Jan. 7, 2025, 6:36 p.m.
Key House lawmakers hope to revive health provisions dropped from the temporary funding agreement in December, with some floating the fiscal 2025 omnibus package and reconciliation measures as possible avenues.
In the last week before Congress left for the holidays, lawmakers rushed to extend government funding into March. A first draft of this extension clocked in at over 1500 pages, with more than 500 of those devoted to health policies.
The provisions spanned several bipartisan health issues, including regulating pharmacy-benefit managers, addressing patent thickets, and reauthorizing laws that help address drug overdoses and prepare for pandemics.
But due to complaints from President-elect Trump and his billionaire adviser Elon Musk about the scope of the bill, the measure was cut down to fewer than 200 pages without most of those health reforms.
House lawmakers on Friday told National Journal they don’t think this is the end of the line for the measures. “They were very bipartisan. … They just didn’t belong on this package and they confused a lot of people,” said House Appropriations Chairman Tom Cole when National Journal asked if they could be revived.
Incoming Energy and Commerce Committee Chair Brett Guthrie said, “We’re still pursuing them,” but he added that he wasn’t sure which legislative vehicle they would ride on. Guthrie said there were communications challenges surrounding the continuing resolution. “That’s what I talked to the steering committee [about] when I was running for this chair, to communicate with the conference more on bills,” he said.
Rep. Frank Pallone, who will serve as top Democrat on the committee, said he is working hard to get the measures into the final fiscal 2025 omnibus. The gutting of the continuing resolution drew the New Jersey lawmaker’s ire, and he called the Republicans’ move to “walk away from that bipartisan agreement” shameful in a statement last month.
Some of these measures, including the multitude of pharmacy-benefit-manager reforms, are scored as cost-savers by the Congressional Budget Office. Pharmacy-benefit managers design and implement the drug benefit for a health plan, which involves negotiating drug rebates and creating formularies. But lawmakers on both sides have been concerned that the “middlemen” have been adding to drug costs.
Proposals that were axed last month would have delinked PBMs’ compensation under Medicare from the cost of a drug. Instead, their remuneration would rely on a service fee. A version of this proposal included in a package from the Senate Finance Committee, which also had transparency requirements, was preliminarily estimated to save the program $702 million over a decade.
Under Medicaid, spread pricing would be prohibited. This is where a PBM charges a health plan more than what is paid to the pharmacy, pocketing the difference. A version of this proposal that was also in the Senate Finance Committee bill was estimated to save the government $313 million over 10 years.
An additional provision dropped in December was an effort to prevent pharmaceutical “patent thickets.” This is when pharmaceutical companies use their patent claims to keep competitors off the market. The policy, which passed the Senate unanimously in a standalone bill, limits how many patents a biological drug sponsor can assert over drug makers seeking to produce a biosimilar. CBO estimated this section would decrease the deficit by $1.8 billion over 10 years.
Cole and Guthrie said provisions that are cost-savers could be looked at for the Republicans’ reconciliation plans. Trump has called for “one big, beautiful bill” to address his agenda but signaled on Tuesday morning that he is open to two reconciliation bills. He also noted in remarks at Mar-a-Lago that he likes spending cuts.
When asked if the PBM reforms could be included in reconciliation, Guthrie said since they save money, that “makes them certainly a candidate for reconciliation.” Anything going through a reconciliation package, which can be passed out of the Senate on a simple majority, has to meet strict requirements on how it impacts the federal budget and is often left up to the judgment call of the parliamentarian.
Guthrie later told National Journal in an emailed statement Tuesday, “We’re laser focused on working to deliver on [President Trump’s] agenda for the American people through the reconciliation process.” He added that members had done “significant work” on a variety of health issues and they will look for opportunities to get them across the finish line.
Rep. Vern Buchanan, chair of the House Ways and Means Health Subcommittee, expressed disappointment when several of the health measures were dropped from the continuing resolution. But his office said in an emailed statement that “he is hopeful that the Republican House majority can use the appropriations process or a reconciliation bill to pass wider health policies to increase access to affordable health care and help Make America Healthy Again.”
Buchanan would like measures to reform PBM regulations, modernize health savings accounts, and lower costs for caregivers included in forthcoming packages. Already in this Congress, the Florida lawmaker has introduced legislation that would allow individuals to pay for care for a parent out of their HSAs.
Buchanan also wants a permanent extension of telehealth flexibilities that remove geographic limitations and allow beneficiaries to receive services in their homes. These flexibilities were enacted during the COVID-19 pandemic and have been temporarily extended. The continuing resolution continued these flexibilities through March.
Rep. Buddy Carter, chair of the House Energy and Commerce Health Subcommittee, also named Medicare telehealth extensions as a priority in a statement to National Journal. When it comes to PBMs, Carter said that all “options are on the table” and that these reforms “are desperately needed to build a health care system that puts patients before profits.”
Carter also touched on reauthorizing health care programs without naming specific policies.
The original, lengthy funding package included reauthorizations of the Support Act and policies under the Pandemic and All-Hazards Preparedness Act.
The original continuing resolution provided a five-year extension to grant programs to support substance-abuse treatment for pregnant and postpartum women, train first responders, and run a loan-repayment program for the workforce. Preparedness measures included enhancing domestic wastewater surveillance, planning for cybersecurity threats in health care systems, and improving development of diagnostic tests.
Guthrie said he hopes with the new Senate, both chambers can negotiate policies and not “at the last hour.”
“The preferable way is you pass bills and the Senate takes up bills and they send them back. … But the Senate didn’t do that last time. [They] left everything to the very end,” he said. “You see what happens when you leave everything to the very end?”
