Over the weekend, two victories in Nevada and Arizona secured Democratic control of the Senate. With control of the House still undecided, Congress on Monday reconvened with a long list of health care priorities for the lame-duck session, including a potential federal spending package.

Democrats retain control of the Senate, House is still undecided

Sen. Catherine Cortez Masto (D-Nev.) and Sen. Mark Kelly (D-Ariz.) over the weekend were projected to win their seats in the 2022 midterm election, maintaining Democratic control of the Senate for the next Congress.

As a result, Democrats will control the legislation brought to a vote on the Senate floor. In addition, they will be able to set committee agendas, and President Joe Biden will have an easier time confirming nominees, including the new head of the NIH.

This will also likely prevent Republican investigation into the Biden administration's pandemic response, including how pandemic relief dollars have been spent, as well as the origins of Covid-19.

Republicans are currently projected to win control of the House. In this scenario, partisan gridlock would likely hinder many items on the Biden administration's legislative agenda leading up to the 2024 election, including more pandemic relief funding and codifying Roe v. Wade.

However, there could be opportunities for legislation around more bipartisan topics, such as telehealth expansion and mental health care access.

What are the key health care priorities for the lame-duck session?

On Monday, Congress reconvened with a long list of health care priorities for the lame-duck session. In particular, Democrats intend to approve a federal spending package for 2023, which could include major health care policies.

Funding for several government programs is set to expire on Dec. 16, and Democrats hope to push a year-end spending package through both chambers before the end of 2022. If Republicans win control of the House, a year-end spending bill during the lame-duck session would mark Democrats' last chance to pass legislation with the "trifecta" of the House, Senate, and the White House before the new Congress, CQ News reports.

The legislation would likely provide temporary or longer-term funding for several programs expiring on the Dec. 16 deadline, which include a bipartisan home visiting program, expanded Medicaid funding to U.S. territories, mental health grants, and a deal to reauthorize FDA industry user fees for five years. 

In addition, provider groups are urging Congress to prioritize several other Medicare policies before the end of 2022, including blocking several cuts that are set to take effect in 2023. Congress previously waived cuts through 2022, but there will be a roughly $36 billion reduction in Medicare spending if they do not take further action by the end of the year.

If Congress does not act, the Medicare conversion factor—which calculates billing codes into payment rates—would incur a 4.5% cut, resulting in a roughly $3 billion or $4 billion payment reduction to providers under the Medicare Physician Fee Schedule.

Lab groups have also encouraged Congress to further delay Medicare reimbursement cuts that stemmed from a 2014 law intended to align Medicare lab payments with the commercial market's lower rates. However, the industry has argued for years that Medicare's data collection methods are flawed.

Before the end of the year, Congress may also attempt to pass other health policies, including measures that establish a new standard for prior authorization in Medicare Advantage plans. (Cohrs, STAT, 11/13; Roubein, Washington Post, 11/14; Keith, Health Affairs, 11/10; Raman et al., CQ News, 11/14 [subscription required])