The push for Medicare site-neutral pay reform

Dec 12, 2024

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Sens. Maggie Hassan (left) and Bill Cassidy speak on stage at a POLITICO event.

Sens. Maggie Hassan and Bill Cassidy highlighted their bipartisan work together on site-neutrality. | Rod Lamkey Jr./POLITICO

TAKEAWAYS FROM POLITICO’S EVENT — Advocates and opponents of policies having Medicare pay the same price for the same services at different locations, including Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.), spoke at POLITICO’s “Defining Site-Neutrality” event Wednesday in Washington.

Cassidy — the incoming chair of the Senate Health, Education, Labor and Pensions Committee — will soon have significant latitude over health policy with unified Republican control of Washington. He said Wednesday he’ll prioritize site-neutral payment policy next Congress.

Cassidy and Hassan’s bipartisan plan on site neutrality would stop hospitals from getting paid more by Medicare for the same care received at a doctor's office, and the lawmakers want to invest the savings in rural and urban so-called safety-net hospitals. The proposal could bring significant savings but has run into obstacles — including opposition from hospitals.

Here are some key takeaways from the event:

Reconciliation up in the air: With full control of Washington weeks away, Republicans are looking to the reconciliation process, which allows lawmakers to avoid the Senate filibuster.

Site-neutral payments could result in significant savings to help pay for other programs on President-elect Donald Trump’s agenda. Cassidy said it was “premature” to say whether site-neutral policies are a target for reconciliation.

“It’s better to stay focused on the policy,” Cassidy said. “If you tell me the process of next year and you know it down to a T, you shouldn’t be here. You should be at the track ... betting.”

Hospital opposition remains: Hospitals have fiercely opposed site-neutral payment changes, saying they would imperil access to care and increase wait times, especially in rural and underserved areas.

Beth Feldpush, senior vice president of advocacy and policy at America's Essential Hospitals, which represents rural and underserved facilities, compared those hospitals’ financing to “Jenga” — having to piece together many sources of funding.

“It stands, and it’s not sturdy. When you start to pull out all of those things — it could just be one thing — it all starts to wobble eventually," Feldpush said during a panel discussion at the event.

Bipartisanship emphasized: Bipartisan dealmaking may be less common with full GOP control of Washington, but Cassidy and Hassan both emphasized areas of agreement and even fist-bumped when talking about their track record of bipartisan work.

Cassidy spoke highly of Sen. Bernie Sanders (I-Vt.), with whom he has clashed at times and who will be the ranking member on the HELP Committee. Sanders told POLITICO in an interview Tuesday that his six-year term beginning next month is likely to be his last in Congress.

“Obviously, he’s very liberal,” Cassidy said. “My practice is to find out where we can agree on things, which are probably neither left nor right ... We’ve worked very well together."

Cassidy — who voted to convict Trump in his impeachment trial over Jan. 6 — faces reelection in 2026.

WELCOME TO THURSDAY PULSE. We’re reporting on the latest in the end-of-year health package. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.

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Around the World

People against transgender care for minors stand together at a protest.

The ban of puberty blockers in the U.K. could have an impact on legislation in the U.S. Congress involving transgender health care. | Angelina Katsanis/POLITICO

RAMIFICATIONS OF UK PUBERTY BLOCKER MOVE — New restrictions on puberty blockers for people under 18 overseas could impact the American debate over transgender health care, POLITICO’s Daniel Payne reports.

The U.K.’s Labour government announced an indefinite ban on puberty blockers for minors Wednesday. The move comes after conservative U.S. Supreme Court justices last week pointed to European restrictions on gender-affirming care as the reason why Tennessee stood on firm ground in banning puberty blockers for youth with gender dysphoria. The Biden administration had challenged the Tennessee law.

The U.K.’s Department for Health and Social Care, following advice from a commission on medicines, announced that a temporary ban put in place by the previous Conservative Party government in May would be made indefinite because of “unacceptable safety risk,” though use in a clinical trial setting would still be allowed.

The bigger picture: Many U.S. arguments about care bans — including those from Supreme Court justices, civil liberties advocates and state lawmakers — point to European countries’ approaches.

Congress is considering a must-pass defense authorization bill that would bar the military’s health care system from paying for puberty blockers for children of servicemembers. Some Democrats say they’ll vote against the bill to protest the provision.

In recent years, several countries have walked back previous support for some medical interventions for people under 18 with gender dysphoria, though few have impeded access.

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In Congress

OLDER AMERICANS ACT UPDATE — The Senate unanimously passed legislation that would reauthorize the Older Americans Act.

The legislation — which funds meals and medical services such as health screenings and transportation to doctors’ offices — could ride on the continuing resolution lawmakers are considering to avert a government shutdown.

The Senate’s version would reauthorize the act for five years and boost funding from $2.3 billion to $2.76 billion in fiscal 2025.

Senate HELP chair Bernie Sanders (I-Vt.) and ranking member Bill Cassidy (R-La.) said they’re working with the House to get it signed into law.

ACA TWEAKS PASS CONGRESS — The Senate passed by unanimous consent a pair of bills easing compliance requirements under the Affordable Care Act for employers, sending them to President Joe Biden’s desk.

One bill would no longer require employers and insurers to send tax forms to covered individuals showing proof of minimum coverage unless requested, which is tied to the effectively repealed individual mandate under Obamacare requiring minimum health insurance coverage. Another would give more time for employers to respond to a penalty assessment and allow employers to file some documents related to coverage electronically.

“These two bills will help relieve much of the burden of … compliance for applicable large businesses,” Neil Trautwein, executive director of the Partnership for Employer-Sponsored Coverage, said in a statement.

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HEARTS ACT ADVANCES — Legislation that would bring more automated external defibrillators into schools and ease access to CPR training is poised to become law.

President Joe Biden is expected to sign the bill into law soon after it unanimously passed the Senate this week and the House by voice vote in September.

The legislation from Rep. Frank Pallone (D-N.J.), ranking member of the House Energy and Commerce Committee, aims to fight sudden cardiac arrest in young people, particularly student-athletes. About 2,000 young, apparently healthy people under 25 die annually of sudden cardiac arrest in the U.S., according to federal estimates.

Senate Majority Leader Chuck Schumer worked on the legislation with Buffalo Bills safety Damar Hamlin, who suffered cardiac arrest during a game in January 2023. The Bills’ medical team saved his life with an AED and CPR, and Hamlin is back playing for the team.

“This bill will create lasting change, and I’m proud and humbled to have played a part in supporting it,” Hamlin said in a statement.

Names in the News

Patroski Lawson has been appointed to the board of directors of BioGene Therapeutics. He's the founder and CEO of KPM Group.

Laura Warnier is joining Sunrise as chief growth officer. She was previously at GoStudent.

Julie Nickson is now vice president of federal advocacy and coalitions at the American Cancer Society Cancer Action Network. She was previously the group’s director of federal relations.

Dr. Kate Koplan is joining SCP Health as executive vice president and clinical quality officer. She was previously at Kaiser Permanente.

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WHAT WE'RE READING

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NBC News reports that President-elect Donald Trump plans to end policies restricting ICE arrests at hospitals.

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