The lame duck health care agenda

OK, back to work! Congress is back and here’s what we’re hearing from lobbyists and aides about what is most (and least) likely to make it through the lame duck.

The big picture: The size of the year-end legislative package is still unclear, and negotiations haven’t started in earnest yet.

What’s most likely to pass:

• Averting physician and PAYGO cuts: Everyone thinks providers will get some relief from looming payment decreases. The 4% pay-as-you-go sequestration will probably be fully waived, but not the 4.5% physician fee schedule cuts. Expect only 2% to 3% of those to be averted.
• Medicare extenders: Extensions for the Medicare-Dependent Hospital program and low-volume adjustment should sail through without difficulty. Congress wouldn’t have continued the programs into December through this fall’s CR if lawmakers didn’t plan to keep them going.

What’s up in the air:

• Pandemics: At least pieces of the Murray-Burr PREVENT Pandemics Act could make it in, given that Sen. Richard Burr is retiring and has priorities around reforming the CDC’s structure. Sen. Patty Murray wants the 9/11 style commission on the COVID-19 response.
• Mental health: Big-ticket mental health items like increasing parity enforcement are very unlikely, but the Finance Committee has some bipartisan material to work with like ideas for better integrating mental and physical care, and other panels have worked on reauthorizing some programs.
• Medicare bonus payments: There’s bipartisan support for a two-year extension of the 5% bonus providers get for participating in certain value-based care programs. But advocates say a CBO analysis of the policy came in twice as high as expected.
• Medicare Advantage: Provider groups are holding out hope that the House-passed bill to streamline MA prior authorization will fly through the Senate during the lame-duck period, but an unexpectedly high CBO score of more than $16 billion over 10 years has hindered progress here, too.
• FDA reforms: Big-ticket FDA reform items, like increasing oversight of cosmetics and dietary supplements, face a tough path, though the Democrats’ stronger-than-expected showing could give them a boost. A lab-developed test regulation overhaul at least has some more GOP support, though it also is a heavy lift.
• Telehealth and Hospital at Home: We’re hearing mixed messages on these. There’s bipartisan and industry support for at least a one-year extension, but Republicans could decide to punt them to next year and count it as a party win.

What’s tougher:

• Delaying home health cuts: Sorry, home health providers. Congress isn’t likely to provide relief to the industry after regulators spread out payment cuts for home health over two years.

Between the lines: The bill’s size in part depends on the payfors both sides can agree on.

• At the lowest end of the scale, the roughly $7 billion in the Medicare Improvement Fund would pay for a smaller package, but more payfors could make it bigger.

What we’re watching: Sen. Roger Marshall is planning to file an amendment to the National Defense Authorization Act blocking the Defense Department from paying for abortion travel, his comms director told us.

• That means Republicans could hold up the only other bill besides the omnibus likely to have traction in the lame duck. Whether that amendment goes up for a vote is TBD.