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Category: Health/Medical

Mark Up Still Going

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The House Ways and Means (W&M) Committee finished their portion of the Republican ACA repeal measure around 4:30 am this morning. The Committee approved their marked up draft by a vote of  23-16. The panel worked through the night, with Republicans overcoming Democratic protests that the process was rushed and the bill would force Americans to lose insurance coverage. 

The House Energy and Commerce  (E&C) Committee continues to mark up their section of the measure — 23 and a half hours as of this posting. Watch the hearing live here. For both committees, it has been an exercise in procedural maneuvering , particularly for E&C. To wit, it took E&C 12 hours to debate and then vote on the first amendment offered to the bill, which came from Ranking Member Frank Pallone (D-NY), to rename the bill “Republican Pay More for Less Care Act”. It failed along party lines. They are still working, and Democrats have asserted the they have “hundreds” of amendments.

During the week of March 13, the House Budget Committee is expected to package the W&M language with provisions from the E&C. The House will vote on the combined measure later in the week.

House Committees Mark Up ACA Repeal

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Mark up for both the House Energy and Commerce (E&C) and House Ways and Means (W&M) committees will happen this morning beginning at 10:30 am. Both committees will consider the bills until they’re done and each committee is expecting around 100 amendments per committee. Highlights of the bill are below . 

Watch the W&M hearing here. 

Watch the E&C hearing here. 

Big Items:

  • It would convert federal Medicaid financing to a per capita cap beginning in FY 2020 based on FY2016 enrollment.
  • It would reduce eligibility from 138% to 100% of FPL. 
  • It repeals all ACA taxes except for the Cadillac tax, which is delayed until 2025.
  • It repeals Medicaid DSH cuts for non-expansion states beginning in 2018 and for
    expansion states in 2020. Expansion states will not absorb cuts for DSH across all states. Rather,
    the cuts will be divided across states, and expansion states will absorb only their share in 2018
    and 2019.
  • It would retain coverage requirements like preexisting conditions, dependents up to age 26, preventative coverage, and prohibition on lifetime and annual limits.
  • Tax credits to purchase coverage are reduced. 
  • It would repeal of the individual mandate (but insurers may charge a 30 percent higher premium for one year for individuals returning to the health care market after having been uninsured.

House and Senate Consideration

The House E&C and W&M mark up is today. After that, both parts will have to go to the House Budget Committee to be “married together” and more changes can be made. House Budget consideration could be as soon as Friday depending on when E&C and W&M finish. House Leadership will likely try to put the bill up for full consideration by next week. 

From there, it will go to the Senate.  The Senate will attempt to pass this via the Senate Budget Reconciliation process, which means that the Senate will consider this via a straight up or down vote — 60 votes are not needed. However, whatever the House passes, the Senate will change to conform to Reconciliation rules, so presumably McConnell can change the legislation enough to pacify some of these Senators and/or pick up Democrats like Senator Joe Manchin (D-WV), who represents a state where Trump is very popular. 

There are restrictions in what the Senate can considered via Budget Reconciliation. Namely, there is a restriction called the Byrd Rule, which means, in overly simplistic terms, provisions considered in a budget bill have to be related to cost or spend money; they cannot legislate. Why is this important? There are items in the House draft, such as Section 103 in the E&C draft (the provision defunds Planned Parenthood) that will be struck from the Senate’s version by virtue of the fact that these provisions legislate. 

While officially, the Senate should do as the House and send the bill to the companion Senate committees (HELP, Senate Finance, and Senate Budget), there is a push to have McConnell move this straight to the Senate Budget Committee or Senate Floor. Regardless, this legislation will move quickly in each legislative body. 

The goal is to have the whole bill passed and signed before Congress leaves for a two-week Easter Recess on April 7th. 

In the mean time, the Congressional Joint Committee on Tax has estimated this will cost $500 B over the next 10 years due to all of the ACA taxes repealed — all ACA taxes are repealed but for the the Cadillac Tax, which is delayed until 2025. There still is no CBO score, which would include an accounting of all revenue lost as well as the number of people losing coverage. A CBO score isn’t expected until after the measure is considered by the House. 

Politically

Conservative political groups are blasting the measure already. The Club for Growth, Heritage Action, FreedomWorks, and Americans for Prosperity have all been very critical of the measure and have the ear of conservative Members. Other groups, such as AARP, have also come out against the bill. 

The Office of Federal Relations will continue to track the legislation and continue to provide updates.

Trump to Address Congress Tonight, Senate Approves Ross, and Zinke Up

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Last night, the Senate confirmed another Cabinet nominee for Trump as it voted 72-27 to confirm billionaire investor Wilbur Ross as Commerce Secretary.

Ross is a 79-year-old businessman who made his fortune by turning around companies in distressed industries like textiles and steel and is expected to play a leading role in trade policy.

The Senate now turns to Interior Secretary nominee, Rep. Ryan Zinke (R-MT). Out of the 15 primary federal department chiefs, Zinke looks like he will soon become the 11th Cabinet member confirmed. The Zinke nomination is expected to take the maximum amount of time possible similar to nearly every other Trump nominee.

Trump Address Congress, 

Meanwhile, it’s a little over a month into his new Administration and President Donald Trump will address a joint session of Congress for the first time tonight at 9 pm Eastern/6 pm Pacific. While not an official State of the Union address, the new president’s first address to Congress traditionally has been a tone setting speech. Expect a speech from Trump that will offer his vision for the country, including his policy priorities, but will not likely be heavy on details.

The While House has previewed the speech and expect Trump to hit on such topics as: the coming Presidential Budget Request (PBR); recent antisemitic attacks; the White House and the media, including CNN and false reporting; Obamacare repeal and replacement; and an extreme vetting Executive Order (expected Wednesday).

See the White House preview here. 

Meanwhile, the White House has said that the PBR will be previewed March 16th with something akin to a skinny budget, but the complete PBR will not be released until mid-May. The OMB, with newly approved OMB Director Mulvaney, began circulating top line numbers to agencies yesterday in preparation for a full budget preview and request.  As those documents were circulating, the Trump PBR will call for $603 billion in military spending, which is a 2% boost from current levels. That sum would also represent a $54 billion, or 10%, increase over budget caps set in law. Additionally, the plans has no cuts coming from entitlement programs such as Medicare and Social Security. The increase would come from the non discretionary defense portions of the budget.

Before the FY2018 PRB is released, the Trump Administration is expected to ask Congress for a $30 billion in supplemental defense spending via the Overseas Contingency Operations account that is not subject to the spending caps. It’s a move that’s been used by Congress previously. 

Administration Regulatory Reform Update

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Last week, White House Chief of Staff, Reince Preibus, issued a memorandum to all executive departments and agencies to freeze new or pending regulations — giving the new Administration time to review them, which is a common practice for any incoming administration.

For any regulations that have yet to be sent for publishing in the Federal Register, the memo asks the agency to not send any regulation to the Federal Register until reviewed by someone selected by the President.

The memo makes an exception for “critical health, safety, financial, or national security matters,” and asks agencies to identify any regulations that can’t be delayed for other reasons.

Recently issued research-centered regulations that could be impacted include:

  • federal policy for the protection of human subjects (Common Rule),
  • Department of Education’s final Rule on open licensing requirements for competitive grant programs, and
  • updates to the Uniform Guidance (including updates to the procurement rule and the micro-purchase threshold).

The Office of Federal Relations will continue to monitor actions coming from the Administration.

More Confirmation Hearings, Republican Retreat

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It’s a busy short week for Congress. House and Senate Republicans head to Philadelphia this week to begin sorting out fiscal priorities for the coming year in the party’s annual retreat. 

The retreat should lay out the first 100 days game plan for the Administration and Congressional Republicans and could lay the groundwork for setting fiscal priorities in the first year of the Trump Administration.

The Government Accountability Office (GAO) warned Congress in a report last week that the country is headed toward a fiscal train wreck. That’s even before any new spending programs or tax cuts are considered. Soaring costs for entitlement programs, from an aging population and rising health care costs, will combine with increasing interest payments to push the federal debt to record levels, the GAO said.

Federal debt as a share of the economy reached 77 percent last year, compared to the historical average since World War II of 44 percent. Without a change in policy, the ratio will exceed its historic high of 106 percent within 15 to 25 years.

Also, welcome to the first week of Congress with President Trump in the White House. Congressional leaders from both parties will meet with the new president at the White House today for a 5 p.m. reception. 

The House will have a light week of mostly suspension bills. The only non-suspension bill the House will vote on next week is HR 7, the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2017.  The measure, sponsored by Rep. Chris Smith (R-NJ), would prohibit federal funds, including those provided to the District of Columbia, from being used for abortions or for health benefits that cover abortions. The House has voted on a version of the bill in prior years as part of Republicans’ sustained targeting of Planned Parenthood.

The Senate continues to work on the confirmation process. Senate Democrats are demanding paperwork and additional time to question the remaining nominees, but truly all they can do is slow down the process. Up this week are Rep. Mike Pompeo (R-KS),who is up for CIA director, Rep. Tom Price (R-GA), who is up for Secretary of HHS and will appear before Senate Finance for another chance to defend ACA repeal, and Rep. Mick Mulvany (R-SC), who is Trump’s pick for White House budget director. Rep. Mulvaney gets a full day on Tuesday at two confirmation hearings: a morning hearing by the Senate Budget Committee and an afternoon examination by the Senate Homeland Security and Governmental Affairs Committee.