After a six-week break, Congress was back in session on Tuesday, November 12^th.

It was a busy first week of the lame duck session, where notably Senator John Thune (R-SD) was elected by fellow Republican senators as his party’s Senate Leader. Senator Thune replaces Senator Mitch McConnell (R-KY) who led Senate Republicans for the last 17 years. One of Senator Thune’s first major tests will be confirming President-elect Trump’s cabinet picks in January.

On the House of Representatives side, Republicans officially clinched a majority. This gives Republicans a unified government with control of the Presidency and both chambers of Congress. Even with a unified government, intra-party agreement will be necessary to pass legislation, especially given the slim majorities in both chambers.

One of the biggest hurdles remaining for the 118^th Congress before the next Congress begins in January is funding the US government. The current Continuing Resolution (CR) is set to expire on December 20^th. With Democrats losing control across the government, they will likely aim to strike a deal with Republicans on the 12 appropriations bills necessary for the government’s annual funding. Although some Republicans may want to aim for another short-term CR so they can pass a long-term annual spending bill in the new year when their party will be able to more fully dictate the spending packages.

Before the end of the year, healthcare will almost certainly be on the Congressional agenda as well. As noted in previous editions of Capitol Insights, one of the most pressing healthcare issues on Congress’s remaining docket this year is a two-year telehealth extension. As a refresher, there are two telehealth extension bills being considered. With some slight nuances, both would extend pandemic-era telehealth rules that end on December 31^st.

Another extremely important healthcare issue facing this Congress is addressing the 2.83% payment cut facing physicians going into next year if no Congressional action is taken. Legislation was introduced in the House led by Rep. Greg Murphy (R-NC-3) that would offset the 2.83% payment cut and also provide an additional increase to half of the Medicare Economic Index (MEI). If passed, this legislation would result in a 4.73% increase to the 2025 Physician Fee Schedule (PFS) Conversion Factor (CF).

We are also keeping a close eye on if Congress acts on Pharmacy Benefit Manager (PBM) reform or site neutral reforms this Congress. Notably, Senators Bill Cassidy (R-LA) and Maggie Hassan (D-NH) recently introduced a white paper that outlines site-neutral payment reforms for outpatient services and additional measures to support rural and high-needs hospitals.   

Lastly, the GOP Doctors caucus elected Rep. Greg Murphy (R-NC-3) and Rep. John Joyce (R-PA) as co-chairs. The caucus represents the interests of physicians in the House of Representatives.

President-elect Trump has nominated Robert F. Kennedy Jr. for the Department of Health and Human Services (HHS) Secretary. 

CMS released the CY 2025 Medicare Physician Fee Schedule final rule which includes a 2.83% cut in Medicare payments for physicians starting in 2025.  

The Government Accountability Office (GAO) released a report showing that the Department of Health and Human Services (HHS) has fallen short in overseeing health sector cybersecurity. The report covered various topics, including HHS’s inadequate oversight of healthcare organizations’ ransomware protection measures. 

CMS announced changes to Medicare premiums and deductibles for Part A and Part B plans in 2025. The Medicare Part A deductible will rise to $1,676, an increase of $44 from 2024. The Medicare Part B premium will increase to $185, which is $10.30 more than in 2024, and the deductible will be $257, reflecting a $17 increase from 2024.

CDC released its quarterly estimates of health insurance coverage, showing that 7.6% of Americans are uninsured in 2024, remaining consistent with the record low uninsured rate reported in 2023. 

A study published by JAMA Network Open examined telehealth use in primary care and found no evidence that it leads to increased low-value care for Medicare beneficiaries. The study looked at 577,928 fee-for-service Medicare beneficiaries in Michigan from 2019 to 2022 and showed no correlation between high levels of telehealth use and an increase in unnecessary medical procedures. ‘

President-elect Trump announced that he has appointed Elon Musk and Vivek Ramaswamy to lead a new Department of Government Efficiency, aimed at cutting government spending and reducing bureaucracy. This could impact various agencies including HHS and NIH.

The U.S. Department of Veteran Affairs (VA) has proposed eliminating copayments for telehealth services and implementing a grant program to expand telehealth access in rural and medically underserved areas. 

The U.S. Justice Department and four state attorneys general are suing UnitedHealth for its $3.3 billion deal to take over Amedisys, a home health company. Although UnitedHealth claims that the deal would benefit consumers and give them more choices, officials are concerned it would negatively impact patients needing in-home or hospice care.