Welcome from Washington DC, where a few inches of snow canceled schools and closed the federal government leaving parents gazing into the horizon for relief and confirmation schools will open in the next day or so. As we stare into the legislative horizon, we wonder if Republicans and Democrats can come together to fund the government to avoid a shutdown. During the Martin Luther King, Jr. holiday weekend a deal was struck on a stopgap measure to extend spending authority until March 1 and March 8, keeping intact Speaker Johnson’s laddered approach. However, with time being of the essence, can Congress act quickly (not its best trait) to pass the measure through both bodies in time? Welcome to the Week Ahead – where the 118th Congress continues to struggle to meet the most basic legislative tasks.
The Administration
The Border. Negotiations on border security continue but seem to be stuck at the same time. As we reported earlier, border security is being tied into any additional funding for Ukraine, Taiwan, and Israel by Speaker Johnson and other Republicans. The issue at hand appears to be the ability for the administration to continue to use parole authority. This power allows the government to grant the ability for migrants to have temporary permission to live and work in the United States even though a path to citizenship may not exist. Parole authority is a must have for the Biden administration, but Republicans see this tool as a way for immigrants to get around Congress when they otherwise cannot gain access into the country. It remains a sticking point and could tie up foreign aid to America’s allies.
Healthcare
Medicare Advantage. A MedPAC presentation and report Friday states the federal government will pay $88 billion more than it should this year because they attract healthier lower-cost beneficiaries thus driving sicker beneficiaries into traditional Medicare. The report also mentions complicated upcoding procedures used to drive up payments to plans.
The Senate
The Continuing Resolution. The Senate is scheduled to hold a vote on the legislative vehicle short-term continuing resolution to extend the government funding deadlines to March 1 and March 8. Despite the snow, the vote is on! Senators who wish to oppose the CR can do so until Sunday, but the Senate really needs to move on this to avoid a shutdown. Both Leader Schumer and Senator McConnell will work to address any concerns members have to prevent this from happening. The CR does not address major issues like funding for our allies or the border security issue, but it does give more time for appropriators to pass their bills before automatic spending cuts come to fruition in mid-April.
Healthcare
The Senate Health, Education, Labor and Pensions Committee will hold a hearing addressing long COVID on January 18th at 10am.
The House
On the Clock. The House is scheduled to hold votes tonight to encourage members to be back in town despite the weather. It is thought Speaker Johnson may have to work this week to get the proposed CR to pass via suspension which requires a two-third majority, Democrats appear to be united behind passing the CR and helping get this across the finish line. However, it will not come without asks from the Democrats – so let the negotiating begin!
Healthcare
The House returns after the Martin Luther King, Jr. holiday with a slate of bills and resolutions to consider, but the most pressing question as the House reconvenes will be whether enough House Republicans will vote to join Democrats later in the week and avert a partial government shutdown before the first funding deadline under the “laddered” continuing resolution (H.R. 6363) that Congress passed late last year hits on January 19.
While an agreement has been reached between Speaker of the House Mike Johnson (R-LA) and House Majority Leader Charles Schumer (D-NY) on topline spending numbers, much remains to be determined—not only on final appropriations for the rest of the fiscal year but on health policy priorities as well. Under the “laddered” agreement agreed to by Speaker Johnson and Leader Schumer reached late last week, a final agreement on significant health legislation is now not expected until at least March as multiple health extender deadlines that were previously set for either January 19 or 20 will now be extended to either March 8 or 9. Expiring provisions pending to be renewed include payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).
Prior to adjourning in December, the House passed both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act with broad bipartisan support, and House leaders are pushing for inclusion of many of the bills’ provisions including measures on price transparency, pharmacy benefit manager reform, and hospital payments in a final government funding package for 2024.
The largest health policy casualty of Congress failing to reach an agreement on government funding and larger health hit physicians and other clinicians under Medicare. When Congress adjourned in December, momentum appeared to be building for Congress to provide at least partial relief from the 3.37% cut in Medicare physician payments that took effect on January 1, but Congress failed to reach an agreement on additional relief from Medicare payment cuts in 2024. As a result, Medicare payment rates resulting from the 3.37 percent cut are expected to remain throughout 2024.