Health

Business As Usual? – Not This Time!

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The end of the year usually brings an abundance of legislative initiatives at an accelerated if not frenetic pace. The must pass funding bills offer the ideal platform for amendments and additions, especially for healthcare focused legislation. With funding running out for critical government programs, the fast-approaching Christmas holidays, and the campaigning for office in the coming year, lawmakers are especially motivated to get to work. This fast-paced environment can generate good things and bad things. The looming deadlines have historically produced an environment where deal making becomes pervasive, resulting in both good and bad legislation, some of which wouldn’t have had much of a chance of passing during normal order. This has become the normal year end legislative process, but it will not be the case this year.

Out of the bizarre and unprecedented chaos in the House came a continuing resolution (CR) that continues the string of never seen before actions. CRs, which extend funding for critical programs at current funding levels as the new funding bills are debated, have been common in the past, but this year is different. The CR that was signed into law was a never seen before two-tiered stop gap measure that sets up two deadlines, January 19th and February 2nd, with department funding split into two parts. It extended the deadlines past the Christmas recess, removing one of the reasons that usually motivates lawmakers to pass the funding bills with the accompanying healthcare legislation. It also removed the primary vehicle used for attaching proposed healthcare legislation that looked like they had a good chance to become law and stopped Congressional action on existing healthcare processes.

While the delay of action may be a positive thing for some entities, other parties may see it as delaying the enactment of long overdue changes to healthcare.

Some of the actions that were affected by the delay are:

  • How Medicare pays for outpatient care
  • Legislation on changing how Pharmacy Benefit Managers operate
  • Changes to the price of insulin
  • Delaying the looming cuts to Medicare provider payment cuts
  • Continued uncertainty for the funding of the Food and Drug Administration and Health and Human Services

Most D.C. pundits don’t expect any action this year, and many don’t see anything substantial happening next year given the ever-rising cacophony generated by the presidential campaigns.

One of the reasons for this dire prediction is the fact that the clean CR (the bill contained no funding for Ukraine or cuts to government programs) just kicked those high-profile issues down the road without offering any solutions. This fact was demonstrated by the Republicans failure to pass the rule to begin consideration of the Commerce, Justice, and Science Appropriations bill a day after the CR passed. This immediate rebuke was stark evidence of the tough job that is looming for Speaker Johnson. This failure was just another example of the historical nature of these moves in the House given that this is the fourth rule to fail this year. Prior to this year, a rule hadn’t failed in over two decades. Those fights will still need to be fought, especially in the House. Each day without the passage of the funding bills brings lawmakers a day closer to the 2024 elections and the ensuing change in focus.

There might be a silver lining to the fact that next year is a Presidential election year and the reality that both the Senate and the House majorities are very much in play. This makes the coming elections even more important to the members of both parties, which might motiveate them to pass some positive legislation that they can point to as they go back to their states to campaign. There are always ways to push through legislation or postpone Medicare cuts if it benefits the profiles of enough lawmakers. This will require some bi-partisan cooperation which will only happen if both sides can somehow claim victory for passing the legislation. We’ll wait to see how this plays out.

There is another thing that I want to bring up as we consider the unprecedented actions of the House. As we talk with lawmakers about legislation and rules that affect older Americans, we are careful to use data and logic in our arguments while also serving as a conduit for the voices of seniors throughout our country. We try to highlight the impact, both good and bad, of the proposed solutions that are brought forth by lawmakers. Most members of Congress calmly and thoughtfully consider both sides of the question and decide where they stand on the issue. The problem comes when issues have been kicked down the road, like has occurred here, and they are pushed up against deadlines, like they will experience at the beginning of next year. Often, as the members of both parties seek votes for their favored legislation, the calm and thoughtful decisions they made earlier are replaced by the lure of the deal. I’ve seen it in the frenzy of amendments added to must pass legislation and votes made in support of bills that wouldn’t have been made in calmer times. It’s the nature of Washington these days and it is a dangerous time. The speed at which these back-office deals are made often don’t give stakeholders any time to make lawmakers aware of the proposed legislation’s impact on all facets of providing healthcare to Americans. It certainly doesn’t offer the time for the lawmakers to consider the issues calmly and thoughtfully. It is a time fraught with danger, and I hope that lawmakers hold to their principles during this hectic time.

The situation that lawmakers find themselves in is certainly NOT business as usual. I will work to keep you up to date as this hectic period plays out. I encourage you to take the time to inquire where your Members of Congress stand on those healthcare issues that affect you and your family. Your voice can be powerful as it encourages lawmakers to not let the frantic oratory of the moment and the lure of the deal overcome their calm considerations and decisions.

Best, Thair

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