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After fierce pushback from hospitals, the Senate's version of President Joe Biden's $1.7 trillion social spending package excludes the House's cuts to Medicaid disproportionate share hospital payments. The House-passed Build Back Better Act would cut Medicaid DSH payments by 12.5% to hospitals operating in the 12 states that have not expanded Medicaid under the the Affordable Care Act. House Democrats justified these cuts because the bill also would provide subsidized private health insurance from the exchanges to those who would qualify for Medicaid had their home states broadened program eligibility, thereby reducing the need for DSH funding to cover uncompensated care costs. (Hellmann, 12/13)

Hospitals and their lobbyists in Washington just wriggled their way out of a major, looming cut to Medicaid payments to facilities in a handful of states. Now, they’ll have to try to pull out a second victory — deflecting an even bigger cut to Medicaid payments targeted at hospitals in even fewer states. The messy politics that underpinned the first fight are similar. Both sets of cuts target red states that haven’t yet expanded their Medicaid programs under the Affordable Care Act, since those states will get the expansion paid for in President Biden’s major domestic spending legislation. (Cohrs, 12/14)

The head of a Senate panel that oversees Medicare says the Biden administration should use its legal authority to cut back a hefty premium increase soon hitting millions of enrollees, as a growing number of Democratic lawmakers call for action amid worries over rising inflation. Last month, Medicare announced one of the largest increases ever in its “Part B” monthly premium for outpatient care, nearly $22, from $148.50 currently to $170.10 starting in January. (Alonso-Zaldivar, 12/13)

Joe Manchin remains at the negotiating table, despite deep concerns about President Joe Biden’s climate and social spending bill. After speaking with Biden on Monday afternoon, Manchin said he was still "engaged" in discussions. And as he left the Capitol, the key Democratic senator made clear he wasn't ready to commit to voting for or against a bill that is still coming together behind closed doors. (Everett and Levine, 12/13)

Senator Joe Manchin III of West Virginia, the most prominent Democratic holdout on President Biden’s $2.2 trillion social safety net, climate and tax bill, cast fresh doubt on Monday on his party’s plans to speed the measure through the Senate before Christmas, saying he still had grave concerns about how it would affect the economy. Mr. Manchin outlined his skepticism before speaking by telephone about the bill with Mr. Biden, a discussion that aides to both later characterized as positive. After the call, Mr. Manchin, who represents West Virginia, did not rule out the possibility of supporting the measure this month. (Cochrane, 12/13)