Wednesday, February 8, 2023
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Spending Bill Makes Big Changes to Healthcare

The bill would tweak the Food and Drug Administration’s controversial accelerated approval program for drugs.

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The U.S. Senate’s massive omnibus spending proposal could result in millions of Americans losing Medicaid coverage, tweak the Food and Drug Administration’s controversial accelerated approval program, and put off cuts to Medicare physician fees.

The bill, which weighs in at more than 4,000 pages and directs $1.7 trillion in federal funds, is a behemoth. Released the week before the Christmas holiday, as members of Congress rush to leave town ahead of an expected blizzard, it is jammed with proposals, many of which have been under consideration in other forms for months.

At a press conference on Tuesday, Sen. Chuck Schumer, the majority leader, called the bill “aggressive, generous, and far-reaching in healthcare, making it more affordable and more expansive.”

The Senate advanced the bill on Tuesday, but the legislation must clear more hurdles in both the Senate and the House to be signed by Friday, when the one-week stopgap provision currently funding the federal government expires. The shutdown will start Saturday, if the bill isn’t signed by then.

Here are some of the healthcare-related provisions that will go into effect if the bill passes:

  • A pandemic-era requirement that barred states from kicking recipients off Medicaid, the federally funded health insurance program for low-income disabled people, will expire in April. An early December report from the Robert Wood Johnson Foundation found that 18 million people could lose Medicaid coverage as a result.

  • The bill would require states to keep children enrolled in Medicaid covered for 12 months, even if parents’ income levels change.

  • The bill would also extend funding of the Children’s Health Insurance Program by two years, to 2029.

  • The bill puts off an automatic spending cut known as PAYGO that would have resulted in a 4.5% cut next November in physician fees for Medicare providers.

  • A pandemic-era loosening of telehealth rules would be extended through the end of 2024.

  • A section of the bill dedicated to the Food and Drug Administration would make changes to the agency’s accelerated approval program, which allows new drugs to be approved based on preliminary evidence on the condition that the drug company run confirmatory trials after the fact. The program has grown increasingly controversial in recent years, after some companies waited years to begin those confirmatory trials. The bill would now allow the FDA to require that confirmatory trials begin within a certain period following accelerated approval, and would make it easier for the FDA to revoke an accelerated approval after the fact.

  • The FDA portion of the bill also includes a number of measures intended to increase the racial and ethnic diversity of populations represented in clinical trials.

  • The bill includes $4.9 billion aimed at addressing the opioid epidemic, $345 million more than was allotted in 2022.

  • The bill would make it easier for doctors to prescribe the opioid addiction treatment buprenorphine, eliminating a requirement that they obtain a special waiver from the Drug Enforcement Administration.

  • Funding for the National Institutes of Health for 2023 would be $47.5 billion, an increase by $2.5 billion from the last fiscal year. Of that funding, $3.7 billion is earmarked for Alzheimer’s and related dementia research, and $7.3 billion for the National Cancer Institute.

  • Centers for Disease Control and Prevention funding would be $9.2 billion for 2023.

Write to Josh Nathan-Kazis at


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