Congress releases spending package, which includes big boost for veterans’ care

PROGRAMMING NOTE: We’ll be off next week for the holidays but will return to your inboxes on Tuesday, Jan. 3.

CONGRESS BRINGS PRESENTS TO SOME, COAL TO OTHERS — Leading lawmakers unveiled a $1.7 trillion year-end spending bill early Tuesday as they raced to pass the sprawling package by week’s end, with federal cash expiring at midnight on Friday. The so-called omnibus includes nearly $119 billion for veterans’ care, a 22 percent increase, according to the office of Senate Appropriations Chair Patrick Leahy (D-Vt.).

What else: The spending package includes a deal that saves the government billions by ending pandemic era-Medicaid policies and directs some of the saved dollars toward giving low-income moms an extended coverage period on Medicaid in states that don’t already offer it.

— The deal includes language to extend hospital at-home waivers for two years, running through the end of 2024, POLITICO’s Ben Leonard reports. The waivers, established in November 2020, allow hospitals to treat some emergency department and inpatient hospital patients from their homes. The move was aimed at expanding hospital capacity as health care organizations were slammed with Covid-19 patients. The extension is one of several wins in the omnibus for those who favor expanding virtual care. Lawmakers also proposed a two-year extension of Medicare telehealth waivers as well as a provision enabling high-deductible health plans to offer telehealth appointments to subscribers before they’ve hit their deductibles.

— Ben also notes that lawmakers decided to sustain a ban on using federal dollars to craft unique patient IDs meant to pair patients with their health records. Close to 120 groups including AHIP, EHR vendors Epic and Cerner, and other industry groups pushed appropriators this spring to end the ban, along with AHIMA, HIMSS and CHIME.

— Physicians, who faced a 4.5 percent cut in Medicare rates in January, get a bit of a reprieve in the package. The new language would cut rates by 2 percent in 2023, and then 3.25 percent in 2024. Jack Resneck, the president of the American Medical Association, said in a statement that the move endangers the financial viability of some practices and threatens patient access.

“This 2 percent following two decades of flat payment rates will have consequences on health care access for older Americans,” he said in a statement. “High inflation compounds the threat to practice viability because physicians are the only Medicare providers without annual inflation-based updates.”

Meanwhile, Sen. Bob Menendez said in a statement that he helped secure more funds for Puerto Rico’s Medicaid program to stabilize the territory’s health care system and improve the quality of care for residents. “I am proud to have secured this 76 percent FMAP reimbursement level over five years that will provide Puerto Rico with federal dollars that will enable the island to make critical investments that will help stabilize their health care system, retain health care providers, and improve access and quality of care for all of its residents,” he said in the statement.

The Senate is expected to act first on the spending package in the coming days, seeking a timing agreement that would allow the bill to pass before Thursday night and send it to the House. Any senator could hold up that deal in exchange for amendments or concessions. Senate Minority Whip John Thune said Monday that he expected conservatives to push for an amendment related to stripping out earmarks — or projects in lawmakers’ home states.

What senators were saying: Sen. Ron Wyden (D-Ore.) told Alice Miranda Ollstein he was confident the final bill would include policies that made “substantial concrete headway” on several health issues. “We made progress with respect to the areas of telemedicine, postpartum coverage and Medicare. You can question if this change or that is appropriate, but the reality is this is significant headway compared to the status quo that we were dealing with,” he said.

Sen. Roger Marshall (R-Kan.) said that while there were “some victories” in getting provisions from the PREVENT Pandemics Act into the text, he was disappointed that his bill to create a 9/11-style commission to investigate Covid-19 won’t be included. “Every layer of the onion that we peel back on the origins of Covid, we find that there’s more to it,” he said. “It’ll take a huge effort to really get to the truth.”

WELCOME TO TUESDAY PULSE — We give you the latest affordable cosmetic surgery to be trending on TikTok. What could possibly go wrong? Send other dubious ideas, news and tips to [email protected] and [email protected],

TODAY ON OUR PULSE CHECK PODCAST, Ben Leonard talks with Mark Cuban, famous for his “Shark Tank” reality TV show on ABC and one of America’s most prominent investors, about the Cost Plus Drug company he founded with Alex Oshmyansky to take on the pharmaceutical market and lower drug prices — and about his plan to try to disrupt the prescription drug space.

ABORTION AND THE 2024 RACE — Despite his pivotal role in the overturning of Rowe v. wadeFormer President Donald Trump’s 2024 presidential run has been met with a measured response by the nation’s anti-abortion groups, Alice and Meredith McGraw report.

The same groups that helped put Trump in office in 2016 are now keeping him at arm’s length, illustrating how the Supreme Court’s June ruling erasing federal abortion rights has created a new litmus test in Republican presidential politics.

No longer is it sufficient for a candidate to identify as “pro-life,” promise to defund Planned Parenthood or even provide — as Trump did — a list of potential Supreme Court nominees who would vote to curtail abortion rights.

Anti-abortion advocates insist on more in a post-Rowe era — namely, a hard commitment to back a federal abortion ban — putting potential Republican presidential hopefuls under pressure to go further in this election cycle.

That puts prospective candidates in a bind between what GOP primary voters will demand and what general election voters will accept.

Even within the anti-abortion movement, early fissures are emerging. Some groups are demanding 2024 contenders push for nothing less than a complete ban on abortion starting at conception, while others urge a less hard-line stance, saying they’re open to 15-week restrictions or other incremental steps they see as more politically realistic. .

FIRST IN PULSE Rep. Abigail Spanberger (D-Va.) sent a letter on Monday to DEA Administrator Anne Milgram and FDA Commissioner Robert Califf asking the agencies to act on the ongoing shortage of Adderall and other drugs used to treat ADHD.

After Congress waived in-person requirements for providers prescribing Schedule II drugs like Adderall via telehealth during the pandemic, demand for the medication surged, resulting in a persistent shortage that’s impacting patients who rely on them, Spanberger wrote.

“Patients who rely on Adderall to function daily deserve a comprehensive federal response to ensure access to their medications,” she wrote.

PANEL SLAMS FDA ON TOBACCO — An independent panel composed of former FDA and Centers for Medicare and Medicaid Services officials have recommended that several changes be made at the FDA’s Center for Tobacco Products, citing the center’s lack of clarity about its direction, priorities and goals, POLITICO’s Katherine Ellen Foley reports .

The panel found that CTP is more reactive than proactive and plagued by litigation.

Background: Califf asked the Reagan-Udall Foundation, a nonprofit tasked with helping the FDA carry out its mission, to review the FDA’s food safety and tobacco programs in July.

What’s next: Califf said the FDA would have an update by early February on how it plans to implement the recommendations outlined by the Reagan-Udall report.

WH BOOSTER PUSH TARGETS OLDER AMERICANS — The Biden administration is launching a new effort to vaccinate the most at-risk older adults and people with disabilities for flu and Covid amid increasing fears of a holiday-fueled surge in respiratory illnesses, POLITICO’s Megan Messerly reports.

Covid hospitalizations are up nearly 50 percent, and deaths are up about 22 percent from last month, according to the CDC.

USAging and the National Council on Aging were notified Monday that they would receive a combined $125 million from the HHS’ Administration for Community Living to host and provide transportation to vaccination clinics, administer shots in people’s homes and conduct outreach and education events.

Why it matters: While an additional 9 million people have gotten their updated booster since the beginning of the administration’s six-week push in November, only 14 percent of people eligible for the shot have received it, including a little more than a third of older adults, who continue to be at greatest risk for hospitalization and death from Covid.

SUPREME COURT BLOCKS END OF BORDER POLICY — The Supreme Court postponed a pandemic-era border policy set to end on Wednesday, agreeing to press pause on lifting the federal order based on public health grounds that’s prevented millions of migrants from crossing the Mexican border, POLITICO’s Myah Ward and Josh Gerstein report.

On Monday, Chief Justice John Roberts temporarily stayed a lower court’s ruling that required the Biden administration to lift the implementation of Title 42 by Dec. 21 after 19 Republican-led states filed a request.

Roberts asked the Department of Justice to respond by Tuesday evening. But for now, it appears his decision gives the Biden administration the flexibility to leave the border policy in place while the high court considers whether to grant longer-term relief.

The Government Accountability Office has named seven new members to its Health Information Technology Advisory Committee: Kikelomo Belizaire, Shila Blend, Hannah Galvin, Bryant Karras, Anna McCallister, Deven McGraw and Naresh Sundar Rajan,

CVS and Walgreens have started limiting the sale of children’s pain medication amid a supply crunch, Reuters reports.

The Anchorage Daily News reports on a DOJ investigation that’s found Alaska unnecessarily institutionalizes children because community-based behavioral health services don’t exist.

KHN reports on why the HIV outbreak in West Virginia isn’t getting better.

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