Financial Leadership

During a potentially tumultuous Congress, healthcare stakeholders should communicate their policy priorities

Negotiations over federal spending and audits of COVID-19 funding are possible developments that would make life complicated for providers over the next two years.

January 24, 2023 5:33 pm

With the 118th Congress bringing the potential for policy upheaval, one of the best things healthcare stakeholders can do is make themselves heard on Capitol Hill.

The new Republican majority in the House of Representatives has signaled its intent to use the federal debt ceiling as leverage in budget negotiations. President Joe Biden and the Democratic majority in the Senate have said they will not negotiate over the debt ceiling, which in previous years has been raised as needed to accommodate allocated expenditures.

But in the run-up to a looming debt ceiling breach that the Department of the Treasury says would curtail most federal spending starting around early June, there’s a real possibility that negotiations will have to happen.

“I think [Democrats] are going to have to negotiate with the House,” Tom Spulak, co-leader of the Government Advocacy and Public Policy practice at King & Spalding, said during a webinar hosted by the firm.

In such a scenario, provider payment rates in Medicare and Medicaid (and funding for numerous other government programs across sectors) would be at stake. Given that context, stakeholders such as hospitals and health systems should be contacting legislators who either are engaged with pertinent policy areas or represent the district in which the organization is based.

“You want to make sure that your member of Congress, anyone who’s a policymaker in D.C., has a sense of what you do with federal fundings — i.e., what would happen if they were cut significantly, or cut in a way where you don’t have input into that decision,” Allison Kassir, senior government relations adviser with King & Spalding, said during the webinar.

Scrutinizing the use of funds

Stakeholders also should prepare to clarify how they used relief funding to ensure members of their community retained healthcare access during the COVID-19 pandemic, Kassir said. That’s because congressional audits are looming.

William Clarkson, counsel with the Government Advocacy and Public Policy Practice at King & Spalding, said the House Select Subcommittee on the Coronavirus Crisis likely will focus on relief funding, “specifically waste, fraud and abuse uncovered in the context of these programs.” Although an upcoming hearing is scheduled to examine unemployment aid, the focus eventually could shift to CARES Act funding such as the Provider Relief Fund.

Another prospective area of investigation is funding used to reimburse providers for COVID-19 testing, treatment and vaccination services for uninsured patients, Clarkson said. Last February, Rep. Cathy McMorris-Rodgers (R-Wash.), now the chair of the House Energy and Commerce Committee, co-authored a letter to HHS about the COVID-19 Uninsured Program, saying that as operated by the Health Resources and Services Administration, the program had “subsidized providers for services that they do not provide or, in some cases, are not even licensed to provide.”

On the Democrats’ radar

In the Senate, potential areas of oversight include hospital billing procedures, Clarkson said, noting that such an investigation could be bipartisan. Sen. Patty Murray (D-Wash.), chair of the Appropriations Subcommittee on Labor, Health and Human Services, and Education, last year requested extensive information on billing and debt collection practices, and Sen. Chuck Grassley (R-Iowa) has made similar inquiries.

Other possible areas of bipartisan collaboration in Congress include price transparency, behavioral health, the opioid crisis and cybersecurity. Kassir also noted that Sen. Bill Cassidy (R-La.) is looking to gather feedback on policy solutions to improve care for dually eligible Medicare and Medicaid beneficiaries.

A Senate subcommittee during the prior Congress held at least one hearing on hospital consolidation, and Clarkson said the chamber may continue to examine mergers and acquisitions in support of the antitrust work taking place at the Federal Trade Commission and the Department of Justice. Biden in 2021 directed the FTC to seek ways to promote market competition in healthcare, among other industries.

“One could envision sort of a tandem approach where an investigation unveils certain things, [and] hearings then support administrative action” taken up by the FTC or DOJ, Kassir said.

CMS could be busy

A lack of big-ticket legislation in a divided Congress would leave regulatory agencies as the primary policy driver over the next couple of years. CMS’s top priority in the coming months likely will be to set the stage for drug price negotiations in Medicare starting in 2026 as authorized by the Inflation Reduction Act, Kassir said.

The agency also will be looking to further incorporate efforts to promote health equity. A recent example was seen in the 2024 proposed rule for Medicare Advantage health plans and Part D sponsors, with a health equity index factoring into the published star ratings for those organizations beginning in 2027.

CMS also is “keenly aware,” Kassir said, of the need to address access and workforce issues through comprehensive solutions that don’t impose a significant administrative burden on providers.

As with congressional activity, stakeholders shouldn’t underestimate their ability to influence regulatory policy.

“Even just inquiring about where a particular policy proposal is, that’s an incredibly effective way to ensure you are being heard,” Kassir said.


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