education program would also earn a five-year extension.
Additionally, the Centers for Disease Control and Prevention’s World Trade Center Health Program, which provides treatment and support to first responders and survivors of the Sept. 11, 2001, terrorist attack, is listed for extension in the legislation.
The bill also includes funding for ongoing public health initiatives like the Pandemic and All-Hazards Preparedness Act, mental health programs for the healthcare workforce and reauthorization of a traumatic brain injury program.