Congress Passes End-of-Year Spending Bill with Mixed Results for Health Care
In Congress, end-of-year government spending packages adorned with numerous other priorities attached are called “Christmas tree” bills. This year, however, the health care policy haul is looking more like Charlie Brown’s tree and less like Rockefeller Center’s.
House lawmakers voted 366-34 to pass a spending bill on Friday, with the Senate passing it on a 85-11 vote. The bill, which funds the government for three months, still needs to be signed by President Biden. Despite some victories, lawmakers were unable to accomplish any significant health care goals beyond maintaining the status quo.
One major setback was the failure to pass legislation to rein in prescription drug middlemen known as pharmacy benefit managers (PBMs). Despite introducing 95 bills related to PBMs in the past two years, Congress was unable to make any progress, leaving the industry largely unscathed. The biggest PBMs, including UnitedHealth Group’s Optum Rx, CVS Health’s Caremark, and Cigna’s Express Scripts, continue to operate without regulation.
The bill does include more than $100 billion of disaster relief and $10 billion in emergency farm aid. However, doctors will see a 2.8% reduction in Medicare pay starting on Jan. 1, as lawmakers ignored calls to continue bonus payments implemented during the Covid-19 pandemic.
Legislation to address legal tactics used by pharmaceutical companies to delay competition for expensive medicines also failed to pass after five years of debate. Provisions of a law designed to prevent pandemics expired, and a law to address the opioid crisis lapsed.
Despite these setbacks, hospitals fared relatively well in the bill. Subsidy programs for hospitals were extended, and a hospital billing transparency measure that the industry opposed was removed from the final package.
While some provisions may be revived in the future, the convoluted process of avoiding a government shutdown highlighted the challenges of passing meaningful health care legislation. Recent statements from former President Trump and Senator Johnson show interest in regulating pharmacy benefit managers, but uniting the entire House Republican caucus on these issues remains a challenge.
Overall, the end-of-year spending bill reflects a mixed outcome for health care policy, with some wins for public health programs and hospitals, but significant setbacks in addressing issues like prescription drug pricing and the opioid crisis. The future of health care legislation remains uncertain as Congress continues to navigate complex political dynamics and industry interests.
