While this update covers what happened in Washington during January regarding issues important to seniors, it also will report on the upcoming events and issues that seniors should be aware of as we enter February.
Congress managed to keep at least the government open, which seems like a major accomplishment. However, they will again face the prospect of shutting down in a few weeks if they can’t agree on the needed funding.
Congress Keeps Government Open – for Now
There was really only one accomplishment by Congress in January, although it was an important one.
On January 18, Congress avoided an impending government shutdown by temporarily passing legislation to fund the federal government until March.
The House approved the measure by a vote of 314-108, with opposition coming mainly from the more conservative members of the Republican conference. Just over half of Republicans joined with all but two Democrats in passing the third stopgap funding measure in recent months. The action came a few hours after the Senate had voted overwhelmingly to pass the bill by a vote of 77-18.
The measure extends current spending levels and buys time for the two chambers to work out their differences over full-year spending bills for the fiscal year that began in October last year. The temporary measure will run until March 1 for some federal agencies and until March 8 for the remaining government operations.
As we approach the March 1 deadline, there will undoubtedly be much more drama over the funding issues.
Assuming Congress can agree to fund the government for the rest of the 2024 fiscal year, they will have to move immediately to work on funding the fiscal year 2025, which will begin on October 1.
However, Rep. Tom Cole (R-Okla.), chairman of the Rules Committee and the House Appropriations Transportation-HUD Subcommittee, has already said that it is likely Congress will not be able to pass the needed 2025 funding by then, and he anticipates there will once again need to be temporary funding legislation to avert a shutdown.
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Adjustment to Cost-lowering Prescription Drug Legislation Introduced in the House of Representatives
This new bipartisan legislation, the Ensuring Pathways to Innovative Cures (EPIC) Act, is complicated because it involves small-molecule drugs and biologics, and we’re not going to try to explain that here. However, the legislation is important because it involves the research and development of certain drugs that are critical therapies for persons with cancer, neurological conditions, and other debilitating diseases.
The bill is a fix for President Biden’s prescription drug price-reducing legislation, which Congress passed in 2022.
Supporters of the bill say it will incentivize investments in and development of cutting-edge therapies and will ensure these life-saving products reach patients who need them.
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House Continues Work on Legislation to Prohibit Medical Treatments that Place Different Values on Patients’ Lives
Originally introduced in January of last year, the Protecting Health Care for All Patients Act of 2023 (H.R. 485) continues to be worked on in the House of Representatives.
If passed by Congress, federal health programs would be prohibited from using cost-effectiveness measurements for medical treatments that value patients’ lives differently. Healthcare payers use value measures such as “quality-adjusted life” years (QALYs) to estimate the value and need for a treatment or drug based on a patient’s length and quality of life.
Federal law already prevents the Health and Human Services Department from using any measure “that discounts the value of a life because of an individual’s disability” to determine Medicare coverage or incentive programs.
President Biden’s 2022 health, tax, and climate law also prohibited the use of comparative-effectiveness research in the law’s Medicare drug price negotiation program.
However, Federal law doesn’t restrict other agencies and programs from using such measures and doesn’t restrict states from using that measure in Medicaid or the Children’s Health Insurance Program decisions. Many of those programs use cost-effectiveness research when negotiating the placement of drugs on health plans’ coverage lists and discounts with drug manufacturers.
The bill would apply the prohibition to additional health programs, including Medicare prescription drug plans, Medicaid, the Children’s Health Insurance Program, Defense and Veterans Affairs departments’ health programs, and the Federal Employee Health Benefits Program.
It also would expand the prohibition on similar value measures to include those that treat “extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, non-disabled, or not terminally ill.’’
QALYs are the subject of fierce debate among healthcare experts. Supporters say the value measure drives efficiency to improve overall patient outcomes, while critics say QALYs devalue treatments for individuals with shorter life expectancies.
House Energy and Commerce Chairwoman Cathy McMorris Rodgers (R-Wash.), the bill’s sponsor, said last year that " the federal government can evaluate the effectiveness of treatments and cures without devaluing the lives of seniors and people with disabilities. "
Democrats on the committee opposed the bill last year due to concerns over its inclusion of the phrase “and similar measures. " They found it overly broad and believe it could lead to a ban on non-controversial alternative metrics.
The Congressional Budget Office (CBO) expressed uncertainty about the definition of “similar measures” and the range of metrics lawmakers could restrict through the bill. This ambiguity could diminish the states’ bargaining power in securing drug discounts and complicate the process of determining formulary placements, according to the CBO report.
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Will Lower Payments to Insurance Companies Threaten Medicare Advantage Benefits?
Health insurance companies selling private Medicare Advantage plans face a modest payment increase in 2025 as the government phases in changes that make the program less lucrative for the insurance companies.
This proposal sets up another conflict between the Centers for Medicare and Medicaid Services (CMS) and private insurers over the final policy, which is due by April 1. Last year, insurers lobbied for more money and said the government’s changes threatened patients’ benefits. Medicare officials Wednesday countered that the market for private Medicare plans remains robust even as Washington cuts back some policies that had made the business attractive.
The update ensures that Medicare Advantage rates “accurately reflect what it costs to care for beneficiaries” while addressing practices that result in “wasteful spending,” according to CMS Deputy Administrator Meena Seshamani.
The US paid $403 billion to private Medicare Advantage plans in 2022, and the program now covers more than half of all Medicare-eligible people. CMS says the policy will pay the industry an additional $16 billion in 2025.
Private Medicare Advantage plans powered growth and profits across the health insurance industry for years. Payments ballooned as baby boomers aged into the the program and insurance companies maximized revenue under a system designed to pay more for taking on sicker members.
But watchdogs and whistleblowers warned that some companies were manipulating diagnostic codes to inflate payments, leading to a series of civil cases. Insurers maintain they’re paid accurately for the risk they take under the program’s rules.
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For progress updates or more information about these and other bills that would strengthen Social Security and Medicare programs, visit our website at www.SeniorsLeague.org or follow TSCL on Facebook or Twitter.