Summary
Congress ended last year having accomplished a sizable amount of policymaking on health. In addition to the several bipartisan provisions included in the fiscal year (FY) 2023 omnibus, lawmakers also passed bipartisan legislation on mental health and gun reform, and congressional Democrats were successful in advancing substantial drug pricing reforms and coverage expansions via the Inflation Reduction Act.
Following a highly productive 2022, the federal outlook for health policy in 2023 appears slated to feature a familiar set of priority areas. We expect that conversations will focus on issues such as health equity, affordability, public health, mental health, health care coverage, and health technology, among others. However, we expect that a greater share of the work on health policy will be advanced through the Administration and that less will be accomplished by Congress. This is largely because the political appetite for additional health policy legislation may wane following the activity of the year prior. A divided Congress will also complicate the ability for lawmakers to coalesce around bipartisan solutions for health reform.
Despite this dynamic for 2023, a number of upcoming deadlines may necessitate a must-pass vehicle focused on health policy, which could feature additional bipartisan riders. Notably, a number of major expirations for federal programs and other policy changes will occur at the end of the fiscal year (i.e., September 30, 2023), including:
- The expiration of the Pandemic and All-Hazards Preparedness (PAHPA);
- The expiration of several provisions included in the SUPPORT Act;
- The Farm Bill; and
- The scheduled Medicaid Disproportionate Share Hospital cuts, which are set to go in effect at the beginning of fiscal year 2024.
Beyond this, Medicare physician payments are scheduled to decrease at the beginning of calendar year 2024, which may prompt legislative activity to prevent such decreases from taking effect by the end of the calendar year. Congress will also have to address the debt ceiling in the summer and resolve how to fund the government for FY 2024.
Still, the ability for Congress to pass substantial health-focused legislation appears slim. The focus on mental health last year may remain this Congress – especially the Senate Finance Committee’s mental health provisions were not included in the omnibus – though there may be a greater emphasis on substance use disorder as attention shifts to address the SUPPORT Act reauthorizations. Congress also must pass the Farm Bill, which will reauthorize crucial programs including the Supplemental Nutrition Assistance Program (SNAP) and The Emergency Food Assistance Program (TEFAP), and may include notable nutrition-related policies. Aside from these efforts, however, it remains uncertain whether Congress will accomplish much else on the health policy front. And efforts to further bolster the U.S. public health system – despite an opportunity to do so with the upcoming PAHPA reauthorization – do not appear viable following the successful inclusion of several public health provisions in the fiscal year 2023 omnibus.
Instead, the Biden-Harris Administration is planning to engage in multiple rulemaking efforts to advance its health-related priorities. For example, we expect to see more from the Administration this year on its plans for implementing the drug pricing provisions included in the Inflation Reduction Act. We also anticipate additional work on advancing the Administration’s behavioral health integration strategy, which it unveiled last year. Last, the Administration is expected to end the COVID-19 public health emergency (PHE) this year and will begin supporting health care providers, states, and other stakeholders in the unwinding of the various pandemic-related flexibilities and requirements that have been in place since 2020. The Administration will also likely move forward on a variety of efforts to support access to reproductive health, support public health systems, and improve access to equitable care.