It’s lame-duck time. Here are Congress’s health priorities.

Lawmakers grapple over provider pay, covid funding and Medicaid for new moms

Lawmakers and trade groups are starting to push their health priorities in a last-ditch attempt to get their wish lists passed this year. Congress has until Dec. 16 to finalize legislation to avoid a government shutdown, and top lawmakers are hoping to clinch a long-term funding deal before then. 

Doing so would provide a must-pass vehicle for other smaller measures to hitch a ride to before the new Congress begins in January. The prospect is setting off a scramble on Capitol Hill on everything from staving off cuts to providers’ pay, approving more dollars to combat the coronavirus and avoiding a Medicaid cliff for new moms, according to multiple lobbyists and Hill aides.  

One fast-approaching deadline: Funding for the U.S. territories’ Medicaid programs. The safety net program is funded differently than it is for the states, requiring Congress to periodically re-up certain dollars the federal government provides to the territories’ Medicaid programs. 

The rate at which the administration matches the territories’ Medicaid dollars is set to decrease significantly if Congress doesn’t swoop in by mid-December. Meanwhile, top Puerto Rico officials began pushing for a bigger boost in federal funds after Hurricane Fiona ripped through the island in September. 

Fending off pay cuts: Doctors are rushing to avert a nearly 4.5 percent cut to their Medicare reimbursement set to go into effect Jan. 1. 

Anders Gilberg, a senior vice president for the Medical Group Management Association, told The Health 202 it was the “number one priority” for his group as well as every physician organization.

Meanwhile, providers and major hospital trade groups are lobbying Congress to again waive a mandatory across-the-board up to 4 percent cut to Medicare payments. In a letter sent to congressional leaders yesterday, eight groups like the American Hospital Association, Federation of American Hospitals and America’s Essential Hospitals argue that facilities are grappling with high inflation and increasing workforce costs, and thus need financial relief.

If at first you don’t succeed: The White House is mounting yet another effort to secure billions of dollars from Congress aimed at creating new iterations of coronavirus vaccines and treatments, The Post’s Dan Diamond reports. Biden health officials are finalizing a request this week for about $10 billion as part of a larger request in the lame-duck session, even as Republicans remain deeply skeptical of how the previous dollars were spent. 

The fight for more dollars has been waging since March, when House Democrats stripped covid aid from a broader package to fund the government. Some in the party were upset over an effort to redirect money set aside for some state governments. The effort to approve more dollars has since run up against Republican resistance and a dispute over pandemic border restrictions in place.

Back at it: Key negotiators on Food and Drug Administration policy have pledged to try again on bills aimed at improving the agency that failed to make it into legislation reauthorizing critical agency fees. Two Hill aides say lawmakers are interested in passing bipartisan efforts agreed upon in the respective chambers.

Medicaid for new moms: Several leading Democrats are pushing to make 12 months of postpartum Medicaid coverage mandatory and permanent for states. Over half the states have taken advantage of a vehicle in Biden’s coronavirus relief bill that made it easier to temporarily extend Medicaid benefits to a full year after birth for low-income mothers. 

Such a policy is a top priority for groups like the American College of Obstetricians and Gynecologists, which is pushing for its inclusion in a year-end spending package. But the prospects of including the measure aren’t yet clear.

Other pushes: A Republican aide also pointed to other priorities for the party including the permanent scheduling of fentanyl, set to expire at the end of December, as well as a long-term extension of Medicare’s pandemic-era telehealth flexibilities, which has bipartisan support. 

Biden says Democrats likely to fall short of keeping House

Republicans are on the cusp of winning back the House after competitive races were settled in a handful of states. But even so, their majority will be slim, a disappointment to many in the party that will make finding consensus among moderates and conservatives challenging. As of 7:30 a.m., The Post has reported that Republicans are projected to win 215 seats of the 218 needed to clinch control.

Biden conceded yesterday that Democrats are likely to come “very close” to maintaining control of the House but ultimately fall short once all races are called. He acknowledged that the outcome would probably doom his pledge to make codifying Roe v. Wade his first legislative priority if Democrats controlled Congress next year. 

One caveat: Even if Democrats held onto the House, the party would have also likely needed to pick up at least two Senate seats to codify Roe, since Sens. Joe Manchin III (D-W.Va.) and Kyrsten Sinema (D-Ariz.) have opposed overturning the 60-vote filibuster. The party has flipped only one seat.

House Republicans kicked off their leadership elections last night. Candidates made their pitches to their colleagues in a closed-door setting, where members questioned them ahead of a secret-ballot vote scheduled to happen later today, our colleague Marianna Sotomayor writes. 

Members were also set to debate rule changes that will dictate the 118th Congress, if they win back the majority, and who will sit on the influential Steering Committee, which determines committee assignments for members.

Kentucky’s abortion ban is heading to court today

The issue of abortion will be front and center again today in Kentucky, as the state’s Supreme Court hears arguments over whether its near-total bans on the procedure can remain in place while a case challenging the constitutionality of the restrictions winds its way through the courts, our colleague Kim Bellware reports.

The case is the first major legal test for legal abortion since Kentuckians rejected a ballot measure last week that would have amended the state constitution to clarify that it does not protect the right to abortion, clearing the path for challenges to the states abortion bans to move forward. Kentucky’s Republican Attorney General Daniel Cameron filed a motion with the high court last week arguing that the election results should have no bearing on the justices’ decision.

Key context: The lawsuit filed on behalf of the state’s two remaining abortion providers claims that Kentucky’s near-total “trigger” ban on abortion, along with its law prohibiting the procedure after fetal cardiac activity is detected, violates the state constitution’s rights to privacy and self-determination. Plaintiffs are asking the state’s high court to block the bans while the case is litigated, which would temporarily restore abortion access up to 15 weeks in the state. 

Kentucky’s Republican Attorney General Daniel Cameron:

Experimental Alzheimer’s drug from Roche fails in trials

An experimental Alzheimer’s drug designed to slow cognitive decline failed to meet the primary goals of two closely watched clinical trials, a discouraging development that underscores the challenges of developing treatments for the devastating disease, The Post’s Laurie McGinley writes. 

The treatment, called gantenerumab, slowed the pace of decline in patients with early-stage disease but not enough to be statistically significant, Genentech, a division of health-care giant Roche, announced in a news release yesterday. 

The details: The drug was designed to target amyloid beta, an abnormal protein that builds up in the brains of Alzheimer’s patients that many scientists hypothesize is behind the hallmark symptoms of the debilitating neurological disease. The therapy was tested in a pair of identical 27-month late-stage trials consisting of 1,000 participants each, which both found that it removed less of the protein than expected. The company is planning to present more data from the trials at an Alzheimer’s conference this month.

Hopes for the drug were raised in September, when Japanese drugmaker Eisai and its U.S. partner, Biogen, announced that their experimental amyloid-reducing drug slowed the pace of cognitive and functional decline by 27 percent. The news had followed the FDA’s controversial approval of an Alzheimer’s treatment last year, called Aduhelm, despite questions over its effectiveness.

Howard Fillit, co-founder and chief science officer of the Alzheimer’s Drug Discovery Foundation:

• Gabe Bankman-Fried has stepped down as head of Guarding Against Pandemics, an advocacy group bankrolled by his brother whose cryptocurrency exchange filed for bankruptcy Friday, The Post’s Dan Diamond reports.
• On the move: Families USA appointed Yael Lehmann to serve as its new senior director of strategic partnerships. Before joining the left-leaning consumer health lobby, Lehmann ran her own consulting firm advising nonprofits.
• Thousands of experts contracted by a nonprofit tied to the Centers for Disease Control and Prevention to assist struggling public health departments during the pandemic are being let go because of depleted coronavirus relief funding, Kaiser Health News reports.
• The Centers for Medicare and Medicaid Services released sample machine-readable file format recommendations for hospitals to more easily make their standard charges public, as required by price transparency regulations, the agency announced yesterday.

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Thanks for reading! See y’all tomorrow.