Congressional State of Play
While recent legislative activity has involved significant bipartisan compromises on tax and supplemental appropriations packages, conflicts between the chambers now threaten to hinder the passage of either proposal. Despite the recent burst of activity on these measures, lawmakers will soon be compelled to redirect their attention back to appropriations – as the looming two-tiered government shutdown deadlines of March 1 and March 8 persist. Although lawmakers were able to reach an agreement on overall spending just before the end of January, the breakdown of recent bipartisan compromises coupled with ongoing debates over the inclusion of contentious policy provisions jeopardizes any potential to pass all twelve appropriations measures before the respective deadlines. Both the House and Senate are scheduled to break for recess this month, meaning lawmakers will once again return to DC with a short timeline to reach an appropriations compromise before government funding runs out at the start of March.
In the Senate, four months of negotiations culminated on February 4 with a bipartisan unveiling of a $118 billion proposal for a national security supplementary appropriations bill that would include funding for Taiwan, Ukraine, Israel, and immigration enforcement. The bill would have represented some of the most significant immigration reforms seriously considered by the Senate in years. However, the proposal quickly lost momentum after nearly half of Republican Senators, Speaker of the House Mike Johnson (R-LA), and former President Donald Trump all announced their opposition based on rumors of the package’s contents. Speaker Johnson’s opposition, outlined in a letter he shared with House Republicans, compelled Senate Minority Leader Mitch McConnell (R-KY) to acknowledge that the package did not have a realistic path forward despite widespread support in the Senate. While Majority Leader Chuck Schumer (D-NY) still brought the package up for a procedural vote on February 7, after that vote failed, he pivoted quickly to drop the measure’s immigration provisions before reconsideration. Additionally, Republican Senators are delaying consideration of the House’s bipartisan tax package over frustrations that they were excluded from the negotiating process. The GOP Senators are demanding an opportunity to review the bill in committee and submit amendments – threatening to block the measure entirely if their demands aren’t met.
In the House, Speaker Johnson suffered two significant defeats in back-to-back votes at the hands of his members on the evening of February 6, further complicating a Republican conference that has only grown more frustrated with Johnson’s leadership abilities. The first measure to fall short was Speaker Johnson’s response to the bipartisan national security supplemental appropriations package that is moving through the Senate, an Israel aid-only version of the measure out of protest for the Senate’s refusal to negotiate with the House on the package’s immigration provisions. While Johnson’s standalone Israel-aid bill had been expected to fail, later the same evening the House’s Republican Majority also narrowly failed to impeach Homeland Security Secretary Alejandro Mayorkas for his handling of illegal immigration. The high-profile impeachment defeat, coming after months of Republican-led investigations and plenty of consternation from the Speaker over whether to proceed with the heavily politicized effort, was deeply embarrassing for Republican leadership who appear to have underestimated Democratic attendance for the vote. Even just hours ahead of the final vote, Johnson had expressed confidence that the measure would pass, despite the exceedingly tight margin. While several Republicans have committed to revisiting both proposals once Majority Whip Steve Scalise (R-LA) returns from treatment the week of February 12, there is no doubt that the tandem of highly visible defeats for the Republican leadership has only further driven speculation about Johnson’s ability to govern the caucus and deliver votes on pressing matters like appropriations."
On January 26, Senate Appropriations Chair Patty Murray (D-WA) and House Appropriations Chair Kay Granger (R-TX) announced they had reached a deal on the topline spending totals for each of the twelve appropriations measures. The individual funding toplines, known as ‘302b’ numbers, are the split of the roughly $1.7 trillion federal budget that will be allocated to each appropriations subcommittee to draft their respective appropriations measures. With the 302b numbers in hand, it allows subcommittee leaders to begin crafting the finer points of policy and funding priorities for the spending bills that fall under their jurisdiction. Although the 302b numbers are customarily safeguarded until the subcommittees unveil their initial drafts, Rep. Sanford Bishop (D-GA), the leading Democrat on the agriculture appropriations subcommittee, has hinted in interviews that his subcommittee's allocations surpass those designated for FY2023. While this information alone cannot project the totals for other spending bills, there's a possibility of additional funding details emerging through media reports as the deadlines for federal appropriations draw near.
Equipped with the topline numbers, Chairs and Ranking Members of the Appropriations subcommittees in both the House and Senate engaged in meetings during the week of February 5 to discuss the programmatic details of the individual bills under their purview. However, discussions about potential policy riders attached to the final House and Senate versions of each measure are notably absent from these deliberations. This year, the House opted to incorporate several highly contested policy riders, particularly those restricting abortion access, deemed as "poison pill" provisions by many Congressional Democrats. While temporarily setting aside the possibility of these provisions making it into the final appropriations bills may be the only way to achieve consensus on other aspects of the legislation, lawmakers will need to address these details before the government funding deadlines on March 1 and 8 to avert a shutdown. Despite this looming threat, Committee leaders Rosa DeLauro (D-CT) and Tom Cole (R-OK) have expressed confidence in their ability to resolve any outstanding disagreements ahead of the March 1 deadline.
In addition to the provisions within each spending bill, there are still lingering questions about how pass the final measures – a growing concern given the limited timeframe. Discussions persist among lawmakers in both chambers about consolidating the dozen FY2024 funding bills into one omnibus package, a mechanism that has been staunchly opposed by Congressional Republicans throughout the past year. Sen. John Kennedy (R-LA), the ranking Republican on the Energy-Water subcommittee, predicts that the government will either be funded through an omnibus or a continuing resolution until September, depending on the popularity of the omnibus among his Republican colleagues. On the opposite side of the Capitol, counterparts of Kennedy, like Rep. Mario Diaz-Balart (R-FL), chair of the State-Foreign Operations funding panel, assert that a large omnibus is not on the table, emphasizing the Speaker's clear stance against it.
While the fate of FY2024 appropriations remains uncertain, the White House has disclosed that President Joe Biden will present his FY2025 budget request to Congress on March 11, just three days after the second government funding deadline lapses. This document will outline the Biden administration's funding priorities and establish a framework for congressional action. The release of the budget will also exert new pressure on Congress to initiate work on fiscal 2025 bills at the conclusion of a tumultuous and protracted fiscal 2024 appropriations process that has already necessitated three short-term funding extensions.
Issue Overview: Medicare Pay Reform
SNO has undertaken the initiative to assess reforms to the Medicare physician reimbursement system, aiming to establish a more equitable structure that accurately reflects the comprehensive services provided and the intricate care demanded by patients with brain tumors. While existing billing codes encompass a variety of services beyond direct brain cancer treatment, there is a notable absence of codes specifically quantifying the unique time and effort invested in addressing cases related to brain cancer and other complex pathologies. The varied origins, manifestations, and complications associated with brain tumor development pose a distinctive challenge, influencing treatment options and strategies. Crafting a precise and individualized treatment plan demands the involvement of neuro-oncologists and other specialized professionals in activities that go beyond the routine services provided during a patient visit. These activities include in-depth case research, collaborative information sharing with colleagues in both office settings and conferences, and tumor modeling—activities not adequately addressed by current billing codes. Existing codes, such as 99367 for medical team conferences involving an interdisciplinary team of healthcare professionals or 99358 for prolonged evaluation and management services before and/or after direct patient care, come with cumbersome stipulations. For instance, they may require multiple participants to be engaged in the face-to-face treatment of the same individual or demand that services must fall within a narrow window preceding face-to-face time. These conditions create limitations that hinder the codes from effectively capturing the nuanced and comprehensive care provided in cases of brain tumors.
A potential avenue for advancing the Medicare pay emerged on February 9 when Senators Catherine Cortez Masto (D-NV), Marsha Blackburn (R-TN), John Thune (R-SD), John Barrasso (R-WY), Debbie Stabenow (D-MI), and Mark Warner (D-VA) jointly announced the formation of a bipartisan Medicare payment reform working group. According to the group's press releases, their primary goal is to conduct a thorough examination and propose enduring reforms to the physician fee schedule (PFS) while also making essential updates to the Medicare Access and CHIP Reauthorization Act (MACRA). Recognizing the dynamic nature of the healthcare system, the Senators contend that the current physician payment system is inadequate in keeping pace with the actual cost of care and advancements in new services and technologies. Underlining the crucial role of Medicare Part B in delivering essential services to millions of Americans, the Senators believe this initiative will underscore the necessity for Congress to address reimbursement challenges and transition towards a payment system aligned with patient outcomes. The working group aims to ensure financial stability for healthcare providers, improve patient outcomes, promote access to quality care, and encourage the adoption of emerging healthcare technologies. They plan to seek bipartisan solutions through stakeholder feedback and policy development in the coming weeks.
House E&C Chair Announces Retirement
On February 9, Representative Cathy McMorris Rodgers (R-WA), the leading Republican on the House Energy and Commerce Committee, announced her decision not to seek reelection, joining the ranks of a number of senior Republicans on the committee that have opted for retirement in recent weeks rather than stand for re-election this November. To provide context, the Energy and Commerce Committee holds broad jurisdiction encompassing a spectrum of policy areas, with a particular focus on health-related matters and shaping the structure of the nation's healthcare system. Chair McMorris Rodgers, in particular, has earned recognition for her endeavors in reforming US health policy, playing a crucial role in negotiating the five-year reauthorization of the FDA's user fee program, among other initiatives. The announcement of her departure creates a notable opening at the helm of one of the House's most influential committees, triggering a race to succeed her. Although McMorris Rodgers has declared her intent to complete her current term, several colleagues have not hesitated to express their ambitions to replace her. The following Members of Congress have either announced or are expected to announce their intention to succeed Chair McMorris Rodgers:
- Rep. Brett Guthrie (R-KY), chair of the E&C Health Subcommittee, will run to replace her, his office confirmed.
- Rep. Bob Latta (R-OH), who will be the most senior Republican on the E&C Committee next Congress, is running for the chair, per two people with knowledge of the matter.
- Rep. Richard Hudson (R-NC), chair of the National Republican Congressional Committee, is also being encouraged to run for the top committee role, according to two high-level Republicans familiar with the matter. If he ultimately launches a bid, that would mean Hudson would forgo seeking another term in leadership.