The Week Ahead 12/18/23: Bah Humbug! The Senate in One More Week – No Real Traction on Supplemental

Good morning from Washington DC, where like much of the east coast we were battered with rainstorms last night.  Fortunately, we woke to sunny skies coupled with forceful winds. The turbulence remined me of the push and pull taking place over the war supplemental request tied to border security measures, as conservatives are angling to slow roll the process and liberals are expressing concerns over actions in Gaza. We continue the conversation below as President Biden is being pulled in both directions, while also battling troubling poll numbers. As we conclude a turbulent political year which saw the ousting of a House Speaker, surprise retirements, and the expulsion of a perpetually lying congressman, we can only hope the administration and a divided congressional body learn to work together to fund the government and pass meaningful legislation in 2024. We can all learn something new – as I read an article last night clarifying the true cause behind the Boston Tea Party. It was caused over a corporate tax decrease (not an increase on tea tax) which would have enticed the colonists to buy lower-cost taxed tea thereby giving up the principle of no taxation without representation. The Senate is in this week and President Biden dodged a car crashing into his motorcade!  Welcome to the Week Ahead!

The Administration

What a past few days President Biden experienced.  Last night, a car crashed into a SUV in his motorcade right after he answered questions from reporters about why he is trailing Trump in the polls.  Fortunately, the President and First Lady were fine.  In addition to polling headaches, the President continues to face an uphill battle in terms of his war supplemental request. As we’ve mentioned in past weeks, the administration wants to provide funding to Israel, Ukraine, and Taiwan, but the House wants to link any funding request to changes in border security measures. The President, feeling much like the Stealers Wheel Song – Stuck in the Middle With You, is feeling clowns to the left of him and jokers to the right. Conservative opposition to funding Ukraine without reforming border security measures continues to mount and stall the process, while members of the Congressional Hispanic Caucus voiced concerns about the Biden Administration not communicating with them regarding negotiations which took place this weekend.

In healthcare news, the Center for Medicare and Medicaid Services released a voluntary payment model to improve maternal health in the US, a pillar of the Biden Administration’s goals in healthcare. The Transforming Maternal Health Model (TMaH) plans to partner with state Medicaid agencies to lower maternal mortality rates while reducing associated health disparities. The initiative will develop a value-based alterative payment model which will improve health outcomes and quality.  TMaH will focus on three main pillars: 1. Access to care, infrastructure, workforce capacity; 2. Quality and safety, 3. Whole-person delivery.  The program aims to work with participating states to address gaps in maternal health care by supporting access to midwives and doulas, improving perinatal care for chronic conditions like diabetes and hypertension, and reducing c-sections for low-risk mothers.


The Senate

Senate Majority Leader Schumer made sure he received less holiday cards this season as he called the Senate in session this week.  Senator Schumer hoped this week would allow for a negotiated package to come to the floor this week.  However, negotiators on the supplemental request, while making progress, failed to come to agreement on a package.  The White House was directly involved, and it is reported that some provisions were agreed to but that large hurdles remain.  Senate Republicans are in no rush to have a vote, and Senator Chris Murphy stated no legislative text exists for members to vote on at this time.  Senator Ron Johnson led a group letter of conservatives requesting a conference-wide meeting to discuss what they felt were “secret” negotiations with Democrats. All this to say, it is unlikely a floor vote on a supplemental request without legislative text will pass this week.  This sets up a particularly busy early part of January which also runs into the first tranche of government funding.  The Senate is also moving on stalled military nominations this week.

Senators are moving in a bipartisan work on health transparency with new legislation that requires insurers, hospitals, and other health facilities to disclose more pricing information.  The legislation entitled, The Health Care Price Transparency Act, 2.0, aims to be more stringent than its House counterpart by requiring hospitals to post the actual price for a service, rather than the median price. Like the House passed Lower Costs More Transparency Act, the measure extends transparency requirements to imaging centers and clinical labs, among others.

The House

The House finished its business last week and is out until next year.

Things will pick up quickly come January 8 as the House will only have eight legislative days before the first set of appropriations and health extender deadlines hit on January 19.  The House will only have an additional 4 legislative days before the second set of appropriations deadlines hits on February 2.  Rumors have started to percolate the House could extend the appropriations bills set to expire on January 19 to February 2, and a very likely scenario is a year-long continuing resolution to fund the government at current levels through Fiscal Year 2024 will be the result in February.

With multiple health extender deadlines hitting on either January 19 or 20, whatever government funding package is passed to fund the government past January 19 is expected to include health extenders. With the House having passed the Support for Patients and Communities Reauthorization Act last week with broad bipartisan support, it is rumored that the legislation could be packaged and passed along with provisions to provide partial relief from a scheduled 3.37% cut in Medicare physician payments and extend incentive payments for alternative payment models that would closely align with provisions passed the House Energy and Commerce Committee and by the Senate Finance Committee. Other provisions to be included would extend payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, an extension of the Work Geographic Practice Cost Index (GPCI) Floor, and extensions of funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).

While the House did also pass the Lower Costs, More Transparency Act with bipartisan support last week, it seems less likely that the pharmacy benefit manager reforms and other measures, including site neutral payments for certain services, will be in play for moving in a January package because why include things to which everyone agrees?

As always, we value your insights and look forward to hearing from you!  This will most likely be the last Week Ahead for 2023.  Thank you for making this a wonderful year, and from all of us at Chamber Hill Strategies we wish you happy holidays and a fantastic New Year!

Create a great week!

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