On December 20, President Joe Biden signed a funding bill to avert a government shutdown during the holiday season, approving measures to temporarily extend healthcare provisions. The legislation, passed by Congress, included limited extensions for telehealth services but fell short of the broader reforms sought by healthcare advocates.
The approved funding package came after much debate and aimed to maintain government operations through March 14, 2025. Despite the urgency, it became evident during the legislative process, particularly as the day of reckoning loomed, there was substantial wrangling over its contents. The bill retained only certain health-related measures, primarily providing extensions to telehealth flexibilities, which are set to expire on March 31, 2025.
Key players who shaped this final package included House Speaker Mike Johnson and other congressional leaders who felt pressure from various advocacy groups, including the American Physical Therapy Association (APTA) and the American Telemedicine Association (ATA). These organizations intensively lobbied for more significant inclusions, such as extending the 2.5% Medicare Physician Fee Schedule increase and wider applications for telehealth services through the end of 2026. They contended these provisions had bipartisan support and were viewed as uncontroversial by many.
Yet, these hopes were dashed when President-elect Donald Trump and billionaire Elon Musk criticized the sweeping healthcare package earlier, arguing it was overly expensive. They leveraged their considerable influence to sway some Republican lawmakers, which led to significant cuts and omissions from the original package. Effectively sidelined were measures aimed at addressing severe issues like pharmacy benefit managers' (PBMs) reform and the broader impacts of scheduled Medicare cuts to physicians.
After the bill’s passage, President Biden stated, "This agreement ... means neither side got everything it wanted." This sentiment captured the mixed response from both sides of the aisle as lawmakers gritted their teeth through negotiations, tempered by the ambitious proposals many initially pursued.
Stark criticism came from physician groups immediately following the legislation's passing. Bruce Scott, M.D., president of the American Medical Association (AMA), asserted, "For the fifth consecutive year, Congress has adjourned and allowed Medicare cuts. What will be the result? Patients struggling to access health care. Physicians closing or selling their private practices, others opting to leave the profession." The significant cuts precipitated by this latest funding deal were particularly disheartening, as they represent yet another setback for healthcare providers across the nation.
Meanwhile, Kyle Zebley of the ATA noted, "Together, with future actions to come, we are on the brink of achieving landmark victories for patients, the healthcare system, and the future of care delivery." His comments were tinged with cautious optimism amid calls for more stability and permanence concerning telehealth services, which have proliferated since the onset of COVID-19.
Notably, the health provisions included extensions for Medicare telehealth services, allowing patients to receive virtual care at home and providing relief to the CMS Acute Hospital Care At Home program for the next few months. While healthcare groups expressed some relief at the temporary extensions, many remained concerned over the bill being “far from ideal.” Anthony Wright, Executive Director of Families USA, criticized the compromises, referencing the setbacks and lack of sustainable solutions within the funding agreement.
Looking forward, with the government funding set to expire again by March 14, 2025, more contentious negotiations are anticipated. Congress may face another round of discussions to determine the future of healthcare funding, including potentially applying retroactive relief to physician pay cuts, which have drastically affected Medicare providers and their ability to serve patients.
The crux of the matter is the growing stress on healthcare providers amid looming pay cuts, lack of sufficient funding, and the continued pressure from various advocacy groups. Heading back to the drawing board, the new Congress will have to tackle these issues head-on and strive for long-term reforms if they wish to stabilize the healthcare system effectively. The challenges, ranging from sustaining telehealth flexibilities to revising the complex reimbursement structures within Medicare, remain pivotal for the future health of both patients and providers alike.
