Lame Ducks and Stopgaps: End of the Year in D.C.

The term “stopgap” is defined as “a temporary way of dealing with a problem, and something used as an emergency measure until something better can be found.”

As of this writing, we are within a few days of yet another government shutdown. By Friday, Dec. 20, Congress needs to pass a continuing resolution to push the deadline forward again – “continuing resolution” is a polite euphemism for a stopgap measure, or a temporary, emergency method for dealing with a problem.

Interestingly, for the past quarter-century, Congress has passed 136 stopgap bills, averaging five per year. That’s five funding emergencies a year that need a stopgap measure.

But let’s come back to that.

As of a few weeks ago, Congress had hoped to pass this stopgap to fund the government through another year, and it wanted to add on to that budget bill a package that includes disaster aid, aid for American’s farmers, a defense bill, and some healthcare provisions.

A past example of an (overly) comprehensive lame-duck government funding-plus-the-kitchen-sink-type bill is the Consolidated Appropriations Act (CAA) of 2021, the longest bill in U.S. history, put together and passed during the first Trump Administration’s lame-duck session. It included COVID relief, tax and energy provisions, plus a year’s funding for the government. In terms of healthcare, the CAA 2021 also included the No Surprises Act and its many requirements.

Broad legislation the likes of CAA 2021 is likely not going to happen this week. Text of the continuing resolution was supposed to be published so lawmakers could have a couple of days to read it; that didn’t happen. On the last week before the government might shut down, The Hill said that the funding package, as a whole, looks “murky,” and there’s no clarity on what it will include.

One thing we do know is that the stopgap bill is likely to be much skinner than what was first hoped.

It looks like, on the funding end, the proposed stopgap will keep the government open just a few months, until this March, passing the buck to the new Congress to grapple with the budget.  

We expect some (again, skinny) healthcare provisions to be attached, including funding for Community Health Centers.

At the beginning of December, we heard there was bipartisan support for including extensions of the telehealth waivers and some kind of fix for provider reimbursement – which is, as readers know, facing a 2.8-percent cut in Medicare payments in 2025. We’ll see soon enough whether these issues have made the cut.

Since the beginning of December, other suggested healthcare bills have been introduced in Congress as possible candidates to be included in an end-of-the-year package. We’re going to focus on two of them.

We don’t think that these bills will make it into the end-of-the-year package, but both of them are harbingers of what we will see addressed more broadly by the new Congress in the coming year.

First, in early December, Congressional Democrats privately proposed legislation to Republicans to extend the Patient Protection and Affordable Care Act (PPACA) premium tax credits, which are set to expire at the end of 2025.    

Last week, the Congressional Budget Office (CBO) published a report that predicted that if Congress doesn’t extend those PPACA tax credits by December 2025, millions will lose coverage and premiums will jump. However, it’s not clear if the Republicans are on board with an extension; they have been skeptical of the tax credits in the past, and their focus is going to be on tax cuts this year.

Second, a bipartisan bill was introduced last week that would require insurers and Pharmacy Benefit Managers (PBMs) to sell any pharmacies they own. The “Patients Before Monopolies (PBM) Act” gives insurers and PBMs three years to sell any pharmacies they “directly or indirectly own, operate, (or) control.” 

Again, it is unlikely that this bill will pass before the end of the year, but look for both PPACA subsidies and PBM reform to be on Congress’s docket for healthcare issues in 2025.

Now, back to this idea of Congress using stopgap measures in order to kick the can down the road on funding the government.

An idea: I, too, have the usual slew of monthly bills that I have to pay to keep the household functioning. I’m wondering if I could simply write a continuing resolution that, say, sets those bills away a couple months, maybe to the middle of next year. I could send that resolution to my utilities company, my cell phone and Internet providers, and my mortgage lender as a stopgap until I’m in a better position to pay.

Like Congress, I think I could hold myself to only using these stopgap measures say, five times a year.