Pending Legislation – The Good, The Bad, and The Ugly

Congress is poised to fund some programs that will impact many of us and it’s about time. I say that because we’ve been fighting for many of these programs to be implemented or extended for quite a while and they’ve often had bipartisan support, yet they kept putting them off until they were forced to act by a hard deadline. Not that a hard deadline has always forced them into action – remember the government shutdown. It’s too bad that this seems to be the only way that our lawmakers take action, but more about that later. Let’s get right into the good, the bad and the ugly of this pending legislation.

This is a funding bill that was the result of the recent government shutdown that was ended by a continuing resolution (CR). This CR kept the government funded but only at the existing levels and programs. This resolution is set to run out on January 30th, hence the deadline that has forced our lawmakers into action. This bill will fund multiple programs, but I will focus on the funding of HHS since this is where the healthcare funding that will impact you and I resides. First, let’s talk about the good parts.

The Good – I think it’s good when we have bipartisan buy in on any legislation and this, surprisingly, happened on this funding bill, it passed the House by a 341 – 88 majority. The first good part is the extension of the Medicare telehealth program that was instituted during COVID. As I have written many times, this was a silver lining that came out of the pandemic and has proven to be an efficient and cost-effective way to provide care, especially for rural patients. This extends the telehealth program till December 31st, 2027, but it also extends the Hospital-at-home waivers through September 30th, 2030. These remote methods for patient care, while continuing to require refinement, have shown to be effective, to say nothing of the savings to the patients who won’t need to travel to obtain care.

The funding for mental-health support for caregivers was extended through 2027, which has been a worry for providers in this area. The funding was also extended for the Medicare-Dependent Hospital program, which supports small, rural hospitals that treat a high proportion of Medicare patients. This was certainly welcomed by these hospitals that were under financial strain and were facing closure.

There was also a positive outcome for National Institutes of Health (NIH). The President’s budget and the administration’s proposed cuts to NIH troubled many, including myself. I’ve often discussed the chilling effect on the drug manufacturer’s ability to innovate that the drug price fixing scheme of the IRA would have. The NIH is also an important part of our nation’s successful innovation ecosystem, as is the fertile discovery environment present in our country’s colleges and universities. Both of these institutions have come under fire with threats of cuts in financing. This bill strengthens NIH, avoids catastrophic cuts, and provides a modest funding increase. It’s a stabilizing, protective budget rather than a transformative one — but in the current fiscal climate, that stability is significant.

The Bad – An initial bad thing is the fact that the Senate still has to pass this funding bill which may face changes and conference committee work. However, there does seem to be some bi-partisan support in the Senate which may lessen the chance of bad changes and the deadline doesn’t give them much chance for long discussions.

There are changes that have been threatened in the past which look like they will be included in this bill. Changes to the way Pharmacy Benefit Managers work and are reimbursed, the implementation of site-neutral payments and restrictions on some aspects of the Medicare Advantage program, are all part of this bill. While every government program has room for improvement, I’m always wary when the government increases its power and control in our healthcare. The current government has used many methods of leverage to change our healthcare and it has impacted drug manufacturers, insurance companies, doctors, and hospitals alike. Depending on your point-of-view these interventions may be good or bad but, in all cases, it is our government inserting itself deeper into our healthcare and that worries me.

One thing that this bill doesn’t do is extend the ACA subsidies which was a big reason for the initial government shutdown. These subsidies helped people afford insurance premiums and already have had an impact on the number of uninsured Americans. There were solutions offered, vouchers and payments to Health Saving Accounts, both of which I thought needed to be considered. The bottom line is there are people that are uninsured that didn’t have to be and that is never a good thing.

The Ugly – In my opinion the ugly part of this whole thing is the fact that our lawmakers can’t do their most important assigned duty - funding the government, in a beneficial and efficient manner without the threat of a deadline. Why couldn’t 341 members of the house have come together before September 30th of last year and agreed to the bill that is headed to the Senate and avoided the shutdown? Why do they limit the input of stakeholders by waiting until they have just a few days to discuss and vote on a bill that impacts the lives of millions of Americans? This is just ugly, and every lawmaker should be embarrassed that it has come to this.

Our power is to advocate for legislation that overall will benefit us, and this funding bill will do that. Contact your Senators and tell them to pass this funding bill. You can click here to help you contact your Senators. I will keep you informed on how things are moving this week.

Best, Thair