With the clock ticking on the current stop-gap bill that funds the us government through Feb. 8, Congress is steeling itself to think about another must-pass budget bill. And, once more, health care might be caught within the crosshairs.
During previous debates over government funding, it had been the high-profile Children's Medical health insurance Program that went months without reauthorization and have become a bargaining chip in January. That program has since been extended for six years.
But the future of a number of other individuals remains unsettled. Included in this, funding for the nation's 1,400 community health centers and a delay on capping Medicare coverage of physical and outpatient therapy.
The specific provisions behind these initiatives expired last fall. Advocates now are pressing lawmakers to ensure that they're operational by including language in the broader spending bill that has to pass next week to avoid another government shutdown.
Some of the items in this eclectic legislative mix are often left towards the last second to catch a ride on another bill – referred to as “extenders” by Washington insiders, because they extend funding that is set to expire or delay funding cuts that would otherwise take effect.
On the surface, these efforts may seem like wonky, inside-the-Beltway machinations, but program advocates say they've real-life implications for a lot of of the nation's neediest patients. For them, the congressional delay causes concern. Here are a few things you should know:
The provisions are essential and wide-ranging.
Renewing federal funding for community health centers is the biggest ticket item – the clinics cost $3.6 billion each year, and provide basic health care for around 27 million low-income people. Also at stake may be the Maternal, Infant and Early Childhood Home Visiting Program, by which trained home visitors teach poorer, at-risk mothers healthy parenting ways of new mothers who are deemed at-risk and have low incomes.
Another provision forestalls planned reductions set up through the Affordable Care Act – in federal funds provided to particularly vulnerable hospitals that serve a particularly high rate of low-income patients, referred to as Disproportionate Share Hospitals.
And another would prevent limits, set up by earlier budget bills, from being applied to Medicare's coverage of physical therapy, occupational therapy and speech-language pathology treatment. Without action, coverage would be stop after $2,010 of occupational therapy is provided and another $2,010 for the mixture of physical therapy and speech-language pathology. Each limit would result in Medicare reimbursement for fewer than 20 visits.
OK, so why hasn't Congress acted on these yet?
These are generally smaller programs that, in the past, were authorized or extended via provisions mounted on larger, must-pass bills. One of the favorite vehicles was the “doc fix,” which will moved through Congress to create adjustments in how Medicare paid doctors. That is, until a landmark 2021 law – the Medicare Access and CHIP Reauthorization Act, or MACRA – permanently addressed physician payment.
CHIP finally got funding in the Jan. 22 federal spending deal, however the other items were left on the table. One issue, many said: They're simply not as sexy, and also the impact is harder to identify immediately.
“The issue is too much of the focus was on only one egg in the basket, which egg got done. The remaining eggs say, 'What about me?'” said Rodney Whitlock, any adverse health policy consultant and former Republican Senate staffer. “The real-world impact of not addressing those is slowly becoming problematic.”
Most of the programs aren’t politically controversial.
These programs usually pass with bipartisan support. For lobbyists and policy analysts on sides of the aisle, which makes the funding lapse especially disorienting.
“Even things that should be simple and easy , bipartisan are taking much, much longer and encountering a lot more difficulty than I believe any of us might have expected,” said Eliot Fishman, senior director of health policy at the liberal advocacy group Families USA and a former member of the Federal government. “It's clearly dependent on political gamesmanship.”
There is a few room to talk about how to pay for these initiatives. But even that is limited, suggested Thomas Miller, a homeowner fellow in the conservative American Enterprise Institute.
“If it's your economic interest at stake – it is really an end-all and be-all. But these aren't gigantic items – the consequences for the larger fiscal picture are not immense,” Miller said.
Take the treatment caps. These were first put in place included in the 1997 Balanced Budget Act, included in an attempt to curb Medicare outpatient spending.
But in 1999, as soon as the caps were scheduled to kick in, pushback from physicians and patient advocates led Congress to obstruct their effective date. Since that time, Congress, has – except for a brief lapse – kept them away.
This delay in funding has consequences for patients.
Stephanie Weyrauch, a Minnesota-based physiotherapist worried about the treatment caps, said she and her colleagues are already starting to ration care.
She described, for instance, a 69-year-old man who is recovering from a stroke contributing to halfway through his allotted therapy. He'll require several more sessions later this season only for that condition, which would bring him as much as the cap. If his other ailments – shoulder problems and poor blood circulation – worsen, Medicare wouldn't cover treatment.
“We have to make sure we're doing what's best for our patients. Sometimes that means we stop therapy early to prepare for a potential next episode,” she said.
A fix from Congress could come next week.
Congress already provided some short-term funding for community health centers, that is “keeping the lights on,” Fishman said. But it lasts only 'till the end of March.
And the Maternal, Infant and Early Childhood Home Visiting Program is operating on previously allocated dollars.
In the meantime, the affected programs are can not plan for the near future, Fishman noted. They are trying to develop budgets and make staffing decisions with no sense of what their income will in fact be.
But many people expressed optimism by what is going to be contained in the funding bill likely to take shape in Congress in a few days.
“I still think that when a spending deal gets exercised this train will ride along. – It is an election year,” Whitlock said. “No matter what, this really is among those where it's to obtain worked out.”