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Trending:
First Opinion
Coronavirus
STAT+
Health

Politics


CONGRESS REACHES MAJOR HEALTH POLICY DEAL ON MEDICARE, MEDICAID, AND PANDEMIC
PREPAREDNESS

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By Rachel Cohrs and Sarah Owermohle Dec. 19, 2022

Reprints
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Andrew Harnik/AP
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WASHINGTON — Leaders in Congress have reached a sweeping deal to ease Medicare
pay cuts to doctors, make major changes to post-pandemic Medicaid policy, and to
help prepare for future pandemics.

Lawmakers are aiming to pass a health care policy package along with legislation
to fund the federal government by Friday. The details of the omnibus spending
package were confirmed by two lobbyists and two congressional aides.

The bill’s text is not yet finalized, and the deal is still subject to changes.

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MEDICARE POLICY

Doctors were facing down 4.5% Medicare pay cuts at the end of the year, and had
pleaded with Congress to cancel the cuts altogether. Lawmakers met them halfway:
In 2023, physicians will face a 2% cut, and in 2024, the amount will increase to
3.5%, two lobbyists said.

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Lawmakers are also expected to waive a rule that would have resulted in further
cuts to Medicare. The Medicare hospital at home program is also supposed to be
extended for two years.

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Some of the package will be paid for by extending future Medicare pay cuts until
2032. Leftover Medicare funds from the gun safety bill that Congress passed
earlier this year were also used to pay for some of the policy.

Some behavioral health policy could also be included, as well as two-year
extensions of programs that support safety-net and rural hospitals.


MEDICAID POLICY

Lawmakers also agreed to allow states to begin kicking ineligible people off
their Medicaid rolls in April, regardless of when the Covid-19 public health
emergency ends. Previously, states had to agree to hold off on re-evaluating
people’s eligibility in exchange for more federal Medicaid money, and the end
date was contingent on the end of the public health emergency.

In addition, lawmakers are expected to extend the Children’s Health Insurance
Program until 2029. Children on Medicaid are expected to get one year of
continuous eligibility, which means they won’t lose insurance even if their
circumstances change. But while Democrats fought to require every state Medicaid
program cover postpartum care for a year, the final legislation has fallen short
and instead would only make permanent 33 states’ extended coverage.

Advocates have long argued that expanded coverage could help reverse staggering
maternal and infant mortality rates, among the worst for high-income countries.
Thirty-three states had already extended care for a year after Congress passed
the option in last year’s American Rescue Plan, but among the 17 holdouts are
some of the states with the highest maternal mortality rates in the country —
figures that have only surged during the pandemic.

More robust federal Medicaid funding for Puerto Rico and other territories will
be extended for five years, which offers some certainty for territorial
governments and providers, according to one congressional aide and and one
lobbyist.


RELATED: PHARMA WINS CHANGES IN BILL REGARDING FDA’S ACCELERATED APPROVAL


TELEHEALTH

Pandemic-era telehealth flexibilities are expected to be extended for two years,
which was a major ask from the health care industry.


PANDEMIC PREPAREDNESS

The pandemic preparedness package negotiated by Senate health committee leaders
Patty Murray (D-Wash.) and Richard Burr (R-N.C.) also made it in the deal,
though it was narrowed somewhat, according to one lobbyist and one congressional
aide. It is unclear precisely which policies made the final cut.

The package included a policy that would require Senate confirmation for the
director of the Centers for Disease Control and Prevention.


NO DIAGNOSTICS REFORM

A provision that would have given the Food and Drug Administration more
authority to regulate in-house tests developed in clinical labs like academic
medical centers and hospitals was squeezed out of the agreement. While the
device industry and federal regulators backed the measure, arguing it would
close an oversight gap that helped Theranos thrive with unproven tests, labs
argued it would hobble their ability to quickly diagnose patients.

Ultimately, those labs found sympathy with some Republicans, namely Rep. Cathy
McMorris Rodgers (Wash.), who stands to lead the powerful House Energy and
Commerce committee next year, two sources familiar with the deliberation said.
Besides being hesitant to give the FDA more authority, Rodgers argued that the
bill, called the VALID Act, had not gone through any House hearings or markup,
those two people said. FDA Commissioner Robert Califf has said that if the
legislation fails to make it into the omnibus, the agency will begin rulemaking
itself to bring these labs under its regulatory umbrella.

VALID’s omission from the bill is “disappointing” because many lawmakers in both
parties supported the measure, Scott Whitaker, CEO of device lobby AdvaMed,
said. “The last thing we need is more Theranos-type tests in the health care
system.”


RELATED: CONGRESS HAS A CHANCE TO CLOSE THE FDA’S THERANOS LOOPHOLE

The package is also expected to include some FDA reforms connected to extending
several regulatory flexibilities that Congress punted to this month to bring
negotiators back to the table after they failed to reach a deal in September. At
least reforms to the FDA’s accelerated approval process, FDA’s authority to
regulate cosmetics, and policy on encouraging diversity in clinical trials are
expected to make the cut, two lobbyists said.


NURSING SCHOOL REPAYMENTS

Nursing schools are also expected to get some relief from fees they were
supposed to have to pay back to the government following a mistake by the
government.

The federal government miscalculated funding for hospital-based nursing schools
for nearly two decades, and now the Biden administration was forcing them to pay
up during the worst health care workforce crisis in decades.


COVERAGE OF EMERGENCY USE AUTHORIZATION PRODUCTS

The government has been buying Covid-19 vaccines and providing them for free to
everyone, but that arrangement will likely end once the stockpile of
government-bought vaccines runs out. When it became clear that the Biden
administration was going to have a difficult time getting Republicans to agree
to more pandemic preparedness funding, White House officials began preparing the
public for commercial coverage.

To help with that transition, the bill would allow Medicare Part D plans to
cover coronavirus products through 2024 that have been authorized for emergency
use but not approved.


DOCTOR TRAINING ON OPIOID USE

The end-of-year package is expected to include a bipartisan bill that would
mandate doctors be trained on treating people with opioid use disorder, despite
opposition by the American Medical Association.

A related piece of legislation, called the MAT Act, that would lower barriers to
prescribing opioid use disorder medication like buprenorphine, is also in the
final package.

John Wilkerson contributed reporting. This story has been updated.

 * 
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ABOUT THE AUTHORS REPRINTS


RACHEL COHRS

Washington Correspondent

Rachel reports on the intersection of politics and health policy.


rachel.cohrs@statnews.com

@rachelcohrs


SARAH OWERMOHLE

Washington Correspondent

Sarah is a Washington correspondent at STAT, reporting on the Biden
administration’s health goals, federal health policy and politics.


sarah.owermohle@statnews.com

@owermohle


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