This week, Congress returns to Washington with 11 days to finalize a government spending bill. House appropriators will be meeting throughout the week to finalize their respective packages which means we should expect to see signs of progress by weeks end. However, questions regarding several key health care issues – drug pricing and market stabilization – continue to linger over the debate.

PhRMA is actively engaged in a full court press to modify the donut hole provision included in the February budget deal. While Democrats seem open to this, it’s only on the condition that other provisions are substituted to help lower costs. The CREATES Act is on the table as a potential pay-for despite heavy lobbying against the bill from PhRMA in the past. This week is a real test of PhRMA’s ability to get what they want and stop what they don’t.

Time is up on market stabilization. In or out? Both parties will need time to decide if the ‘juice is worth the squeeze.’ All stakeholders know that any possibility of a stabilization package after March 23rd is a long shot. Like picking Wright State to win the NCAA tournament long shot. While the framework of a deal is being discussed, getting all parties on board, namely the White House, is a key hurdle.

Elections have Consequences 

President Trump went on full court press over the weekend in hopes of securing another special election victory tomorrow (March 13th) in a district surrounding Pittsburgh. If the Democrats take the seat, it would be the first time since 2003 that it was held by a Democrat. Implications for both sides in where they draw policy lines in the sand could be significant.

State Waivers Update

Last week, CMS put the State of Idaho on notice for moving to sell non ACAcompliant health plans. However, CMS signaled the door is wide open for Idaho to push short-term limited duration health plans (STLDI). The Trump Administration has been promoting STLDI plans since the proposed rule was announced last month as an alternative to other individual market plans. The reality is the Administration is making clear they expect these plans to be available very soon. Meanwhile, the Governor of Idaho did not exactly back down following the CMS letter setting up the potential for a legal battle.

Additionally, states continue to pursue Medicaid waivers, pursuing reforms such as work requirements and premiums despite concerns from the Government Accountability Office on oversight and evaluations. As these waivers begin to take shape, outcomes and spending will carry significant weight in the context of future state-based innovations.

Important to follow as Congress slips into election-mode but the Administration’s wheels keep turning.