Congress hides healthcare spending from budget rules in must-pass bill
H.R. 1968 — Full-Year Continuing Appropriations and Extensions Act, 2025 · Filed by Tom Cole (R-OK) · Introduced Mar 10, 2025 · Signed
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What it does
This is a continuing appropriations bill that funds federal government operations through September 30, 2025, and extends various healthcare, human services, and security programs. It extends Medicare waivers for hospital care at home and oral antiviral drugs, allocates $1.8 billion to the Medicare Improvement Fund, delays Medicaid payment reductions through 2028, extends sexual risk avoidance and personal responsibility education programs, and renews authorities for cybersecurity, fentanyl enforcement, and whistleblower protections.
Why we flagged it
The bill's primary function is extending Medicare and Medicaid programs and human services funding through FY2025, but section 3106 deliberately exempts these provisions from standard budget scorekeeping rules, hiding their fiscal impact from deficit calculations and congressional budget enforcement mechanisms.
- Section 3101 extends CFTC whistleblower authorities through Sept 30, 2025—unrelated to healthcare/human services core.
- Section 3102 extends drone-detection authorities at federal facilities—security matter unrelated to appropriations core.
3 unrelated provisions were flagged in total.
What the text implies
- Section 3106 exempts divisions B and C from PAYGO scorecards and budget enforcement rules, meaning the cost of these healthcare and human services extensions will not count against deficit targets or trigger automatic spending cuts. This obscures the true fiscal impact and allows Congress to avoid difficult trade-offs.
- The Medicaid DSH (Disproportionate Share Hospital) reduction delay through 2028 shifts costs forward and may force states to absorb payment reductions later or reduce provider reimbursement rates, affecting hospital financial stability and potentially limiting care access in low-income communities.
The full analysis lists 4 implications of this text.
Who stands to gain
hospitals (via Medicaid DSH delay); pharmaceutical manufacturers (oral antiviral coverage expansion); healthcare providers (Medicare waiver extensions)