Lame Duck Session Priorities in Congress

November 18, 2024 | Catherine Jones

The 118th Congress resumed on Nov. 12 and is now facing a tight deadline to address government funding and other pressing legislation before the session ends on Jan. 3, 2025. With several public health and healthcare policies set to expire, lawmakers have just weeks left to address must-do and nice-to-have items. Only time will tell what gets wrapped up in this lame duck session, and what unfinished bills and appropriations remain on the docket for the 119th Congress.

Must-Do Items

Disaster Relief

Following Hurricanes Helene and Milton, Congress aims to boost FEMA’s disaster relief budget, and Speaker Johnson (R-LA) has prioritized this funding increase. A bipartisan bill led by Jared Moskowitz (D-FL) proposes $10 billion for FEMA and an additional $5 billion for the Department of Housing and Urban Development.

Government Funding

The current Continuing Appropriations Act (H.R. 4366) expires on Dec. 20. Options moving forward include an omnibus bill(s) or, much more likely, a continuing resolution (CR) extension into March 2025. If there is momentum for an omnibus, Congress might pass the 12 appropriations bills in two bundles as it did in 2023. As a reminder, the Senate's Labor, HHS, Education bill proposes modest increases for CDC and HRSA, with funding lines of $9.34 billion for CDC (an increase of $173 million) and $8.94 million for HRSA. In comparison, the House's version includes significant cuts of $1.8 billion (or 22%) from CDC and $647 million from HRSA.

Farm Bill

The Farm Bill, governing nutrition programs (SNAP and WIC) and agricultural programs, expired in September 2023. With a new five-year Farm Bill unlikely to pass, Congress will need to figure out a short-term extension through a CR.

Nice-to-Have Items

In March, the Continuing Appropriations Act (H.R. 4366) extended several expiring healthcare programs until Dec. 31. Addressing policy issues and extending funding in a new CR will require bipartisan cooperation as lawmakers weigh budgetary concerns with healthcare and public health needs.

• Community Health Centers: Reauthorization and continued funding will allow these centers to provide essential primary and preventive care to underserved populations, particularly in low-income and rural communities. Federal funding is needed to maintain operations, staffing, and expanded services.
• Telehealth: Extending telehealth provisions has broad support, but key issues remain, including:
• Long-term funding to sustain telehealth infrastructure and reimburse providers.
• Fraud prevention, particularly around billing, and additional safeguards or restrictions.
• Scope of services that should qualify for telehealth reimbursement, especially as virtual care becomes integrated into the standard healthcare delivery model.
• Hospital-at-Home Program: Popularized during the pandemic to reduce hospital overcrowding and minimize infection risks, this program allows patients to receive acute care in their homes rather than being admitted to hospitals. A two-year renewal is likely, as this model has shown benefits in reducing costs and improving patient comfort; however, long-term sustainability will depend on federal support and reimbursement structures.
• National Health Service Corps: In an effort to alleviate provider shortages and increase retention in high-need regions, federal funding provides scholarships and loan repayment to healthcare providers employed in underserved communities.
• Teaching Health Centers: These centers offer new physicians residency training programs (usually primary care and behavioral health) in community settings to mitigate workforce shortages and improve access to care.
• Special Diabetes Program: Funding supports ongoing studies and innovations.
• Medicaid Disproportionate Share Hospitals (DSH): Scheduled cuts to DSH payments were delayed under the current CR, and further delays are necessary to prevent financial strain on DSH serving low-income and uninsured patients.

Likely Deferred to the 119th Congress

Reauthorization of PAHPA and the SUPPORT Act

• The Pandemic and All-Hazards Preparedness Act (PAHPA) is essential for strengthening preparedness for public health emergencies. Corresponding legislation, S. 2333, is currently under consideration and faces challenges as lawmakers negotiate the scope and authorize funding levels of the act, to ensure the ability to respond to future health crises.
• The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act includes provisions for expanding access to treatment, improving recovery services, and funding programs aimed at reducing opioid misuse and overdose. H.R. 4531, currently pending action in the Senate, aims to reauthorize and extend these initiatives.

Healthcare Policy and Legislation

• 340B Drug Discount Program: This program requires drug manufacturers to offer discounted prices to healthcare providers serving uninsured and low-income patients, allowing hospitals and clinics to stretch scarce resources. Potential reforms have been proposed to address concerns over how the savings are used, with some advocating for tighter controls to ensure that 340B benefits go directly toward patient care rather than administrative costs or other expenses.
• Healthcare Transparency and Pharmacy Benefit Manager Reform: Bipartisan (S. 172) efforts are underway to enhance healthcare price transparency and reform pharmacy benefit manager practices. The House-passed Lower Costs, More Transparency Act (H.R. 5378) includes measures to strengthen price transparency requirements and increase access to lower-cost generic medications.
• Cybersecurity Standards for Healthcare: With increasing cyber threats to healthcare systems, proposed legislation aims to enhance cybersecurity standards to protect patient data, secure hospital and clinic networks, and safeguard against cyber-attacks that could disrupt healthcare delivery.
• Mental Health Parity: Mental health parity laws require health insurers to provide mental health and substance use disorder benefits on par with medical and surgical benefits. Strengthening parity requirements would ensure that individuals receive adequate coverage for mental health services without facing higher co-pays or lower reimbursement rates.
• Artificial Intelligence (AI) in Healthcare: AI is increasingly used in healthcare for diagnostics, patient monitoring, and administrative tasks. Emerging proposals seek to create a regulatory framework that ensures AI's safe, effective, and ethical use. Key concerns include data privacy, potential biases in AI algorithms, transparency in AI decision-making processes, and integrating AI tools in clinical settings. These proposals may also address accountability for AI-driven decisions and the standardization of AI practices.