When Congress returns from its roughly six-week long recess on Monday, they will have a lot to attend to, the most important being funding the government for the FY2025 fiscal year, which begins on October 1^st.

The federal government is funded annually through 12 appropriations bills. These can be passed all at once as a consolidated “omnibus” appropriations bill, in smaller “minibus” packages, or individually. Alternatively, Congress can pass a continuing resolution (CR) to extend current funding levels into the new fiscal year while it completes work on the 12 appropriations bills. Failure to pass any government funding legislation before funding expires will result in a government shutdown for the agencies impacted by each of the 12 appropriations bills.

Like all legislation, appropriations bills must be considered by House and Senate Appropriations Committees (and their relevant subcommittees) before being voted on by their respective chambers. For the government to be funded and to avoid a shutdown, both the House and Senate must pass identical versions of these appropriations bills and it has to be signed into law by the President.

The two appropriations bills with the largest impact on healthcare are:

• Labor, Health and Human Services, Education, and Related Agencies
• Agriculture, Rural Development, Food and Drug Administration, and Related Agencies

Both of these bills have been introduced in each chamber. However, like other appropriations bills, the versions introduced by the Democrat-controlled Senate and the Republican-controlled House differ from each other significantly.

For example, the House version of the LHHS Appropriations bill proposes a major reorganization of the National Institutes of Health (NIH) while the Senate version does not. Furthermore, while both versions propose funding cuts to the Department of Health and Human Services (HHS), the proposed House cut is much steeper than the Senate proposal.

At this time, it is unlikely that Congress is able to agree on FY2025 appropriations bills before the September 30^th deadline. This situation occurs for most government funding cycles and is especially common during an election year.

If Congress takes no action, the government will shut down to begin October. However, there is bipartisan desire to avoid a government shutdown, especially in the weeks leading up to a very competitive presidential election. As a result, Congress is expected to pass a Continuing Resolution (CR) before the September 30^th government funding deadline.  

CRs can vary in two main ways: length and the inclusion of policy riders:

• Length: CRs can technically be agreed upon for any duration, but they are often in one- or two-month increments. However, there have recently been talks about interest in a largely unprecedented six-month CR.

• Policy Riders: CRs may contain provisions unrelated to spending (policy riders) or be passed “clean,” without additional provisions. For instance, House Republicans are currently pushing for a CR that includes the “SAVE Act” as a policy rider. This bill would require proof of U.S. citizenship to register to vote in federal elections. The SAVE Act is largely a non-starter for Democrats. Since Democrats hold the majority in the Senate, it is unlikely that funding discussions will proceed in the Senate with the SAVE Act in the mix. It wouldn’t be surprising if the Senate proposed a clean CR and tried to force the House’s hand.

Operating on a CR for an extended amount of time is not unprecedented. For example, this year the annual funding package was finally signed into law in late March—nearly six months after the September 30, 2023 deadline.

As of this article’s writing, a government shutdown appears unlikely. Congress will almost certainly pass a CR. The only questions are for how long and how “clean” will it be. We do not expect answers to these questions until close to the September 30^th deadline. Congress is very deadline-driven and typically negotiates right up until the deadline. The upcoming election could also complicate things as both parties will try to use the CR to strengthen their positions with voters.

The Cybersecurity and Infrastructure Security Agency (CISA) has introduced a new portal to make it easier for organizations to voluntarily report cybersecurity incidents and data breaches. Prompt reporting allows CISA and other agencies to provide support and resources to targeted organizations and gain real-time insights into cyberthreats.

HHS has dropped its appeal to a ruling that permits hospitals and health systems to continue using pixel tracking technology on their websites. The appeal had argued that such technology violated HIPAA, but with the withdrawal, hospitals and health systems can continue using pixel tracking to monitor website traffic.

A Reuters analysis found that despite Medicare’s drug price negotiations under the Inflation Reduction Act (IRA), U.S. prices for ten drugs remain two to five times higher than prices of the same drugs in Australia, Canada, Japan, and Sweden. For instance, in 2026, Medicare will pay $17,851 for a 30-day supply of nine of these drugs, while the same supply currently costs $6,725 in Sweden.

The federal government has ended the Bridge Access Program, the federal program that provided uninsured and underinsured Americans with the COVID-19 vaccine. Barring state-level intervention, many are now left with a $200 vaccine fee.

UnitedHealthcare has released more details about its national gold card program, a program that allows some providers to be exempt from prior authorization requirements for select services. This includes information on eligibility, program requirements, covered procedure code list, and the conditions under which providers may lose their gold card status.