Congress is Full of Surprises
I wrote this week’s blog early in anticipation of enjoying the Labor Day holiday weekend. I relied too much on Patrick Henry’s famous quote, “I have but one lamp by which my feet are guided, and that is the lamp of experience. I know of no way of judging the future but by the past”, to guide my thoughts concerning when the continuing resolution (CR) would be passed. I expected the members of Congress to once again use this temporary legislative mechanism that funds are government as a political “game of chicken” to see who gives in first as September 30th approaches. Last year, no one gave in, and they shut down the government for a record 43 days. If there is one thing about this Congress, they are full of surprises. Going completely out of character the House and the Senate passed the CR with huge majorities and it was signed into law. The CR expires December 11th, after the mid-term elections, which is one indicator of how important these elections are. Thank goodness for my ever-vigilant editors who keep me from foolishly relying on history and thinking the Congress would continue to let politics steer them away from doing the right thing. This puts healthcare issues in a whole new light and alters when they will be debated and implemented. But, before I focus on these issues, I need to rant just a little.
Since our government can’t seem to ever accomplish one of the most basic and important jobs we trust them with on time, they once again used a stop gap legislative maneuver to avoid shutting down the government at the end of September. They have all year to come up with a budget, but they just can’t seem to get it done. In fact, it’s been 30 years since Congress completed a budget and funded our government for the next fiscal year. The CR they passed only continues funding the many parts of our government at the existing levels, needed changes are ignored. We budget for a fiscal year so we can make important changes which a CR ignores. Our lawmakers should be embarrassed. Since all members of the House are up for reelection every two years, and the House has primary responsibility for funding our government, I think every voter should communicate to their lawmakers that a requirement for their vote in the upcoming elections is predicated on them completing a budget on time. That’s my opinion and ends my rant for today . . . now let’s get back to reality.
The reality is that the CR passed, and it didn’t include any of the healthcare priorities that could have been included - and there certainly (I’m going out on a limb here) will be no movement before the mid-terms. The election will have a huge affect on what happens later this year. The facts are, President Trump will still be President after the November 3rd, but which party holds the majority in the Senate and the House is yet to be determined. There are many iterations of what could happen, one party could have the majority in both houses or the majority could be split. How this plays out will have a huge impact on what gets done until the new Congress begins. Each party will be motivated in different ways depending on the election’s outcome. Historically there is one positive thing that has come after elections, a two-month lame duck congress. I’ve seen bills passed during lame duck sessions that didn’t have a chance at becoming law before. There are coalitions formed across the aisle around certain issues. Lawmakers often have more freedom to vote outside their party’s restrictions, especially if they didn’t get reelected. I think this could be a prime time for healthcare issues to come to the forefront, for rules, waivers, and implementation guidance and for proposed legislation to become law. Following is a list of issues that are most likely to be considered.
Telehealth – The telehealth flexibilities allowed during COVID were extended through 2027 but implementation rules and waivers, especially for mental health, will have a big impact.
Hospital‑at‑Home Program (AHCAH) – While this program was extended through 2030 the rules and implementation will again be very important.
Medicare Physician Payment Reforms – This is a big unresolved issue. Congress included initial steps toward site‑neutral payments and incentives for alternative payment models in the FY26 funding package, but a full physician payment resolution remains unfinished.
Low Income Subsidy (LIS) – There has been some movement to lower the out-of-pocket costs for LIS enrollees and there could be further action this fall.
Rural & Underserved Access – The following items have bi-partisan support and are prime candidates for inclusion in a legislative vehicle this fall:
Staff‑assisted home dialysis
Mental‑health support for dialysis patients
Stabilized reimbursement for independent physicians
Pharmacist‑administered tests/treatments – This has always been a priority of mine. Older patients almost always see their pharmacist more than any other healthcare provider. There needs to be a way for pharmacists to get paid for tests and treatments, especially in a rural setting. This approach would be both cost effective and patient friendly.
Medicare Diabetes Prevention Program (MDPP) Reforms – Congress has been working on modernizing the rules and reimbursement and will likely want to finish the job.
Other Health-Care Issues Likely to Surface - Mental health workforce shortages, Medicaid/CHIP continuous enrollment fixes, and IRA drug‑price negotiation.
These issues could be added individually as amendments to the December CR or there could be a health “omnibus” that included multiple issues that is used as part of negotiations to pass a final budget. If one party wins a majority in both the House and the Senate, I think it’s more likely that these issues will be pushed to next year.
What I do know is your vote is important. I’ve often said that voting gives you the right to express your opinion after the results. Seniors Speak Out will continue to keep you informed as this fall plays out.
Best, Thair