Fight Over House Anti-Shutdown Bill Affects Medicare Provisions

News December 20, 2024 at 03:20 PM
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What You Need To Know

  • The House posted a 1,547-page anti-shutdown package Tuesday.
  • When the first package stalled, the House posted the 117-page American Relief Act package.
  • The shorter package includes some Medicare provisions but leaves out Older Americans Act reauthorization.
  • Efforts to pass the shorter package have stalled, and House negotiators are trying to regroup.
  • A Congressional Research Service guide shows what might happen if the government shuts down.
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House Republicans succeeded Friday at creating and passing legislation designed to keep the federal government running, and that continues to include some provisions related to Medicare funding.

The Senate then rushed to approve the bill, a new, 118-page American Relief Act, 2025 package, and send it to President Joe Biden for his signature.

The previous law authorizing the federal government to operate normally expired at midnight Friday, when many federal offices were closed for the weekend. Senate Majority Leader Charles Schumer, D-N.Y., said as debate started that he believed the ARA, 2025 package would pass quickly enough to prevent any meaningful shutdown. White House officials said they had ended efforts to implement a shutdown.

The new ARA, 2025 package authorizes the government needs to conduct normal operations until March 14, 2025.

The drafters of the ARA, 2025 package kept many of the Medicare-related provisions that were included in a 1,547-page anti-shutdown package, the Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025, that was posted on the House website Tuesday. The Medicare measures in the new version of the ARA, 2025 package appear to be the same ones that were included in an earlier, 116-page ARA, 2025 version that was unveiled Thursday and failed to reach the House floor.

Drafters do not seem to have included sections referring directly to life insurance, retirement plans or estate planning, such as a new bill that could help workers roll assets directly from 401(k) plans into annuities.

The Choices

As of Friday morning, the deal negotiators appeared to have four major options:

1. Resume efforts to pass the Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 package.

This package would provide authorization for the government to continue normal operations until March 14.

It includes many provisions that could affect clients with Medicare.

The package does not appear to include sections that refer directly to life insurance, estate planning or retirement savings arrangements for civilians.

2. Resume efforts to pass the version of the American Relief Act, 2025 package unveiled Thursday. This legislation is a condensed version of the Further Continuing Appropriations Act package. Like the bigger package, it would authorize normal government operations through March 14.

The American Relief Act package includes some of the Further Continuing Appropriations package provisions that would affect Medicare.

It also leaves out a section of the Further Continuing Appropriations package that would reauthorize the Older Americans Act, which provides about 900,000 meals per day for older Americans.

3. Create a short bill that simply prevents a shutdown and postpones the deadline for resolving other issues. In the past, Congress has avoided shutdowns during complicated negotiations by passing bills that authorized the continuation of normal government operations for a few days at a time.

4. Develop a major new anti-shutdown package.

The Timeline

House leaders posted a draft of the first anti-shutdown package to show up, the Further Continuing Appropriations package, Tuesday.

Some House Republicans objected to the rushed process used to develop the package.

President-elect Donald Trump said he opposed the package. Trump objected to some funding provisions in the package. He also said that the package should include a provision raising the federal debt limit, to ensure that the government will not face future debt-limit fights.

Another effect of keeping the debt-limit cap in place could be to hamper Republicans' efforts to extend trillions of dollars in Tax Cuts and Jobs Act of 2017 tax cuts before 2026.

Trump has not discussed the Medicare or Older Americans Act reauthorization provisions included in the original Further Continuing Appropriations package.

House Republicans responded Thursday to Trump's objections by developing the first version of the American Relief Act, 2025 package. They hoped to have the full House consider the package quickly.

House leaders needed approval from two-thirds of members to rush the bill to the floor. Instead, House members voted 174-235 against letting the package onto the House floor.

Around 2:30 p.m. Friday, Politico reported that House Republicans had agreed to support a package that would need votes from Democrats and would not include the debt ceiling limit elimination provision sought by Trump. The revised version of the ARA, 2025 package posted on the House website Friday leaves out the public debt limit provision included in the first ARA, 2025 version.

Members of the House began voting on H.R. 10545, the revised version of the ARA, 2025 package, around 5 p.m. Friday. The House then voted 366-34 around 6 p.m. Friday to approve the package.


All Democrats in the House and most Republicans who cast votes voted for the package. All of the members who voted against the package are Republicans.

The Senate began considering the ARA, 2025 package after passing H.R. 82, the Social Security Fairness Act of 2025, by a 76-20 vote. That bill changes federal laws that have kept some public sector retirees and family members from collecting Social Security benefits,

The Senate then voted 85-11 to approve the ARA, 2025 package around 12:30 a.m. Saturday. The party breakdown for the Senate vote was not immediately available.

The American Relief Act Medicare Provisions

The new ARA, 2025 package includes the Further Continuing Appropriations provisions related to:

  • Maintaining current provisions that boost Medicare reimbursement rates for doctors and hospitals.
  • Maintaining current provisions that boost Medicare reimbursement rates for ambulance services providers.
  • Extending the current, temporary Medicare telehealth coverage rules, which are more flexible than the older Medicare telehealth coverage rules and were adopted in response to the COVID-19 pandemic.

The ARA package appears to exclude the Further Continuing Appropriations provisions that would:

  • Require Medicare Advantage plans to update their provider directories more quickly.
  • Move toward having Medicare cover Grail's Galleri blood test and other blood tests that screen people for many different kinds of cancer at the same time.
  • Limit pharmacy benefit managers that serve Medicare prescription drug plans to collecting service fees and prohibit the PBMs from basing compensation on the value of discounts negotiated.
  • Reauthorize the Older Americans Act.

What if the government had 'shut down'?

The new ARA, 2025 package raises the possibility that Congress could have to go through another dramatic round of negotiations to keep the federal government from shutting down in March.

The Congressional Research Service provided an extensive guide to what would really happen to government operations during a shutdown.

The Social Security Administration, for example, would:

  • Continue to pay Social Security retirement and disability benefits.
  • Continue to process applications for benefits.
  • Stop issuing replacement Medicare cards.

This article may be updated after press time to reflect new developments.

Credit: Bloomberg

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