January 7, 2025
Health Policy Report – January 7, 2025
Congress Passes Stopgap Spending Bill
On December 21, Congressional leaders narrowly avoided a government shutdown by passing a stopgap budget deal that extends government funding through March 14 and Medicare telehealth flexibilities through March 31. The final deal came after a contentious week of negotiations, as Republicans in Congress – backed by President-elect Trump, opposed an earlier bipartisan version of the bill, which had included a more comprehensive health provision.
An earlier version of the budget legislation included mitigation of most of the physician payment cut finalized by CMS for 2025. In response, Bruce A. Scott, MD, president of the American Medical Association (AMA), noted that the legislation “utterly fails to address declining reimbursement rates for Medicare, pushing our health system down a path that will have predictable and deleterious results.”
The pared-down bill also removed a provision from the initial bill that would have required off-campus hospital outpatient departments to use a unique code when billing Medicare – an attempt by lawmakers to improve transparency among hospitals and discourage the use of facility fees. It also omitted reforms targeting pharmacy benefit managers and reinstating patient access to home delivery of cancer drugs, both of which continue to gain bipartisan support in Congress.
The spending deal did not reauthorize funding for childhood cancers, prompting criticism from the pediatric cancer community. However, one of four cancer-related bills, the Gabriella Miller Kids First Research Act, which included $12.6 million in annual cancer research funding through 2031 to study the biology of childhood cancers and structural birth defects, was passed by the Senate as a stand-alone bill.
To read more, CLICK HERE.
To read more about the physician community’s response, CLICK HERE.
House of Representatives Re-Elects Mike Johnson (R-LA) as Speaker
On January 3, House Republicans re-elected Mike Johnson (R-LA) as Speaker of the House. In the first round of voting, three Republican members initially voted against Johnson to lead the House, setting him short of the 218 votes needed to secure the speakership.
The vote was held open and after several minutes, Representatives Keith Self (R-TX) and Ralph Norman (R-TX) changed their votes, handing Johnson the support needed to win another term as Speaker. Representative Thomas Massie (R-KY) was the only Republican to vote against Johnson.
Johnson is now tasked with working with the incoming Trump administration on immediate priorities and reauthorizing government funding in March with a very slim Republican majority.
To read more, CLICK HERE.
NBC News Investigation Shines Light on Insurer Denials in Cancer Care
An NBC News investigation details how health insurance companies are increasingly interfering in patient care. Last year, 17% of Americans reported that their insurance company had denied coverage for care recommended by their physician, according to a survey conducted by The Commonwealth Fund.
In the article, Dr. Bruce Scott, President of the American Medical Association, noted that requiring patients to clear endless hurdles to secure treatment is a rising problem throughout healthcare. “Nowhere are the stakes higher than in cancer care,” he said, “where delays can literally be the difference between life and death.”
The article also highlighted how so-called “gold carding,” which can exempt physicians from going through the prior authorization process, can limit delays. There need to be responsible ways to use prior authorization,” said Dr. Debra Patt, oncologist and breast cancer specialist at Texas Oncology. “It has gotten quite out of hand. I think of it as patients on a journey and prior authorization is like hurdles along the way that they may not be able to progress past.”
To read the investigation, CLICK HERE.
Representatives Bucshon and DeGette Release Discussion Draft on Potential Cures 2.1 Legislation
Representatives Dianna DeGette (D-CO) and Larry Bucshon, MD (R-IN), now retired, released a white paper outlining the potential for a “Cures 2.1” legislation that could build on earlier efforts to expedite development and coverage of new therapies.
Cures 2.0 was introduced in 2021 to build on the work of the original Cures Act. While it was not passed in full, some of its provisions, including the establishment of the Advanced Research Projects Agency for Health (ARPA-H), became law.
The discussion draft highlights the need to ensure screening guidelines keep pace with medical advancement, integration of research into the provision of medical care, and the use of real-world data to inform best practices.
Given that Rep. Larry Buchson, MD retired at the end of the 118th Congress the discussion paper marks the beginning of an ongoing process to continue the work of the Cures Act.
To read the discussion paper, CLICK HERE.
119th Congress Announces Leadership of Key Healthcare Committees
The 119th Congress officially commenced on January 3rd, with Republicans taking control of the White House, House of Representatives, and Senate. In Congress, Republicans will chair key committees with broad influence over healthcare.
The Senate Finance Committee, which oversees Medicare, Medicaid, the Department of Health & Human Services, and the Centers for Medicare & Medicaid Services (CMS), will be chaired by Senator Mike Crapo (R-ID), with Senator Ron Wyden (D-OR) serving as Ranking Member. Crapo has shepherded several bipartisan healthcare bills along with Wyden, who led the panel for the last four years.
Senator Bill Cassidy, MD (R-LA), a gastroenterologist, will serve as Chair of the Senate Health, Education, Labor and Pensions Committee (HELP), which has jurisdiction over employer-sponsored health plans, public health, and agencies such as the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health. Bernie Sanders (I-VT), previous Chair of the committee, will now serve as Ranking Member.
On the House side, Representative Brett Guthrie (R-KY) will serve as Chair of the House Energy & Commerce Committee, while Representative Frank Pallone (D-NJ) will continue to serve as Ranking Member. Also, Representative Buddy Carter (R-GA) has been selected to serve as the Chairman of the Subcommittee on Health. The committee is expected to focus on healthcare transparency, pharmacy benefit manager (PBM) reform, and cuts to Medicaid financing. Guthrie led the committee’s Health Subcommittee in the last Congress. The House Ways & Means Committee leadership will remain unchanged, with Representative Jason Smith (R-MO) serving as Chair and Representative Richard Neal (D-MA) as Ranking Member.
Representative Tim Walberg (R-MI) will take over as Chair of the House Education and Workforce Committee, while Representative Bobby Scott (R-VA) will serve as Ranking Member.
Medicare Drug Price Cap Takes Effect
On January 1, a $2,000 out-of-pocket spending cap on medications – a key provision of the Inflation Reduction Act – went into effect. The yearly price cap has been in the works since the law was signed in 2022, aiming to tackle drug costs for seniors.
“As a result, 19 million people are expected to save an average of $400 each,” President Biden said in a statement. “My Inflation Reduction Act has changed Medicare for the better, and as a result Americans will have more money back in their pockets in the years to come.”
In 2025, Medicare enrollees with standard benefits will pay 25% of their drug costs until their out-of-pocket spending totals $2,000, after which they will pay no additional costs.
To read more, CLICK HERE.
To read the Biden Administration’s statement, CLICK HERE.