House Speaker Mike Johnson unveiled a spending bill late Tuesday that would avert a government shutdown if it is passed by both the House and Senate before funding runs out on Saturday.The spending plan, known as a continuing resolution, has bipartisan support.It would fund the government through March 14, setting up another spending showdown in the early days of the Trump administration. Republicans will control both the Senate and House come January, but the party will have slim margins in both chambers.The deal contains nearly $100 billion in disaster aid and $10 billion more in banking relief for farmers in rural communities. It would also extend the farm bill by one year, continue allowing more seniors to use telehealth and reform how pharmacy benefit managers, known as PBMs, operate.Here’s what else is in the bill:More disaster aid fundingThe deal would provide nearly $100 billion to help Americans trying to recover from multiple natural disasters in 2023 and 2024. The funding is in line with the roughly $100 billion topline request from the Biden administration in November.Some $29 billion would help replenish the Federal Emergency Management Agency’s Disaster Relief Fund, which has dwindled after contending with two major hurricanes that ripped through the Southeast earlier this year, as well as other disasters.In October, FEMA rapidly spent $9 billion of a $20 billion infusion from Congress responding to Hurricanes Helene and Milton. The agency also had to handle wildfires, floods and tornados this year. Federal data shows the costly disasters are now happening more frequently.The package also includes $2.2 billion for the Small Business Administration’s disaster loan program, $21 billion in disaster relief for farmers (including the $10 billion in economic assistance for farmers) and $3.5 billion for state and tribal assistance grants to repair water systems damaged in disasters.A Department of Housing and Urban Development program for disaster relief would receive $12 billion and federal highway and roads disaster relief would total $8 billion.Economic aid for farmersThe bill includes $10 billion in economic aid for farmers, one of the last sticking points in negotiations earlier this week. Lawmakers from agricultural-focused states have argued that the help is desperately needed as America’s farmers are facing lower commodity prices and higher costs for supplies.The spending agreement also includes a one-year extension of the farm bill – a sweeping package that governs many agricultural and nutrition assistance programs. Typically, the bill is renewed every five years, but the most recent version was passed in 2018 and the extension lapsed at the end of September. The continuing resolution extends it until the end of September 2025.Reforms for pharmacy benefit managersAfter two years of failed attempts, lawmakers agreed to a package of reforms for pharmacy benefit managers, the controversial middlemen between drug manufacturers and insurers who have raised the ire of Congress and many others with their opaque practices.The funding deal would require PBMs to provide more information on the rebates they negotiate and retain, as well as what they pay for drugs and how much they compensate pharmacies. It would remove the connection between the price of drugs and the compensation the PBMs receive in Medicare Part D drug plans and shift the payment model to flat fees.Plus, the agreement would require the industry to pass along all rebates to the health plan sponsors, which include insurers and employers, in the commercial insurance market. It would also effectively eliminate so-called “spread pricing,” in which the PBMs withhold part of the payment they receive for drugs from pharmacies, in Medicaid.The effort aims to increase transparency and change the industry’s compensation structure, said Ross Margulies, partner at Manatt, Phelps & Phillips, a law firm specializing in health care. The concern until now has been that PBMs may have the incentive to prefer higher-cost drugs since they can negotiate larger rebates on them.The Federal Trade Commission sued in September the largest PBMs – CVS Health’s Caremark Rx, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx – for allegedly inflating insulin prices.PBMs argue that the legislation will weaken their ability to lower drug costs and could result in higher premiums for senior citizens.The funding agreement also includes a two-year extension of a pandemic-era measure that expanded the use of telehealth in Medicare.More senior citizens and Americans with disabilities have been able to get care via telehealth since the COVID-19 pandemic began in early 2020. Eligibility for the service was broadened beyond just those living in rural areas, and seniors have been able to conduct the telehealth visit at home, rather than having to travel to a health care facility.Maryland bridge fundingUnder the agreement, replacing the Francis Scott Key Bridge in Maryland would be fully funded by the federal government. The legislation would also allow the U.S. Treasury Department to recoup money from any settlements related to the bridge’s collapse to help pay for the rebuilding.A cargo ship crashed into the bridge in March, causing it to collapse and severing access to critical shipping routes in and out of the Port of Baltimore. Six workers on the bridge were killed.Rebuilding the bridge could cost between $1.7 billion and $1.9 billion, according to an estimate released by the Maryland Transportation Authority earlier this year.Control over RFK stadiumThe spending package gives Washington, D.C., greater control of land around the defunct Robert F. Kennedy stadium, paving the way for the Washington Commanders football team to return to the nation’s capital.The provision is a big win for Washington, D.C., which is expected to negotiate the construction of a new stadium where RFK currently sits. The Commanders currently play at FedEx Field, in Landover, Maryland.The provision came after Hill leaders satisfied other demands from Maryland leaders, including for the federal government to cover the full cost of the replacement of the Francis Scott Key Bridge. The spending package also transfers D.C.’s Air National Guard 121st Fighter Squadron into the Maryland Air National Guard.Pay raises for lawmakersThe bill would provide lawmakers with their first pay raise since 2009.Both Republican and Democrat leaders agreed to include the language, which allows members to receive an automatic cost-of-living adjustment to their base salaries of $174,000 per year, according to multiple people familiar with the discussions.This is a change to current practice, in which Congress takes steps in each spending bill to remove that cost-of-living adjustment. That has been in place since the 2009 recession.The provision could be a sticking point. At least one lawmaker, Democratic Rep. Jared Golden of Maine, has said he will oppose the stopgap spending bill unless that provision is removed.
House Speaker Mike Johnson unveiled a spending bill late Tuesday that would avert a government shutdown if it is passed by both the House and Senate before funding runs out on Saturday.
The spending plan, known as a continuing resolution, has bipartisan support.
It would fund the government through March 14, setting up another spending showdown in the early days of the Trump administration. Republicans will control both the Senate and House come January, but the party will have slim margins in both chambers.
The deal contains nearly $100 billion in disaster aid and $10 billion more in banking relief for farmers in rural communities. It would also extend the farm bill by one year, continue allowing more seniors to use telehealth and reform how pharmacy benefit managers, known as PBMs, operate.
Here’s what else is in the bill:
More disaster aid funding
The deal would provide nearly $100 billion to help Americans trying to recover from multiple natural disasters in 2023 and 2024. The funding is in line with the roughly $100 billion topline request from the Biden administration in November.
Some $29 billion would help replenish the Federal Emergency Management Agency’s Disaster Relief Fund, which has dwindled after contending with two major hurricanes that ripped through the Southeast earlier this year, as well as other disasters.
In October, FEMA rapidly spent $9 billion of a $20 billion infusion from Congress responding to Hurricanes Helene and Milton. The agency also had to handle wildfires, floods and tornados this year. Federal data shows the costly disasters are now happening more frequently.
The package also includes $2.2 billion for the Small Business Administration’s disaster loan program, $21 billion in disaster relief for farmers (including the $10 billion in economic assistance for farmers) and $3.5 billion for state and tribal assistance grants to repair water systems damaged in disasters.
A Department of Housing and Urban Development program for disaster relief would receive $12 billion and federal highway and roads disaster relief would total $8 billion.
Economic aid for farmers
The bill includes $10 billion in economic aid for farmers, one of the last sticking points in negotiations earlier this week. Lawmakers from agricultural-focused states have argued that the help is desperately needed as America’s farmers are facing lower commodity prices and higher costs for supplies.
The spending agreement also includes a one-year extension of the farm bill – a sweeping package that governs many agricultural and nutrition assistance programs. Typically, the bill is renewed every five years, but the most recent version was passed in 2018 and the extension lapsed at the end of September. The continuing resolution extends it until the end of September 2025.
Reforms for pharmacy benefit managers
After two years of failed attempts, lawmakers agreed to a package of reforms for pharmacy benefit managers, the controversial middlemen between drug manufacturers and insurers who have raised the ire of Congress and many others with their opaque practices.
The funding deal would require PBMs to provide more information on the rebates they negotiate and retain, as well as what they pay for drugs and how much they compensate pharmacies. It would remove the connection between the price of drugs and the compensation the PBMs receive in Medicare Part D drug plans and shift the payment model to flat fees.
Plus, the agreement would require the industry to pass along all rebates to the health plan sponsors, which include insurers and employers, in the commercial insurance market. It would also effectively eliminate so-called “spread pricing,” in which the PBMs withhold part of the payment they receive for drugs from pharmacies, in Medicaid.
The effort aims to increase transparency and change the industry’s compensation structure, said Ross Margulies, partner at Manatt, Phelps & Phillips, a law firm specializing in health care. The concern until now has been that PBMs may have the incentive to prefer higher-cost drugs since they can negotiate larger rebates on them.
The Federal Trade Commission sued in September the largest PBMs – CVS Health’s Caremark Rx, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx – for allegedly inflating insulin prices.
PBMs argue that the legislation will weaken their ability to lower drug costs and could result in higher premiums for senior citizens.
The funding agreement also includes a two-year extension of a pandemic-era measure that expanded the use of telehealth in Medicare.
More senior citizens and Americans with disabilities have been able to get care via telehealth since the COVID-19 pandemic began in early 2020. Eligibility for the service was broadened beyond just those living in rural areas, and seniors have been able to conduct the telehealth visit at home, rather than having to travel to a health care facility.
Maryland bridge funding
Under the agreement, replacing the Francis Scott Key Bridge in Maryland would be fully funded by the federal government. The legislation would also allow the U.S. Treasury Department to recoup money from any settlements related to the bridge’s collapse to help pay for the rebuilding.
A cargo ship crashed into the bridge in March, causing it to collapse and severing access to critical shipping routes in and out of the Port of Baltimore. Six workers on the bridge were killed.
Rebuilding the bridge could cost between $1.7 billion and $1.9 billion, according to an estimate released by the Maryland Transportation Authority earlier this year.
Control over RFK stadium
The spending package gives Washington, D.C., greater control of land around the defunct Robert F. Kennedy stadium, paving the way for the Washington Commanders football team to return to the nation’s capital.
The provision is a big win for Washington, D.C., which is expected to negotiate the construction of a new stadium where RFK currently sits. The Commanders currently play at FedEx Field, in Landover, Maryland.
The provision came after Hill leaders satisfied other demands from Maryland leaders, including for the federal government to cover the full cost of the replacement of the Francis Scott Key Bridge. The spending package also transfers D.C.’s Air National Guard 121st Fighter Squadron into the Maryland Air National Guard.
Pay raises for lawmakers
The bill would provide lawmakers with their first pay raise since 2009.
Both Republican and Democrat leaders agreed to include the language, which allows members to receive an automatic cost-of-living adjustment to their base salaries of $174,000 per year, according to multiple people familiar with the discussions.
This is a change to current practice, in which Congress takes steps in each spending bill to remove that cost-of-living adjustment. That has been in place since the 2009 recession.
The provision could be a sticking point. At least one lawmaker, Democratic Rep. Jared Golden of Maine, has said he will oppose the stopgap spending bill unless that provision is removed.
