Will Congress Legislate on Important Healthcare Issues Before 2025?

As the calendar year draws to a close, Congress faces ever-increasing pressure to pass important pieces of legislation. The final month of a congressional session is typically a flurry of activity, with lawmakers pushing to finalize bills on matters ranging from government funding and national defense to healthcare policy.

If Congress fails to pass key healthcare legislation before the end of the session, the repercussions could be felt across the nation, as critical funding delays and healthcare policy decisions make the consequences of inaction profound.

Here are a few examples that we’re watching closely as we move into December and approach Congress’s adjournment before the holidays:

One of the most immediate and tangible risks of Congress failing to pass essential legislation before the end of the session is a government shutdown. If lawmakers cannot reach an agreement on appropriations or a continuing resolution to fund the government before the end of the year, federal agencies, including the U.S. Department of Health and Human Services (HHS), will be forced to close their doors, potentially disrupting essential healthcare services and initiatives.

Beyond government agency funding, Congress often uses the closing month of the session to pass bills that address critical domestic healthcare issues. This time around is no different, as Congress is faced with preventing the 2.83-percent cut in Medicare physician payments before the cut takes effect on Jan. 1.

In addition to this pending legislation, a bipartisan group of senators recently sent a letter to Senate leadership arguing that these cuts will lead to lower-quality care – and pointing out that this is the fifth consecutive year of cuts, now compounded by a jump in inflation and the Medicare Economic Index, prompting the president of the American Medical Association (AMA) to suggest that “Medicare plans to pay physicians less, while costs go up.”

Funding for Community Health Centers, Medicaid Disproportionate Share Hospitals, and various Medicare and HHS extensions are also at risk if Congress doesn’t act.

Additionally,while the Drug Enforcement Administration (DEA) and HHS officially extended telehealth flexibilities for prescribing controlled substances for another year – until the end of 2025 – rules for telehealth access under certain health plans are still set to expire at the end of this year if Congress fails to take action.

Initially, COVID-19 pandemic rules allowed high-deductible health plans to cover telehealth for patients before they reach their deductibles, in order to help curb the virus’s spread. Those provisions were continued for two years at the end of 2022, but that extension is nearly up.

And while it’s still unclear whether lawmakers will take up this issue, telehealth legislation in the House to make the rules permanent has been introduced, but comes with a significant price tag of $5 billion over a decade – making other, less-expensive priorities more likely to take precedence in healthcare package negotiations.

Finally, looking forward to 2025, a big question is whether the new GOP-led White House and Congress will continue federal subsidies for enrollees in Patient Protection and Affordable Care Act (PPACA) marketplace plans. A recent report indicates that PPACA enrollment will decline by approximately 7 million people if Congress allows federal subsidies for marketplace plans to expire after next year.

These enhanced premium tax credits helped expand eligibility and lower PPACA premiums during and after COVID, but are set to expire at the end of 2025, which could as much as double premiums for PPACA enrollees in certain states like Wyoming, Alaska, and West Virginia.

So, if you think Congress’s final month of a lame-duck session isn’t very relevant, think again. In the coming days, lawmakers will be judged on what they don’t do just as much as what they do, with serious consequences on the line for the healthcare industry.

As usual, stay tuned.

Reference Material

1. The Trump picks who want to reform health care – POLITICO
2. Upcoming Congressional Fiscal Policy Deadlines-2024-05-17
3. Four Million People Will Lose Health Insurance If Premium Tax Credit Enhancements Expire in 2025 | Urban Institute
4. DEA, HHS issue another extension for telehealth controlled substance prescribing | Healthcare Dive
5. US Senate letter