WASHINGTON — In Congress, year-end government spending programs, along with many other priorities, are called “Christmas tree” bills.
This year, health care policy looks more like Charlie Brown’s tree than the one at Rockefeller Center.
House lawmakers voted 366-34 Friday to pass a spending bill. The bill, which funds the government for three months, must still be passed by the Senate and signed by President Biden.
Funding for little-known public health programs survived in the bill, as did a short-term expansion of the ability of seniors to access telehealth from home. But lawmakers have been unable to achieve any health care goals this Congress beyond the status quo.
After two years, all of Congress’s work on legislation to rein in prescription drug middlemen called pharmacy benefit managers has come to nothing. Lawmakers introduced 95 PBM-related bills during that period, according to the Congressional Legislative Database. It’s a gift to the PBM industry, which has survived nearly a decade of scrutiny intact — and to the massive insurers that own it. The largest PBMs are UnitedHealth Group’s Optum Rx, CVS Health’s Caremark and Cigna’s Express Scripts.
The bill includes more than $100 billion in disaster relief and $10 billion in emergency agricultural aid.
Doctors have lost their vacation bonus. Medicare doctor salaries will be 2.8% lower on Jan. 1, after lawmakers ignored doctors’ calls to continue premium payments that began during the Covid-19 pandemic.
Legislation aimed at combating legal tactics used by pharmaceutical companies to delay competition for expensive drugs has also failed, five years after the start of the debate.
Provisions of a law passed to prevent pandemics have expired, less than five years after society shut down following the deadliest pandemic in a century. And even though more than 100,000 Americans died of drug overdoses last year, a law aimed at combating the opioid crisis has lapsed.
Hundreds of pages of smaller provisions were also hastily deleted, including provisions aimed at helping children with canceropening Republicans to attacks from Democrats. But in a rare move, the Senate unanimously passed pediatric cancer research funding as a standalone bill.
Medicare coverage for cancer screening blood tests has also been thrown out the window.
Hospitals are coming out of this in a pretty good position, however. Grant programs for hospitals were among the few expanded programs in the government’s funding bill, and a hospital billing transparency measure that the industry didn’t like was left out of the final package.
It is possible that some provisions will be reinstated in the future. Both Trump and Johnson have expressed interest in recent days in putting guardrails around pharmacy benefit managers.
“We’re going to cut out the middlemen…I don’t know who these middlemen are, but they’re extremely wealthy,” President-elect Trump said at a news conference this week.
But the convoluted dance aimed at avoiding a government shutdown portends the challenge of doing anything that doesn’t unite the entire House Republican caucus.