Leaders in Congress have agreed on legislation that would stave off Medicare pay cuts for doctors, decrease federal spending on Medicaid, and extend pandemic telehealth flexibilities in their year-end spending bill as they near a Friday deadline to avert a government shutdown.
Democratic and Republican appropriators unveiled a draft of the $1.7 trillion omnibus spending bill overnight, which included a number of priorities for healthcare interest groups, though it excluded portions of a pandemic preparedness bill that would have set up a 9/11-style bipartisan commission to examine the COVID-19 response.
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Medicaid coverage: Lawmakers have reached a deal that will allow states to begin removing ineligible people from Medicaid starting April 1, 2023, decreasing federal spending on the program.
The agreement will begin to unwind a pandemic-era policy that required states to offer continuous coverage for Medicaid enrollees until the end of the COVID-19 public health emergency, which is currently expected to last through at least the end of April, in exchange for additional federal funding.
The deal is a win for Republicans who have pushed for phasing out the policy, arguing that it allowed people who exceeded income qualifications to remain enrolled.
Federal savings from the agreement will go toward two policies long sought by Democrats. Children on Medicaid will receive continuous Medicaid eligibility for a year, likely reducing potential lapses in coverage due to not meeting the eligibility requirements.
The bill will also permanently allow states to continue providing 12 months of postpartum care for women covered through Medicaid or the Children’s Health Insurance Program. Thirty-three states already opted to offer 12 months of continuous coverage during the postpartum period earlier this year. Democrats fell short, though, of their goal of requiring it for all states.
Lawmakers also decided to extend funding for the Children’s Health Insurance Program until 2029.
Medicare pay cuts: The spending bill will ease a scheduled 4.5% cut to the Medicare physician fee in 2023 and instead incrementally increase cuts over the next two years. Physicians will face a 2% pay cut in 2023, which will increase to 3.5% in 2024.
American Medical Association President Dr. Jack Resneck said the group was disappointed that Congress did not avoid pay cuts altogether, suggesting that it could lead some practices to stop taking new Medicare patients.
Telehealth flexibilities: Medicare telehealth flexibilities enacted during the pandemic will also be extended for two years as part of the spending bill. The deal will enable Medicare to continue to reimburse for telehealth services, which have grown popular throughout the pandemic.
Prior to the pandemic, Medicare only paid for telehealth care in limited circumstances and only then allowed video visits, not audio-only calls between a patient and provider. The flexibilities were first granted under the public health declaration and built on an extension that Congress approved earlier this year.
Pandemic preparedness: Portions of a pandemic preparedness package led by Senate health committee leaders Patty Murray (D-WA) and Richard Burr (R-NC) also made it into the omnibus.
The deal included a proposal that will require a Senate confirmation for the director of the Centers for Disease Control Prevention, a position currently held by Rochelle Walensky. It did not, however, establish an independent panel, similar to the one set up after 9/11, to examine the COVID-19 response, as some lawmakers had hoped for. It comes as several GOP leaders signal that they intend to hold hearings on the origins of the COVID-19 virus when they take back the House in the new year.
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The omnibus also included $858 billion in defense-related spending, roughly a 10% hike from last fiscal year, along with aid for the war in Ukraine and a federal ban on TikTok for government devices, among other measures.
The Senate is expected to vote on the omnibus legislation as early as Tuesday afternoon.
