WASHINGTON — In Congress, end-of-year government spending packages adorned with numerous other priorities attached are called “Christmas tree” bills.
This year, 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. The bill, which funds the government for three months, still needs to pass the Senate and be signed by President Biden.
Funding for under-the-radar public health programs survived in the bill, as did a short-term extension of older adults’ ability to access telehealth from their homes. But lawmakers were unable to accomplish any health care goals this Congress beyond the status quo.
After two years, all of Congress’ work on legislation to rein in prescription drug middlemen called pharmacy benefit managers came to nothing. Lawmakers introduced 95 bills related to PBMs in that timeframe, according to Congress’ legislative database. It’s a gift for the PBM industry that has survived nearly a decade of scrutiny untouched — and the massive insurers that own them. The biggest PBMs are UnitedHealth Group’s Optum Rx, CVS Health’s Caremark, and Cigna’s Express Scripts.
The bill does include more than $100 billion of disaster relief and $10 billion in emergency farm aid.
Doctors lost out on their holiday bonus. Medicare pay for doctors will be 2.8% lower on Jan. 1, after lawmakers ignored doctors’ calls to continue bonus payments that began during the Covid-19 pandemic.
Legislation to address legal tactics that pharmaceutical companies use to delay competition for expensive medicines failed too, five years after the debate began.
Provisions of a law passed to prevent pandemics expired, less than five years after society shut down following the deadliest pandemic in a century. And even as more than 100,000 Americans died from drug overdoses last year, a law to address the opioid crisis lapsed.
Hundreds of pages of smaller provisions were slashed in the rush as well, including provisions aimed at helping kids with cancer, opening up Republicans to attacks from Democrats. But in a rare move, the Senate unanimously passed funding for pediatric cancer research as its own standalone bill.
Medicare coverage for blood tests to screen for cancer went in the trash, too.
Hospitals, however, came out in a fairly good position. Subsidy programs for hospitals were some of the few programs extended in the government funding bill, and a hospital billing transparency measure the industry didn’t like fell out of the final package.
There’s a chance some provisions could be revived in the future. Trump and Johnson in recent days have expressed an interest in putting guardrails around pharmacy benefit managers.
“We’re going to knock out the middleman… I don’t know who these middlemen are, but they are rich as hell,” President-elect Trump said during a news conference this week.
But the convoluted dance to avoid a government shutdown foreshadowed the challenge of doing anything that doesn’t unite the entire House Republican caucus.
