Next month, the 114th Congress will convene with an enhanced Republican majority in the House—at least 246 Republicans. The newly GOP majority Senate will have 54 Republicans. Republicans are expected to pursue their health agenda which will certainly mean political and policy confrontation with the President.
Committee Leadership
In the House, Rep. Paul Ryan [WI] will be the new Ways and Means Committee Chair. In an interview with the Wall Street Journal, Ryan said he wanted to pursue ACA repeal and replace.
Reps. Tom Price, MD [GA] and Jason Chaffetz [UT] will chair Budget and Oversight and Government Operations Committees respectively. There will be a new House Labor-HHS-Education Appropriations Subcommittee chair. For Democrats, Rep. Frank Pallone [NJ] will be the Energy & Commerce Committee Ranking Member.
114th Congress Health Care Issues
In the past, rising health care costs have been the primary driver in attempts to significantly change health care policy. However, the Office of the Actuary, Centers for Medicare and Medicare Services (CMS) just reported that national health care spending growth in 2013 was just 3.6 percent. Health care spending as a share of the gross domestic product (GNP) remained at 17.4 percent, as it has since 2009.
Despite the good health care economic news, health care issues certain to arise in the next Congress. The issues will largely fall under three categories. The first is the Patient Protection and Affordable Care Act (ACA). Besides votes on outright repeal, there will be votes on various elements in the law. These include repeal of the individual and employer mandates; repeal of the medical device tax; and a redefinition of a full work week from 30 to 40 hours. There are some expiring ACA programs due for reauthorization in 2015. These include home visitation, the community health center fund, and other maternal and child health programs. These items are likely to become legislative vehicles for conflict between Congress and the President.
Second, under Medicare, Congress will have to deal with at least another temporary fix for Medicare physician reimbursement [SGR], which expires March 31st. The outlook is for the physician payment bill to be modified. Clearly, the struggle over budget offsets will continue. There are some Medicare extenders that also expire on March 31st. You can look for the final SGR bill to include permanent fixes for these also. If Congress cannot reach agreement then, look for another temporary patch. Much will depend upon how fast the new Congress can get started.
Hospitals can expect legislation concerning the two midnight rule, readmissions, hospital-acquired infections, graduate medical education (GME). The draft House Ways and Means Committee discussion draft released by Health Subcommittee Chairman Kevin Brady [TX] looks to be the starting point in the 114th Congress. Likewise, the Medicare fraud bill released earlier will also be on the agenda.
Third, the Children’s Health Insurance Program (CHIP) expires at the end of the year. The House Energy and Commerce Health Subcommittee recently held an oversight hearing on the program.
Also related is the 340B program. Recent published studies in Health Affairs and by the RAND Corporation were not positive towards the program. A recent adverse federal court decision in Pharma v. HHS resulted in the HRSA withdrawing the of the 340B “mega-reg” from Office of Management and Budget following a very long review period. The program, which has grown substantially in recent years, is under severe attack by pharmaceutical companies due to its recent growth. Safety net hospitals are mounting an effort to protect the 340B program.
Process
Under the rules of the U.S. House of Representatives, the majority party can basically pursue its policy agenda without interference from the minority.
The Senate is a different matter. With just 54 members, Republicans are well short of the 60 votes necessary to overcome a Democratic filibuster. Thus, there is discussion about using the budget reconciliation process to achieve Republican health legislative agenda.
During the current Congress, Republicans vowed to reverse the 51-vote majority for executive and judicial nominations. It’s not certain if incoming Majority Leader Mitch McConnell [KY] will pursue a reversal. However, no one is discussing a possible move by the new GOP majority to invoke the nuclear option for legislation. This would enable them to move agenda items without the 60-vote requirement to invoke cloture. Regardless of any potential change in Senate rules, Republicans will not have 290 votes in the House and 67 in the Senate to override a presidential veto.
The other part of the government process concerns the Executive Branch. One can anticipate more interpretive rules and guidances as the Administration seeks to set policy outside of the Administrative Procedures Act.
In the end, the next two years, at best will be more of the same. Federal policy gridlock will continue.
Julius W. Hobson, Jr. is Senior Policy Advisor at Polsinelli P.C. and Adjunct Professor of Political Management, Graduate School of Political Management, George Washington University, where he teaches courses on Lobbying, Electoral and Legislative Processes, and Legislative Writing and Research.