CONGRESS BRINGS PRESENTS TO SOME, COAL TO OTHERS — Leading lawmakers unveiled a $1.7 trillion year-end spending bill early Tuesday as they raced to pass the sprawling package by week’s end, with federal cash expiring at midnight on Friday. The so-called omnibus includes nearly $119 billion for veterans' care, a 22 percent increase, according to the office of Senate Appropriations Chair Patrick Leahy (D-Vt.). What else: The spending package includes a deal that saves the government billions by ending pandemic era-Medicaid policies and directs some of the saved dollars toward giving low-income moms an extended coverage period on Medicaid in states that don’t already offer it. — The deal includes language to extend hospital at-home waivers for two years, running through the end of 2024, POLITICO's Ben Leonard reports. The waivers, established in November 2020, allow hospitals to treat some emergency department and inpatient hospital patients from their homes. The move was aimed at expanding hospital capacity as health care organizations were slammed with Covid-19 patients. The extension is one of several wins in the omnibus for those who favor expanding virtual care. Lawmakers also proposed a two-year extension of Medicare telehealth waivers as well as a provision enabling high-deductible health plans to offer telehealth appointments to s before they’ve hit their deductibles. — Ben also notes that lawmakers decided to sustain a ban on using federal dollars to craft unique patient IDs meant to pair patients with their health records. Close to 120 groups including AHIP, EHR vendors Epic and Cerner, and other industry groups pushed appropriators this spring to end the ban, along with AHIMA, HIMSS and CHIME. — Physicians, who faced a 4.5 percent cut in Medicare rates in January, get a bit of a reprieve in the package. The new language would cut rates by 2 percent in 2023, and then 3.25 percent in 2024. Jack Resneck, the president of the American Medical Association, said in a statement that the move endangers the financial viability of some practices and threatens patient access. "This 2 percent following two decades of flat payment rates will have consequences on health care access for older Americans," he said in a statement. "High inflation compounds the threat to practice viability because physicians are the only Medicare providers without annual inflation-based updates." — Meanwhile, Sen. Bob Menendez said in a statement that he helped secure more funds for Puerto Rico’s Medicaid program to stabilize the territory’s health care system and improve the quality of care for residents. "I am proud to have secured this 76 percent FMAP reimbursement level over five years that will provide Puerto Rico with federal dollars that will enable the island to make critical investments that will help stabilize their health care system, retain health care providers, and improve access and quality of care for all of its residents," he said in the statement. The Senate is expected to act first on the spending package in the coming days, seeking a time agreement that would allow the bill to pass before Thursday night and sending it to the House. Any senator could hold up that deal in exchange for amendments or concessions. Senate Minority Whip John Thune said Monday that he expected conservatives to push for an amendment related to stripping out earmarks — or projects in lawmakers’ home states. What senators were saying: Sen. Ron Wyden (D-Ore.) told Alice Miranda Ollstein he was confident the final bill would include policies that made “substantial concrete headway” on several health issues. “We made progress with respect to the areas of telemedicine, postpartum coverage and Medicare. You can question if this change or that is appropriate, but the reality is this is significant headway compared to the status quo that we were dealing with,” he said. Sen. Roger Marshall (R-Kan.) said that while there were “some victories” in getting provisions from the PREVENT Pandemics Act into the text, he was disappointed that his bill to create a 9/11-style commission to investigate Covid-19 won’t be included. “Every layer of the onion that we peel back on the origins of Covid, we find that there’s more to it,” he said. “It’ll take a huge effort to really get to the truth.” WELCOME TO TUESDAY PULSE — We give you the latest affordable cosmetic surgery to be trending on TikTok. What could possibly go wrong? Send other dubious ideas, news and tips to kmahr@politico.com and dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, Ben Leonard talks with Mark Cuban, famous for his "Shark Tank" reality TV show on ABC and one of America's most prominent investors, about the Cost Plus Drug company he founded with Alex Oshmyansky to take on the pharmaceutical market and lower drug prices — and about his plan to try to disrupt the prescription drug space.
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