As everyone in the health policy world anxiously awaits the outcome of next week’s midterms, some Congress-watchers are looking ahead to the next question: What will be on the healthcare menu when the House and Senate return after the election to finish out the year?
In part, what happens will be determined by who wins the midterms, even though the new members won’t yet have taken office, according to Michael Baker, director of healthcare policy at the American Action Forum, a right-leaning Washington think tank.
“Post-election health policy productivity will depend not only on projected party control of the chambers, but also which sitting members are returning next year, and who may be expected to assume gavels in the new Congress,” he wrote in an email to MedPage Today. “A prospective chairmanship or ranking membership slot may influence what policies a member or committee consider for passage in the remaining 2026 legislative days or [what they decide to] hold for action in the new year.”
Any healthcare bills are likely to be attached to other “must-pass” legislation, Baker explained. “More specifically, the appropriations bills, the NDAA [National Defense Authorization Act], and the Farm Bill are all ‘must-move’ vehicles that could have healthcare policies attached to them.”
In addition, there are some “high-profile” extenders that have already been authorized beyond this year, including Medicare telehealth authority and acute hospital care at home, he said. “The more standard extenders are all that are left. I expect these to be noncontroversial.”
One area that might be considered is a “doc fix” to raise physician reimbursement rates under Medicare, Joe Antos, PhD, senior fellow emeritus at the right-leaning American Enterprise Institute in Washington, said in an email.
“Congress will be under pressure to override CMS’s proposed 1%+ reduction in Medicare physician payment as well as a CMS plan to limit payment for same-day physician services,” he said. “Since this is mostly just money, I can see some change included in the final budget bill.”
One thing that could present more of a challenge is passing a fix to the No Surprises Act, the measure that barred patients from receiving surprise bills for getting out-of-network care at an in-network facility. Although everyone agrees that the law has achieved its main goal, the arbitration system included in the bill has been generating headaches for payers and providers.
“It’s not clear what the fix is, but the current system is creating a lot of friction,” Antos said.
Wendell Primus, PhD, visiting fellow at the left-leaning Brookings Schaeffer Initiative on Health Policy in Washington, and former health advisor to former House Speaker Nancy Pelosi, agreed.
“No way surprise billing gets done – too big – they will do that next year,” he said in an email. Instead, extenders will be the big thing, he said, adding that the “extenders package will include community health centers – at a cost of $4.4 billion.”
Then there are the proposed changes to the 340B outpatient drug discount program used by hospitals; the Trump administration has proposed switching the program to a rebate program from the current configuration, in which hospitals get the discounts right away. Primus predicts a delay in any kind of fix to 340B “because [a delay] is what hospitals want.”
However, he said, one surprise piece of legislation that might come into play deals with price transparency — “maybe [with] a cost offset by doing more on drug pricing.”
Baker, of the American Action Forum, pointed to the general lack of agreement on many of these issues.
“While No Surprises Act tweaks and 340B program reforms could be debated, I am not sure that there is enough consensus on the preferred solution to have them move in rapid fashion, even if attached to a must-pass vehicle,” he said. “On the other hand, there are bipartisan transparency bills that have passed out of committee that could be reconciled and attached to a package, as well as [the] doc fix.”
Overall, “I think the question is whether there is significant legislation that is ready to attach to a budget/reconciliation bill in December,” said Antos. “Congress hasn’t been at work for a long time, Democrats and Republicans have no incentive to negotiate with each other even if they did come into town, and the White House isn’t pushing anything on health.”
“For those reasons, I wouldn’t expect new policies, and at most, there might be some fixes on existing policies that are causing problems,” he said. “But small fixes, not fundamental changes.”
