Major health bills fail to make cut amid competing priorities

Major bipartisan health bills, including changes to the pharmacy benefit manager (PBM) industry and hospital payment reforms, were excluded from the $1.2 trillion government funding bill after members failed to come to a last-minute agreement. 

Lawmakers and aides said they were close to a bipartisan, bicameral agreement, but there were ultimately too many people involved with too many competing priorities to get the package over the finish line.  

Lawmakers in both chambers said they are not giving up, but the next and potentially last opportunity to pass the reform package in this Congress likely won't be until after the November election. 

Sources said a last-ditch attempt came together after an earlier package of appropriations bills also failed to include the reforms. It involved the leaders and ranking members of the health committees in the House and Senate, and it would have added new funding for community health centers, reformed hospital billing practices, and made changes to how PBMs operate. 

But there wasn’t enough time to come to a consensus. Eight out of 10 committee leaders and ranking members were on board, but there were two holdouts from the House. And leadership ultimately did not sign off, choosing to prioritize a clean funding bill.  

Members aren’t giving up on the deal and are now plotting how best to forge ahead. 

“There's open lines of communication. We're negotiating, and I'm very encouraged,” House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-Wash.) said.  

“The path [forward] is every single opportunity until we get it done. This ought to have been done yesterday,” Senate Finance Committee Chair Ron Wyden (D-Ore.) told reporters, adding that the number of people involved made it difficult.  

“It wasn't even really four corners. You know, the traditional Capitol Hill lingo ... I think it was more like five or six corners, and threading the needle is a challenge. We got some work to do in the House,” Wyden said.  

All the potential health riders had bipartisan support, but some were still contentious.  

For instance, one of the changes was aimed at making hospital billing more transparent. But the hospital industry was opposed. 

Industry opposition similarly ended an earlier push to have Medicare pay hospitals the same amount as it pays doctors and standalone facilities for the same services.  

In December, the House passed a bill that included a provision requiring Medicare to pay the same rates for infusion treatment, regardless of whether its done in a doctor's office or in a standalone clinic. 

Hospitals lobbied furiously against it, as they saw the provision as a slippery slope leading to more payment cuts. Republicans and Democrats expressed reservations, and it wasn’t included in the first tranche of government funding earlier this month. 

There was less opposition to PBM changes. The Finance Committee passed a package of PBM reforms in November by a 26-0 vote, and the House had its own set of reforms.  

Ahead of the bill being released, pharmacy groups last week joined with Wyden and Finance Committee ranking member Mike Crapo (R-Idaho) to push for action on PBMs. 

Wyden and Crapo sent a letter to the Finance Committee last week pledging their continued support for PBM reforms. 

"Simply put, our proposed reforms would lower consumer costs, protect small businesses, and save taxpayer dollars. We will continue engaging with all relevant committees and with congressional leadership to ensure the enactment of the priorities crafted and refined by Members across this committee,” the senators wrote. 

In a joint statement ahead of the bill’s introduction, the National Association of Chain Drug Stores, the National Community Pharmacists Association and other stakeholders urged Congress not to waste the bipartisan momentum. 

“Congress is dangerously close to proving wrong the notion that it’s never too late to do the right thing,” the groups wrote.  

“In the current must-pass legislation, Congress’ failure to enact PBM reforms for Americans in Medicare and Medicaid and for their pharmacies is nothing short of a wasted opportunity – at a moment when time cannot be wasted.” 

While there were earlier disagreements over whether to extend the PBM changes beyond Medicare to private insurance, those were seemingly resolved.  

A source familiar with the negotiation process said it wasn’t one specific policy that doomed the process, but rather nobody involved wanting to separate their priorities from the larger package.

“It wasn’t just one policy. We had to get 10 corners in agreement,” the source said. “You had competing priorities between each committee, between the House and Senate, Republican and Democrat. It was a huge undertaking, but nobody wanted to let one thing go. Everything had to be discussed.” 

But another source placed the blame on congressional leadership for insisting on keeping the funding bill free from potential complications.