We know many readers may still be working through Thanksgiving leftovers, but this week, Congress is serving up nothing but lame duck. However, this meal could turn into a food fight real fast, with Congress running out of time to make decisions about government funding, the Farm Bill, and the National Defense Authorization Act. So, let’s get into it. Welcome to the Week Ahead!
The Administration
The Biden administration proposed its Contract Year 2026 Medicare Advantage and Part D rule on November 26. This rule is one of the last major ways the Biden administration can leave its mark on the MA and Part D programs, and they didn’t hold back. The rule proposes allowing Part D plans to cover anti-obesity medications in cases where the beneficiary does not have another health condition beyond obesity or being overweight. Under the new proposal, plans would be able to cover these drugs for beneficiaries who are obese but not those who are overweight. Additionally, Medicaid plans would be prohibited from excluding anti-obesity drugs if used to treat obesity. The rule also includes proposals to strengthen prior authorization and utilization management guardrails under the MA program. The rule, if finalized, would also codify previously issued guidance about implementing the provision of the Inflation Reduction Act that will allow Part D beneficiaries to spread out their out-of-pocket costs monthly instead of paying all at once.
But here is the kicker: it will be up to the Trump administration to finalize the rule, so what can we expect from the incoming administration on this proposed rule? Well, we know that President-Elect Trump’s nominees to head Health and Human Services (RFK Jr) and the Centers for Medicare and Medicaid Services Administration (Dr. Oz) don’t see eye to eye on anti-obesity medication.
RFK Jr. has criticized these drugs, but Dr. Oz has expressed support for them. We also know Dr. Oz has been a strong supporter of MA, so if he is confirmed, MA plans may have a more friendly voice within the administration.
As far as how the Trump administration will handle the implementation of the IRA, it’s about as clear as Thanksgiving gravy! Congressional Republicans have criticized the Medicare price negotiations as price controls. However, President-Elect Trump did pursue several proposals to reduce drug prices. Combine that with the unconventional pick of Dr. Oz to run CMS, and you’ve got a recipe for a potential surprise.
The Senate
The Senate Democratic Caucus will hold its leadership elections for the 119th Congress on December 3. The most hotly contested race will be between Senator Amy Klobuchar (D-MN) and Senator Corey Booker (D-NJ) to take over leadership of the Democratic Policy and Communications Committee from retiring Senator Debbie Stabenow (D-MI).
In addition to the Senate Democratic leadership races, we will be watching for any news related to the makeup of key health care committees in the Senate, including the Senate Finance Committee, which has jurisdiction over Medicare and Medicaid.
Due to retirements and the results of the 2024 elections, 5 Democratic senators currently serving on the Senate Finance Committee will not be returning for the 119th Congress. Even though the Senate Democratic Conference will have fewer seats on that committee, there will still be a need to fill some of these vacancies. Senator Bernie Sanders (I-VT) made news on November 22 by announcing his desire to serve on the Senate Finance Committee, which would be in addition to his service as the ranking member of the Senate Committee on Health, Education, Labor, and Pensions (HELP) in the next Congress.
Other Democratic senators who have reportedly expressed interest in joining Senate Finance include Sens. Tina Smith (D-MN), Raphael Warnock (D-GA), and Corey Booker (D-NJ).
We predict the GOP will gain 2-3 seats on the Senate Finance Committee due to the revised committee ratios. No Republicans currently serving on the Senate Finance Committee are retiring or lost reelection.
We will also be watching to see if congressional appropriators will respond to the letter from Senator Ted Budd (R-NC) and other senators from states impacted by recent hurricanes, requesting approval of the Biden administration’s request for supplemental funding request for disaster relief.
Additionally, the Senate HELP Committee is holding a hearing on December 5 about what the Food and Drug Administration is doing to regulate the food and beverage industry in light of the diabetes and obesity epidemics in America.
The House
Since the House of Representatives is the starting point for appropriations bills, let’s check in on where things stand on that front. From what we are hearing, it sounds like the House will be teeing up a short-term (3-4 month) continuing resolution – delaying any funding decisions for FY 2025 until the new Congressional session.
We also expect this bill will not include anything related to health care beyond the health care extenders. Based on analysis from recent Congressional Budget Office scores, we estimate extending these health care policies for a few months will cost $2-3 billion. Only acting on health care extenders is bad news for advocacy groups, which have been urging Congress to include other policy changes in any year-end legislation. Physician groups have been hoping that Congress might address concerns about how doctors’ pay under Medicare is calculated, but that seems unlikely to happen.
Additionally, the House Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic will be holding a markup of their final report on December 4.
There You Have It
We recently posted about unique Thanksgiving food on LinkedIn. We’d love to hear if any of these (or any others) made it on your table this year. Make it a great week!