Week in Washington 102821

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Week in Washington


Congressional Negotiations

Congressional negotiations on the Build Back Better (reconciliation bill) continued this week. It appears that an agreement is closer but has not yet been achieved. For example, while the White House released a framework (you can read it here) key Congressional figures were withholding full support. One of the key outstanding sticking points is health care items. Here is where things stand currently:

  • Medicare- There appears to be growing convergence that Medicare will expand to cover hearing benefits but not dental and vision.

  • Medicaid – A full federal Medicaid program for non-expansion states is out but providing coverage to enrollees in non-expansion states through the Exchange is in. The additional coverage option would not be open ended and sunset in four years, absent future Congressional action.

  • ACA- ACA subsidy expansion (e.g., continuing the additional subsidies provided by the American Rescue Plan) is in but debates are ongoing as how long to make the extension. The subsidy extension would also sunset (likely after three years), absent future Congressional action.

  • Prescription Drugs- There continues to be uncertainty surrounding prescription drugs. There has been severe disagreements if negotiations over prescription drug prices or changes to the Part D benefit (e.g., inclusion of an out of pocket maximum that would halt cost-sharing over a certain threshold) would be included in the final version of the bill.

Details of the bill are likely to be known what the actual bill language is released, which is expected in the coming days.


Medicaid Data

  • CMS released the May Medicaid enrollment report. Medicaid and CHIP enrollment now stands at nearly 83 million, an increase of about 500,000 relative to April.

  • KFF released its annual survey of Medicaid directors. It provides an overview of policy changes going on in Medicaid. For example, two-thirds of states that include Medicaid pharmacy benefits in managed care contracts reported prohibiting spreads pricing in managed care subcontracts with their PBMs, a significant increase relative to the previous year.

  • There is interesting research on the effects of Medicaid expansion, on Medicaid participation, payer mix, and labor supply in primary care.  The findings were that labor supply did not increase to meet additional appointments but instead those physicians accepting Medicaid patients shifted away from commercial payers counterintuitively.


  • CMS released a white paper on changes to the ACA risk adjustment program. There is a 30-day comment period. It is likely some of the ideas included in the white paper will be included in the proposed forthcoming 2023 Payment Notice.

Previous editions: 

10/21/2021: Week in Washington

10/14/2021: Week in Washington

10/07/2021: Week in Washington

09/30/2021: Week in Washington



09/23/2021: Week in Washington

09/09/2021: Week in Washington

9/02/2021: Week in Washington

8/26/2021: Week in Washington


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