The midterm elections are behind us, and a lame duck session in Congress is here. What health care elements remain on the 2022 agenda? High-priority issues include: telehealth expansion, physician payments, changes to Medicare Advantage to help patients get more timely care, and certain Food and Drug Administration policies. In this blog post, we highlight policy areas key to supporting health for people with lower incomes that warrant strong consideration for inclusion in a year-end spending package.
Medicaid
While there was little political appetite for sweeping federal legislation to close the Medicaid coverage gap prior to the midterm election, there could be a strong push for more narrow coverage reforms in the end-of-year package. Sustained partisan resistance among nonexpansion states to expand Medicaid, even with the American Rescue Plan Act of 2021’s (ARPA) incentives, makes clear that only federal legislative action can close the Medicaid coverage gap in the near term. Since the year-end spending package will require bipartisan support, efforts to chip away at the coverage gap rather than close it completely are more viable. The following two proposals would expand coverage to targeted groups and advance health equity. Notably, both of these policies had bipartisan support in the Senate, were passed by the House of Representatives in the Build Back Better Act and were ultimately dropped by the Senate before passage of the Inflation Reduction Act.
- Mandate 12 months of postpartum coverage for Medicaid. ARPA gives states the option to extend the postpartum coverage period under Medicaid from 60 days to 12 months. The option is available through March 31, 2027. As of now, 26 states and the District of Columbia have implemented the extension, seven states plan to implement it, and two states plan to implement a limited extension (six months in Texas, 90 days in Wisconsin). Notably, nine of the 12 nonexpansion states have implemented, or plan to implement, the extension. Making the postpartum coverage extension permanent and mandatory would be a meaningful step toward addressing significant variations among states in maternal health outcomes and reverse persistent racial and ethnic disparities in maternal and child health outcomes.
- Provide Medicaid coverage at reentry from incarceration. Currently, the law generally prohibits the use of federal Medicaid funding for individuals who are incarcerated. Through the Medicaid Section 1115 waiver, 10 states provide presumptive eligibility to justice-involved individuals, which allows them to get access to Medicaid upon release without having to wait for their applications to be fully processed. The bipartisan Medicaid Reentry Act of 2021 would allow Medicaid to cover health care services for people in the 30 days preceding release from jail or prison. Lifting the federal Medicaid funding restriction could help improve continuity of health care for the justice-involved population, which disproportionately consists of individuals with mental illness and substance-use disorder.
Public Health
Unseasonably early surges of viral respiratory infections are overwhelming children’s hospitals and drawing attention to significant gaps in our public health system. The end-of-year package provides a timely opportunity to pass the PREVENT Pandemics Act, bipartisan legislation advanced by the Senate Committee on Health, Education, Labor, and Pensions (HELP) that takes steps to strengthen the nation’s public health and medical preparedness and response systems. Chair Patty Murray (D–Wash.) and ranking member Richard Burr (R–N.C.) incorporated ideas from 41 bills and 35 of their Senate colleagues. Notably, the legislation aligns with recommendations from the Commonwealth Fund Commission on a National Public Health System, including expanding the public health workforce, modernizing data systems, and strengthening federal leadership.
Though bipartisan efforts to bolster the federal COVID-19 response with additional funding have stalled, the threat of a wintertime “tripledemic” caused by respiratory syncytial virus (RSV), flu, and COVID-19 is putting pressure on Congress to provide immediate and long-term investments in public health infrastructure.
Impending congressional retirements are anticipated to trigger significant leadership changes in the Senate HELP Committee in 2023 and add urgency for legislative action this year. Burr is retiring in December and Murray will likely give up the HELP gavel to chair the Senate Appropriations Committee, following the retirement of Sen. Patrick Leahy (D–Vt.). Without clear legislative champions such as Murray and Burr, the path forward for the PREVENT Pandemics Act is uncertain.
Mental Health
In recognition of the growing need for a stronger mental health system in the United States, both chambers of Congress have prioritized the development of several bipartisan bills to advance mental health reforms. The Senate Finance Committee has led a deliberate process since August 2021 to craft bipartisan behavioral health legislation across five specific areas: improving access to telemental health services, addressing youth mental health, expanding the mental health workforce, integrating behavioral health services with primary care, and ensuring coverage parity between mental health and substance use disorder benefits and medical or surgical benefits. The committee has released discussion drafts for the first four areas, though remains unclear when it will unveil draft legislation on parity. Meanwhile, the House has advanced multiple proposals, including a bill that would support mental health services for children and students as well as enforcement of mental health parity requirements. The House Energy and Commerce Committee also passed a package that would largely reauthorize funding for existing mental health programs.
Despite continued interest in reform, it remains unclear whether Congress will act on mental health in its year-end package. While there is broad interest among lawmakers, Congress has not yet focused on specific areas. The earlier passage of the mental health provisions included in the Bipartisan Safer Communities Act also may chill certain lawmakers’ interest in passing additional mental health legislation this year. Interest may wane further if proposed reforms pose substantial costs to the federal government. Still, it is possible Congress may include mental health legislation, even if just to reauthorize several existing federal mental health programs. The remaining legislative packages — including the package the Senate Finance Committee is developing — could serve as a basis for legislative action in the next Congress.
Looking Ahead
The current continuing resolution funding the federal government ends on December 16. With the midterm elections over, Congress can now turn its full attention to developing a year-end package. The conversations in the following weeks will provide a clearer sense of what Congress will ultimately include and what will linger as unfinished business going into the 118th Congress.
