HR-10013-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Nanette Barragán (D-CA)
What it does
The Compassionate Care Act would direct the federal government to launch a national public education campaign on advance care planning (living wills, health care proxies, etc.), create provider education resources and a pilot grant program for medical schools to add end-of-life training to their curricula, and develop quality measures for end-of-life care across healthcare settings. It would also permanently extend Medicare's authority to use telehealth for hospice recertification visits and remove geographic restrictions on telehealth delivery of advance care planning services. Additionally, it would commission studies on a national advance directive registry, electronic health record standards for storing advance directives, and the frequency of unwanted medical treatments paid for by the government or patients.
Who benefits
Seriously ill and dying patients who would have better access to advance care planning conversations and whose documented wishes may be more consistently honored. Family members and health care agents who would receive clearer guidance on a loved one's end-of-life preferences. Rural and homebound Medicare patients who would gain telehealth access to hospice recertification and advance care planning services without geographic restrictions. Medical students, residents, nurses, social workers, and other trainees who would receive structured end-of-life education. Hospice and palliative care providers who may see increased patient referrals and earlier engagement. Minority and non-English-speaking communities targeted by culturally and linguistically appropriate outreach. Health IT vendors and researchers who would participate in demonstration programs and studies.
Who is hurt
Medical schools and training programs that would need to redesign curricula to meet new requirements, potentially at administrative cost. Healthcare providers who would face new quality reporting requirements and continuing education obligations. Federal agencies (CDC, CMS, AHRQ, HRSA, ONC) that would bear implementation costs. Taxpayers who would fund the public education campaign, grants, studies, and demonstration programs — though specific dollar amounts are not specified in the bill. Providers in non-rural areas who currently bill for telehealth advance care planning under geographic waivers may face regulatory uncertainty as permanent rules are written. Patients who prefer not to engage in formal advance care planning may face increased institutional pressure to do so.
Supporters argue
Supporters argue that the United States spends an estimated 25% of Medicare expenditures in the last year of life, much of it on treatments patients would not have chosen had their wishes been clearly documented and communicated. They contend that advance care planning is consistently shown in research to improve patient satisfaction, reduce unwanted interventions, and ease the burden on families — yet fewer than one-third of American adults have completed an advance directive. Supporters further argue that the bill's telehealth provisions address a documented access gap: rural and homebound patients face disproportionate barriers to hospice and palliative care consultations, and permanently extending pandemic-era telehealth flexibilities would lock in proven improvements to care access.
Opponents argue
Opponents argue that the bill authorizes open-ended appropriations ("such sums as may be necessary") across multiple programs without specifying spending caps, creating fiscal uncertainty and potential for significant unbudgeted expenditures. They contend that mandating end-of-life quality measures and continuing education requirements imposes new administrative burdens on already-strained providers, particularly small practices and rural hospitals, without clear evidence that federal campaigns meaningfully change patient behavior. Opponents may also argue that a national uniform advance directive policy — studied under Section 201 — could override state laws that reflect local moral and religious values about end-of-life care, raising federalism concerns about the appropriate role of the federal government in deeply personal medical decisions.
Constitutional context
Congress's authority to fund public education campaigns, condition Medicare and Medicaid participation on quality reporting, and modify telehealth reimbursement rules rests on the Taxing and Spending Clause (Art. I, §8, cl. 1) and the Commerce Clause (Art. I, §8, cl. 3). NFIB v. Sebelius (2012) affirmed broad congressional authority to structure Medicare and Medicaid as spending programs with attached conditions, though it cautioned that conditions cannot be so coercive as to leave states no genuine choice. The bill's study of a national uniform advance directive policy (Sec. 201) could raise Spending Clause coercion questions if future legislation were to mandate state compliance as a condition of federal healthcare funding.
Checks and balances
The Executive Branch (HHS, CMS, CDC, AHRQ, HRSA, and ONC) gains significant implementation authority to develop campaigns, curricula, quality measures, and regulations; Congress retains oversight through required reports to relevant committees, and the GAO provides an independent check through its mandated studies.
Historical precedent
The ACA (2010) first authorized Medicare reimbursement for advance care planning conversations, and pandemic-era telehealth waivers temporarily extended hospice recertification via telehealth — both of which this bill builds upon and makes permanent.