congress

Resurrecting a health care deal

In Tuesday’s newsletter, I told you that lawmakers were “near” a health care deal. About half an hour after that newsletter hit your inbox, Congress released that deal as part of the HHS spending bill.

For months, lobbyists had been saying that the deal, struck originally in December of 2024, could come back up. Lawmakers had worked hard on it, and it was scuttled in large part because of an Elon Musk xeet-storm. Musk no longer has lawmakers’ ears, and the deal was low-hanging fruit at a time when politicians were having difficulties agreeing on much of anything.  

The health care measures in the deal range from PBM reforms to hospital billing transparency and measures to induce more pediatric cancer research.  

Anything can happen, but lobbyists say odds are that Congress will pass the HHS appropriations bill and avoid another government shutdown. 

The big snowstorm that is expected this weekend could complicate matters. The House is expected to vote on the bill this week, but senators might have a difficult time returning to town next week to vote if the storm is bad enough.

Read more on what’s in the bill, and see the next item for an explanation of one intriguing measure.

cancer screening

Holy Grail

The bill would allow Medicare to pay for blood tests that screen for multiple cancers. That’s potentially a big win for Grail, which sells just such a test, called Galleri.

Loads of lawmakers have backed efforts to make coverage of Galleri possible, but the potential cost has gotten in the way. Even if the law passes, the FDA would have to approve the test and Medicare would need to undertake a special process to determine whether to pay for it.

To deal with the cost problem, the bill includes a price cap, age restrictions, and a delay in the start of coverage to push most of the cost beyond Congress’ 10-year budget window. Medicare coverage would be phased in, starting in 2029 with aged 65 and younger, and increasing by one year of age each subsequent year. It also ties the pay rate to the price of a colon cancer screening test, which is about $500.