Government Shutdown Looming as Congress Dithers

Like most of the world, I procrastinate when paying my bills. I tend to put them off until the very last minute.

And that pretty much explains Congress’s strategy last year – and they clearly plan on continuing this approach for 2024. The tough stuff, like funding a government, gets put off until it’s coming down to the wire – but then, Congress does something most people can’t: they move the deadlines and keep putting it off.    

And so, Congress is kicking off 2024 with a lot of work on its plate – mostly last year’s work that has been put off until this year. Let’s first talk about this year’s budget.

This past weekend, congressional leaders from both parties announced a kind of agreement on the budget that needs to pass before Jan. 19: that’s the new deadline that Congress had pushed back from last year.

But the announcement last weekend was really just both parties clearing their throats, kind of like when my daughters announce at 9 p.m. that they are going to get started working on their homework … which was actually due yesterday.

A Forbes article cited experts estimating that there’s only a 30-percent chance that Congress will actually pass a budget by Jan. 19. So, go ahead and cue the usual list of consequences that will happen should the government shut down on Jan. 20.

Not mentioned in this round of budget talks is the 3.4-percent cut to the Medicare physician fee schedule. That cut has been in effect since Jan. 1, last week. There are a number of bills that have been passed by the House and Senate that could fix the cut, and late last week the House introduced yet another bill that would cancel it. However, it doesn’t look like any of these bills will make it into the Jan. 19 budget.

The next budget deadline that Congress set for itself was Feb. 2, so we’ll keep our eyes open to see if the cut will be addressed before then.  

If you do the math, we expect a 4.6-percent inflation increase in physician expenses – that’s the yearly Medicare Economic Index – so add the 4, carry the 1, and you’re at an 8-percent shortfall for physicians in 2024.

Looking forward to the rest of the year, there are a number of healthcare policy issues that will impact providers.

Expiring this year: COVID hardship exemptions for the Merit-Based Incentive Payment System – or MIPS. This means that, for some providers, this will be the first year they participate in MIPS – which, depending on one’s performance, can result in a reduction of up to 9 percent in reimbursement for Medicare-covered professional services.

Under construction this year: the government portal for No Surprises Act (NSA) disputes, with upgrades on that portal, promised in a recently proposed rule. Higher dispute resolution fees take effect on Jan. 22 of this year, and NSA lawsuits and appeals promise to continue – so we’ll see plenty of activity here. Also, Congress has a number of bills lined up that will add hospital and health plan transparency requirements and increase enforcement efforts.

Throw in activity on telehealth and artificial intelligence in healthcare, coming from both Congress and the administration, along with policies to fight the opioid epidemic, and the continual administrative struggles of the Medicaid unwinding, and D.C. has a challenging year ahead of it.

One thing we will not see in 2024, despite the fact that it is an election year, is the introduction of any broad, substantive health reform. Both parties and the administration are content with making fixes here and there, but it is unlikely that this Congress – or this or any future administration or Congress – will suggest any overhauls to the system. For substantive health reform, we will look to some interesting experimenting being done at the state level, but we’ll save that for a future article.