On December 20, Congress narrowly avoided a government shutdown by passing a stopgap spending bill to fund federal operations through March 14, 2025. This temporary measure, signed into law by President Biden, includes $100 billion in disaster relief and $10 billion in financial assistance for farmers. However, the legislation excludes key healthcare provisions initially proposed in the bipartisan package.
Healthcare Provisions: What Was Left Out?
The original draft of the spending package included several critical healthcare reforms, such as a two-year extension of telehealth flexibilities, pharmacy benefit manager (PBM) reforms, and a 2.5% adjustment to mitigate the 2.8% Medicare physician payment cut scheduled for January 1, 2025.
However, these provisions were removed following political disagreements and demands from President-elect Donald Trump and tech entrepreneur Elon Musk. The bill’s final version retained only a three-month extension for telehealth services, leaving other healthcare reforms unresolved.
The Medicare Physician Payment Cut
Physicians face a 2.8% reduction in Medicare payments starting January 1, 2025—a cut that coincides with a projected 3.5% increase in practice costs. This marks the fifth consecutive year of declining Medicare reimbursements, exacerbating financial pressures on medical practices, particularly in rural and underserved areas. Advocacy groups like the American Medical Association (AMA) have called for urgent congressional action to reverse these cuts through bipartisan legislation such as the Medicare Patient Access and Practice Stabilization Act of 2024 (H.R. 10073), which proposes a 4.73% payment update.
PBM Reforms: A Missed Opportunity
Pharmacy Benefit Managers (PBMs), often criticized as “middlemen” that inflate drug prices and harm independent pharmacies, were another focal point of the original package. Proposed reforms included rebate pass-through requirements, a ban on spread pricing in Medicaid, and transparency measures across commercial and public markets.
Despite bipartisan support, these provisions were removed due to concerns over their potential impact on commercial market prices and opposition within the House GOP. The exclusion of PBM reforms has drawn criticism from patient advocacy groups and lawmakers who argue that greater transparency and accountability are essential to reducing drug costs.
Political Dynamics and Legislative Challenges
The removal of healthcare provisions reflects broader political dynamics at play. The stopgap measure became a “Cromnibus” bill—combining continuing resolutions with omnibus spending elements—and faced last-minute revisions influenced by Trump and Musk. Their intervention led to a slimmed-down version of the bill that prioritized disaster relief and farm aid while sidelining more contentious issues like PBM reform and Medicare payment adjustments.
Looking ahead, healthcare-focused lawmakers such as Rep. Buddy Carter (R-GA) and Sen. Mike Crapo (R-ID) have pledged to revisit these issues in the new Congress. However, competing legislative priorities—including immigration reform, tax policies, and energy initiatives—may delay progress on healthcare reforms.
Implications for Future Policy
The exclusion of PBM reforms and Medicare payment fixes underscores the challenges of advancing comprehensive healthcare legislation in a divided Congress. While some provisions could theoretically be included in future reconciliation packages—such as Medicaid spread pricing bans—the broader commercial market reforms may not gain traction soon.
The stopgap spending measure highlights the urgency of addressing systemic issues in healthcare and the complexities of achieving bipartisan agreement. As Congress grapples with competing priorities in early 2025, the Infusion Access Foundation and its partners must continue advocating for reforms that ensure transparency, sustainability, and equitable access to care.
