Health Policy Report

The Week in Review

The inception of the 115^th Congress was marked by controversy last Tuesday, after a day typically reserved for the pomp and circumstance of swearing new Members of Congress into office quickly devolved into a firestorm over a rules change that would have gutted the independent Office of Congressional Ethics (OCE). Rank-and-file members of the Republican caucus, led by Rep. Bob Goodlatte (R-VA), overruled the party’s leadership in proposing the change, which would have limited the OCE’s powers and placed it beneath the authority of the Republican-controlled House Ethics Committee. The move was quickly reversed after Democrats successfully rallied public opinion and the Republican party standard bearer, President-elect Donald Trump, criticized the change as a poor use of Congress’s time. 

The majority party found more success in starting the Affordable Care Act (ACA) repeal process, with the Senate approving a budget resolution (S. Con. Res. 3) on Wednesday that would instruct Senate committees to formalize the specifics of repeal. Some Republicans are beginning to express doubts over a strategy that would see a rapid ACA repeal without a clear replacement, but House Speaker Paul Ryan has insisted that both repeal and replace will be completed in the 2017 calendar year. A full breakdown on where the ACA repeal process stands is included in our roundup below.

In other floor action, the House continued targeting the priorities of the Obama White House by advancing a bill that would prevent any major rule from taking effect without explicit Congressional approval (H.R. 26) as well as a resolution (H. Res. 11) objecting to a recent United Nations (UN) resolution that condemned Israel’s continued construction of settlements in the West Bank and East Jerusalem. On Friday, lawmakers convened for a joint session to count the Electoral College’s ballots and officially certify the results of November’s presidential election, but that also quickly fell victim to partisan acrimony as a handful of House Democrats objected to the results due to recent revelations that the Russian government attempted to sway the election in favor of President-elect Trump. The lawmakers’ efforts proved futile, however, and Vice-President Joe Biden officially confirmed the result, clearing the way for Trump’s inauguration on Jan. 20.

The Week Ahead

With President-elect Donald Trump’s inauguration looming closely on the horizon, this week will focus on the incoming Administration as Senate committees begin holding confirmation hearings for Trump’s Cabinet nominees. Despite Democrats labeling some of the choices “troublesome,” as well as reports that the Office of Government Ethics lacked sufficient time to adequately vet many of the nominees due to their extraordinary wealth and unusually complex financial situations, a 5-vote threshold for approval means that most nominees should nevertheless sail through the confirmation process. Additionally, with eight confirmation hearings scheduled for Wednesday and Thursday, along with the President-elect’s first press conference since July, there may not be enough political oxygen for Democrats to launch a significant offensive over multiple nominees. From a health policy perspective, the nominee for Health and Human Services Secretary, Rep. Tom Price, will be in front of the Senate Health, Education, Labor, and Pensions Committee on Jan. 18, but his official confirmation hearing in the Senate Finance Committee has yet to be scheduled.

In floor action this week, the Senate will continue plodding through the ACA repeal budget resolution while House lawmakers will consider measures that would force federal agencies to meet a variety of new requirements when issuing rules regulations (H.R. 5), curb the authority of the Commodity Futures Trading Commission (CFTC) (H.R. 238), and scrutinize the Securities and Exchange Commission’s process for making rules (H.R. 78).

Budget Bill Begins ACA Repeal Process

Last Wednesday, the Senate began the highly anticipated Affordable Care Act (ACA) repeal process. Introduced January 3^rd by Senator Enzi (R-WY), S. Con. Res. 3 set forth the congressional budget for fiscal year 2017 and laid out the appropriate budgetary levels for fiscal years 2018 through 2026. The budget also directs a legislative pathway for an upcoming health care law repeal and replacement package by instructing committees to draft reconciliation bills by Jan. 27., and advanced by a 51-48 vote to allow for consideration to begin in the Senate. Senator Rand Paul (R-KY) voted with Democrats against considering the resolution – not in opposition to the repeal effort, but in favor of a frugal alternative budget plan that would balance the budget instead of increasing the national debt.

The repeal pathway now proceeds toward Senate budget resolution amendment votes this week in a process known as a “vote-a-rama,” in which a marathon of floor votes on amendments will occur.   Democrats plan to offer various amendments in support of various elements of the health coverage law. Following Senate passage, the House will immediately consider the measure, and supporters hope to complete action on the budget plan prior to Jan. 20. The budget resolution urges the completion of a health care law repeal package by Jan. 27 and Republicans are plotting final delivery of the repeal bill — to the White House — by Feb. 20.

Divided GOP Clashes with Dems Over ACA Repeal

Wednesday saw two of the most powerful men in Washington to the Capitol to advance the efforts of their respective parties in the battle over the Affordable Care Act (ACA) repeal. President Obama attended a strategy meeting of congressional Democrats on how to buck the GOP's agenda, and Vice President-elect Mike Pence attended meetings of House and Senate Republicans to encourage GOP lawmakers by suggesting the incoming Trump administration would use the regulatory process to change insurance exchange and health coverage rules. During the last Capitol Hill visit with House and Senate Democrats of his presidency, Obama said they should not seek to solve Republican divisions over how to replace the law. After a meeting with Vice President-elect Mike Pence the same morning, House Republicans revealed that they plan to repeal the ACA in February, but delay its implementation until they can agree on a replacement plan. Both President Obama and President-elect Trump have been very vocal about the repeal process the last week, with Obama daring the GOP to make their replacement plans public and Trump lambasting Democratic leadership and the ACA via twitter.

Although there is a general Republican consensus that the ACA must be repealed, GOP lawmakers are divided on the process and timeline in which “repeal and replace” should take place.  A growing number of Senate Republicans are voicing concerns about the GOP's strategy to repeal the ACA without a replacement plan, including Sen. Rand Paul (R-KY) and Sen. Bob Corker (R-TN), and believe the two separate plans should be moved together to cause minimal disruption. Sen. Susan Collins (R-ME) suggested Friday that lawmakers should release a framework of their plan to replace the ACA before repealing the law. Senate GOP leadership has backed voting to repeal the ACA immediately but with an "off ramp" that would delay the repeal, though GOP leaders haven't locked down an exact timeline. When questioned, Senate Majority Leader Mitch McConnell (R-KY) signaled lawmakers were focused on first repealing the law.

Thirteen self-described moderate Senate Democrats sent a letter to top Republicans asking them not to repeal the Affordable Care Act and work with Democrats to fix the law. Led by Sen. Tim Kaine (D-VA), Democrats wrote to Senate Majority Leader Mitch McConnell (R-KY); Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-TN) and Finance Committee Chairman Orrin Hatch (R-UT) Thursday urging them to abandon plans to repeal the ACA, and to instead work in a bipartisan manner to improve the health care law. The group argued for improvements to the ACA, warning that repealing the law would have "negative impacts,” and added that any changes "must protect" provisions that have allowed millions of Americans to gain insurance. Additionally, the letter warned that moving forward without a replacement plan would open up Republicans to political backlash for roiling the healthcare market and potentially impacting Medicare beneficiaries. Further angering Democrats, House Speaker Paul Ryan (R-WI) announced last week that plans for repeal would include an effort to defund Planned Parenthood. House Minority Leader Nancy Pelosi (D-CA) and other House Democrats have vowed to fight to retain women’s healthcare benefits included in provisions of the ACA, cautioning the GOP it has “awakened a sleeping giant.”

Senate Dems Demand Investigation of HHS Nominee Rep. Price

Senate Democratic leaders asked that President-elect Trump’s pick for HHS chief, Rep. Tom Price (R-GA), be investigated by the Office of Congressional Ethics to ensure the lawmaker didn't breach any laws or regulations when he traded in stocks of dozens of healthcare and pharmaceutical companies while actively pushing healthcare bills, and refused to proceed with his confirmation until completed. The message came as consumer advocacy group Public Citizen also demanded both the congressional ethics office and Securities & Exchange Commission probe Price's stock-buying activity for any potential violations. The Trump transition team retorted it continues to support Price and shot back that the same questions should be directed to three key Senate Democrats who likewise have “traded hundreds of thousands of dollars in pharmaceutical and health insurance company stocks.” The team distributed official Senate financial disclosure data detailing the stocks bought by Sens. Mark Warner (D-VA), Sheldon Whitehouse (D-RI) and Tom Carper (D-DE). The transition team also asserted Price has provided the requested information despite Democrats' claims to the contrary.

Senate Minority Leader Charles Schumer (D-NY) vowed to do all he can to stop the confirmation process until the ethics questions are answered, and established that he is negotiating with Senate Majority Leader Mitch McConnell (R-KY) over next steps for the confirmation, threatening Democrats have certain areas of leverage he hopes they will not have to use. At a Thursday press conference, Sen. Schumer brought up House Republicans’ foiled attempt to abolish the independent ethics committee, stating it coincided with concerns raised over Price’s stock market trading. Democrats have identified Rep. Price as one of the Trump nominees the party is most worried about. Rep. Price has yet to respond to the accusations.

According to a committee spokesperson, the Senate Finance Committee has not yet scheduled a confirmation hearing date for Price. The HELP committee’s hearing has reportedly been set for Jan. 18.