Capitol Outlook: Lame Duck 2024

Our full Capitol Outlook is available here with an abbreviated version below:

October 2024 – Washington, DC: Now that the Fall recess is in full swing, speculation is rampant in Washington, D.C. about what the lame duck session will bring in terms of health care policy after the presidential election.

UNWRITTEN LAME DUCK RULE
Congress is set to return to Washington on Tuesday, November 12th.  There are some unofficial rules that guide so-called “lame duck” sessions. For one, if there is a new incoming administration entering the White House in 2025, virtually all substantive policy decisions are usually punted to the early months of next year. A corollary to that rule is that a large omnibus appropriations bill sustains a similarly substantial end of year health care package. By contrast, potential Continuing Resolutions in December make for small and temporary health care patches. Finally, three out of every five lame duck sessions are truly lame. But the memory of the big year-end blockbusters keeps all the players at the table. These conventions will structure debates around the following health care policy issues:

TELEHEALTH
Both the House Energy & Commerce Committee and the Ways & Means Committee have passed similar legislation to extend rules expanding access to virtual health care for Medicare patients before such provisions expire at year’s end.  For example, both measures continue reimbursement for so-called “audio only” telehealth visits and both provide payment for tele-mental health care offered by Federally Qualified Health Centers and Rural Health Clinics. The policy questions still in play are what is the length of the telehealth extensions and what is the cost. The House bills extend telemedicine waivers for two years with a budget score of roughly $2 billion per year, but neither measure fully offsets the cost.

DOCTORS, CLINICS, HOSPITALS
The last day of 2024 confronts Congress with a series of deadlines for Medicare and Medicaid health care providers. Medicaid Disproportionate Share Hospital (DSH) cuts are scheduled to impact safety net hospitals around the United States. In addition, operating funds for hundreds of Community Health Centers (CHCs) are also set to expire. Not to be left out, physicians are seeking help from members of the Senate Finance Committee and the House Ways and Means Committee to avert a scheduled cut to how much Medicare pays doctors, which is set to go into effect in early 2025.

LEGACY HEALTHCARE AGENDAS
An astonishing number of senior members from key health care committees of jurisdiction are retiring at the end of the 118th Congress. Many will be seeking to secure their legislative legacies in the lame duck session.  Here are two examples:

Rep. Cathy McMorris Rodgers, Chair of the powerful House Energy & Commerce Committee, has allocated an enormous amount of committee time and political capital to reforms of – and improvements to – the Medicaid Home and Community Based Services (HCBS) program. Since its inception more than 40 years ago, Medicaid recipients – typically persons with disabilities or multiple chronic conditions – must demonstrate a need for an institutional level of care to qualify for an HCBS placement in the community. Chair Rogers strongly supports an ambitious bill that would remove that requirement, thereby substantially expanding access to home-based care.

Sen. Debbie Stabenow, a social worker by trade, has spent many years advocating in Congress for better mental and behavioral health care, and much of the last fifteen years building on President John F. Kennedy’s legacy to create a nationwide system of truly effective community-based services for persons with serious mental illness, called Certified Community Behavioral Health Clinics (CCBHCs). In her remaining days in Congress, it is reported that Sen. Stabenow may see an opportunity to make CCBHCs a permanent part of the Medicaid program by securing appropriate reimbursement for intensive community-based care, while also seeking to expand the role of clinical social workers in Medicare.

HOMELESS WOMEN AND FAMILIES
In the last year, we have seen increasing bipartisan attention on Capitol Hill and in the Administration aimed towards Social Determinants of Health (SDOH) such as housing, food security, education, and other factors. A particularly tight focus is on the nationwide plight of shelters and safe havens who serve homeless women and children. This summer, the Senate Appropriations Subcommittee on Transportation, Housing, and Urban Development (THUD) released specific committee report language on interagency technical assistance for housing-related supportive services and behavioral healthcare. Further, they directed the Department of Housing and Urban Development (HUD) to review its implementation of grants for emergency shelters. To our knowledge, this is the first THUD report in a long time that points to the importance of homeless shelters and the need to support their continuum of operations. We anticipate more attention and action will focus on these issues.

WILD CARDS
Players at the table always have wild cards are they are not showing. In the health care space, we are not talking about a hidden card up a sleeve, but rather legislation associated with substantial projected Congressional Budget Office (CBO) scored savings. In the context of this lame duck, there are at least four.

Repealing the Medicaid Nursing Home Staffing Standard: Over the summer, the Center for Medicaid and CHIP Services promulgated a set of regulations that established minimum staffing requirements for hundreds of nursing facilities across the country. On a party-line vote, the House Energy & Commerce Committee recently passed legislation repealing those rules.
Hospital Site Neutral Legislation: For several years now, there has been substantial bipartisan interest – in both houses of Congress – in standardizing Medicare payments for outpatient services regardless of the healthcare facility in which they are delivered. These bills have triggered furious opposition from hospitals who say they cannot afford payment cuts for care provided at their outpatient facilities.    
Pharmacy Benefit Managers (PBM): There seems to be endless television and digital advertising to the front-page New York Times stories exposing seemingly shady PBM dealings. To say that there is significant bipartisan momentum to reform the business practices of PBMs, which are intermediaries who negotiate rebates between insurers and drug companies, is the understatement of 2024. 
Hurricane Relief:  The upcoming disaster supplemental funding bill has the potential to completely upend the lame duck session. There are credible reports that the legislation could exceed $100 billion with all the funding directed at red states – Florida, Georgia, North Carolina, and Tennessee – making it a must past legislative vehicle by New Year’s Eve. Bills of this type have historically become Christmas trees attracting all manner of health policy ornaments. [See the legacy items discussed above].

One more quick, non-partisan note…

HAVE YOU CHECKED YOUR VOTER REGISTRATION?
‘Tis the season for doing your civic duty. At Guide Consulting Services, we encourage full participation in the election process and ask that you take a moment to verify, update, or register your voter status. For a quick overview of the process and to find your state’s election site, check out https://www.usa.gov/confirm-voter-registration.
 
We will see you after the election with an end-of-year update. In the meantime, stay healthy and enjoy the fall colors. You can sign up HERE to personally receive our newsletters in the future.