In a relatively quiet day on the chamber floors of Congress, the Senate moves back to confirming nominations from the White House by considering President Trump’s choice for Director of National Intelligence (DNI), former U.S. senator from Indiana, Dan Coats. The DNI position was created after the Sept. 11 attacks to coordinate the work of the various agencies that make up the Intelligence Community. A cloture vote on Coats’ nomination is expected today, setting up a final vote later this week.
The Congressional Budget Office released its highly-anticipated score of the American Health Care Act (AHCA) – the Republican plan to repeal and replace parts of the Obama-era Affordable Care Act (ACA). Both supporters and detractors of the AHCA will find favorable information in the score; the CBO projects federal deficit savings of $337 billion over the next ten years, but at the cost of coverage losses for 24 million people in that same timeframe. The proposal’s effect on premium prices, the stability of the non-group market, and Medicaid spending are also detailed in the CBO’s analysis.
The release of two separate documents – a Congressional Budget Office (CBO) score for the Republican health care plan and President Trump’s budget proposal for fiscal 2018 – will drive conversation in Congress this week far more than any of the measures on the chamber floors. The first document is sure to add a wrinkle to the debate over the Republican health care proposal after the House Committees with jurisdiction approved the bill last week before the non-partisan CBO could release its analysis. The House Budget Committee will meet midweek to help turn the proposal into a single bill that meets the requirements of budget reconciliation, with Republican leaders hoping to get the bill to the floor next week.
The Week in Review
It was a monumental week in health policy as Republicans went to work advocating for their plan to repeal and replace the Affordable Care Act (ACA), dubbed the American Health Care Act (AHCA). The House Ways & Means and Energy & Commerce Committees held marathon markups for their respective portions of the bill last week over the objections of Democrats, who delayed the process as much as possible through parliamentary procedure. The details of the plan, the list of its supporters and detractors, and its path forward in both chambers is included in our roundup below. Expect the AHCA to control much of the legislative oxygen in the weeks to come.
Action on Capitol Hill today will be relatively tame as the Senate has already closed up shop for the week and the House considers a tort reform bill to finish its scheduled legislative business. The measure (H.R. 720) hitting the House floor would impose financial penalties on plaintiffs that file frivolous lawsuits and repeal a provision that allows them to avoid punishment if they withdraw their claims within 21 days. The bill will be considered with four amendments and is unlikely to draw the support of many Democrats, who opposed the bill unanimously when it advanced out of the House Judiciary Committee.
In a marathon session that ended at 4:30 a.m. this morning, the House Ways and Means Committee approved its portion of the bill to repeal and replace the Affordable Care Act (ACA) on a 23-16 party line vote. Democrats stretched out the hearing by offering dozens of amendments and using parliamentary rules to require tedious debate on each one, but no amendments made it on to the version eventually approved by the Committee. The process in the House Energy and Commerce Committee is proving to be even more drawn out as Democrats kept the Committee in session throughout the night and plan to offer over 100 amendments. Due to the rules of the Committee, the first of those amendments, simply to change the name of the bill, was debated throughout the night and as of this writing the Committee remains at work.
During the campaign, it was said by some that Donald Trump is the wrong answer to the right question. Regardless, it was clear – both from the primaries and then in the general – that a big section of the American public was incredibly frustrated with the institutions of governments and were prepared to elect someone willing to be different.
Last Tuesday, the President came to Capitol Hill and by many accounts gave the first “Presidential” speech of his tenure. Depending on where you sit, this was either a necessary reset or an appropriate look forward. Either way, the purpose was to refocus the political capital that the President needs to spend to accomplish the very lofty objectives he campaigned on. However, by the end of the weekend it appears as if the White House is going to add another item to Congress’ already packed agenda.
All eyes will be off the floor today as the House Energy and Commerce and Ways and Means Committees hold markups on the Republican bill to repeal and replace the Affordable Care Act. Democrats will likely offer as many amendments as possible in order to drag out proceedings, and some may argue that the proposed bill (E&C portion; W&M portion) violates the Byrd Rule, a parliamentary ruling that stipulates budget reconciliation bills – including the repeal and replace effort – cannot include provisions that don’t affect revenue or spending. The minority party has also secured consideration of a resolution of inquiry (H. Res. 154) at today’s Energy and Commerce markup that would require Health and Human Services Secretary Tom Price to provide Congress with all the documentation related to “plans to repeal or replace” the Affordable Care Act. However, Republicans can kill that resolution in committee by reporting it unfavorably to the House floor.
A second draft of the Republican plan to repeal and replace the Affordable Care Act (ACA), dubbed the American Health Care Act (AHCA), was released last night and is set to be marked up by both the House Energy and Commerce and Ways and Means Committees tomorrow morning. The bill (E&C text; W&M text) provides for most of the traditional Republican elements of health care reform, such as getting rid of the individual mandate and boosting health savings accounts (HSAs), while also maintaining some pieces of the ACA, including a temporary continuation of federal support for Medicaid expansion.
The House only has a pro forma session scheduled today, but returns tomorrow to a defense appropriations bill (H.R. 1301) that would fund the Pentagon for the remainder of the fiscal 2017 year at $583.7 billion in annualized defense spending. The bill – which will likely be considered without amendments – is the result of negotiations dating to the last Congress. With an Apr. 28 funding deadline looming for the entire government, watch to see if Democrats attempt to hold up the defense bill in order to pressure Republicans to act on omnibus legislation that would fund the rest of the government. Republican leaders are currently crafting their spending strategy, which may include multiple “minibus” appropriations measures to fund the various agencies and departments that make up the federal government. Should that strategy fail, it remains possible that lawmakers will pass a final stopgap bill to maintain fiscal 2016 levels of spending for the remainder of the 2017 fiscal year, which ends Sept. 30.