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Category: Health/Medical

ACA Repeal

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Health care, taxes, and a regulatory reform will dominate the Hill during Trump’s first 100 days in office, and the partisan maneuvering begins today. Both President Barack Obama and Vice President-elect Mike Pence headed to Capitol Hill to discuss the health care law this morning.

Obama’s goal is to rally Democrats.

Vice President-elect Pence met with the Republican conference, which is still sorting through which elements of the ACA to preserve and how long the transition period to a replacement plan should last. Conservatives, like the House Freedom Caucus, want as little as a six-month transition period. Other Members are mulling as long as a four-year-delay, which would keep elements of Obamacare in place past the 2020 elections. During the meeting, Pence announced the incoming Administration’s two track approach of using Congress as well as Executive Order. 

There’s already questions about the timeline for repealing the Affordable Care Act because of the taxes used to fund the law, like the investment tax hike on the wealthy, the medical device tax and the Cadillac tax on expensive employer-provided health plans. Discussions remain on-going about how to best unravel the roughly $1 trillion worth of tax increases in the health care law. House and Senate Republicans will not know what the new baseline is for tax reform until those decisions are made.

The Senate voted to move ahead in debating a FY 2017 budget resolution that would include reconciliation instructions repealing the ACA. The budget instructs House and Senate committees to come up with a repeal bill by January 27th. The motion to proceed to the resolution required only a simple majority vote and the tally was 51-48 as voting continued. Senator Rand Paul (R-KY) voted no. The Senate is expected to consider the resolution the remainder of the week, and the House is expected to pass it prior to the Inauguration on January 20th. It should be noted that the President does not need to sign the resolution, and it does not become law. Rather binding on Congress. 

Senate Passed Cloture on Cures, NDAA & Cures to Pass Wednesday

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The Senate invoked cloture Monday evening on legislation (HR 34, 21st Century Cures) designed to spur medical innovation. Eighty-five Senators supported the motion to limit debate and proceed with a vote on the measure.

It takes two days for a cloture motion to limit debate to “ripen,” and there already is one pending on the defense bill that authorizes myriad Pentagon programs and activities. Other measures are in limbo, with some senators trying to extract end-of-the-year concessions by threatening to stall action and not consent to expediting passage of popular legislation. This means a vote is likely on Wednesday, when McConnell can stack multiple roll call votes together,  so Cures will be immediately followed by a big procedural vote on the FY 2017 NDAA conference report .

The legislation includes $6.3 billion over a decade deposited in three dedicated funds that funnel money to the National Institutes of Health, the Food and Drug Administration, and to the states to respond to the growing opioid abuse crisis. The drawdown of that funding would need to be approved by federal appropriators each year. The money would be earmarked for President  Obama’s Precision Medicine Initiative, the cancer “moonshot” program backed by Vice President  Biden, and  the NIH BRAIN initiative.

The Senate is expected to clear the bill this week and Obama is expected to sign it. Biden was presiding over the chamber Monday for the vote.

 

Home for the Holidays?

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The plan is for Congress to finish all its work for the year this week, with a stopgap spending measure to fund the government through next Spring. When in Spring? That’s still a very good question. 

The House Republicans held a conference meeting on Friday that did not resolve how long the stopgap should last or precisely what level of spending it should allow. Without conference agreement, only a handful of House and Senate GOP leaders and staff will decide the substance of a bill that will shape government spending for at least the better part of the current fiscal year. 

House Majority Leader Kevin McCarthy said his goal is to complete all House action by Thursday, but the true deadline is this midnight on Friday, December 9th. That is when the previous CR expires. Failure to pass a new bill would trigger a government shutdown. The new measure will most likely extend current funding levels for most federal agencies through sometime between March and May. A precise timeline had yet to be decided.

Writing the continuing resolution, which generally forbids any new projects, also requires including provisions that allow agencies to make adjustments in their spending to meet changing needs; these are called anomalies. The Pentagon already has complained to budget writers that a long-term stopgap risks doing harm to needed weapons programs and troops currently deployed overseas. While each CR does have a limited amount of anomalies, do not expect broad sweeping increases, such as a multi-billion increase to NIH. 

As the House takes the first steps on the CR, the Senate will consider both 21st Century Cures and the NDAA conference report this week.

Cures Passes House

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Last night, the House approved, 392-26, the 21st Century Cures Act, amended by a Manager’s Amendment submitted by House Energy and Commerce Chair Fred Upton (R-MI). While the Manager’s Amendment modifies slightly the allocation of funding in the NIH Innovation Account on an annual basis, it maintains the overall level of funding in the Account at a total of $4.796 billion between FYs 2017 and 2026. For the Precision Medicine Initiative, the Amendment provides $1.455 billion between FYs 2017 and 2026; for BRAIN, $1.511 billion between FYs 2017 and 2026; for cancer research, $1.8 billion between FYs 2017 and 2023; and for clinical research to advance regenerative medicine using adult stem cells, the Amendment provides $30 million between FYs 2017 and 2020.

The overwhelming vote tally gained more Republican votes and registered the same level of Democratic support when compared to the vote on a previous 2015 bill version (HR 6).

The legislation now moves to the Senate for consideration next week.