Insights^

Good morning from Washington, DC where the sun is shining, and the town is all abuzz about the finally unveiled bipartisan border package.  Last night, text was revealed after months of negotiations from bipartisan negotiators.  Like anything with good intention in Washington, it was met with mixed reviews and vocal opposition.  The bill was negotiated by Sens. Lankford (R-Okla.), Sinema (I-Ariz.), and Murphy (D-Conn.). The provisions, discussed below, mark the most aggressive and substantive reforms on immigration and border security in years. House Republicans, who wanted border security tied to any supplemental war funding to Ukraine, Israel, and others, are now retreating from the bill.  As previously discussed, election politics and the hand of the presumptive presidential nominee are impacting support while impeding any initial progress. Speaker Johnson labeled the bill “dead on arrival” in the House.  Nothing like members of Congress calling for reform, achieving the reform in legislation, then blasting it as a non-starter. Just like Madonna said, Congress keeps on pushing us – over the borderline. Welcome to the Week Ahead!

The Administration

President Biden will spend some of this week and next pushing for passage of the Senate negotiated border security bill. The bill provides key supplemental funding for Ukraine and other allies. Republican opposition for the bill is largely mounted in not giving President Biden a win on the issue nine months before the election. Opposition is coming from both sides of the aisle, as the ACLU and Latino organizations are concerned the bill does not have substantive immigration reform.  Senator Alex Padilla (D.Cali.) has already opposed the measure.  

In other news, Secretary of State Blinken will be doing a four-day Middle East tour coming on the announcement of a more severe attack on Iran-backed targets due to previously reported drone strikes killing Americans. The President will also speak congressional Democrats at their policy retreat later this week.

The Senate

The border security deal faces a questionable path this week in the Senate.  A summary can be found here. The bill will cost $118 billion and provides over $48 billion in funding to Ukraine, as well as $10.6 billion to Israel.  As mentioned, the bill has opposition from both parties. Minority Leader McConnell, a staunch advocate for Ukraine funding, will face a huge test within his caucus to get support for the bill.  Leader Schumer stated he never worked so closely with McConnell on any other piece of legislation, adding fuel to the fire for Senate Republicans taking shots at McConnell for the top spot. Schumer promises a procedural vote this week which will be the first test of support for this legislation.  

Health Care 

Artificial intelligence in health care is an area in which policymakers want to better understand the impact of technology on a myriad of areas. Currently, AI is used to benefit physicians such as radiologists in analyzing images, it is also used to track cancer, and helps insurers processing claims. Critics of the use of AI in health claim insurers utilize algorithms which disproportionately impact communities of color and sicker individuals further exasperating health disparities. This week, the Senate Finance Committee is holding a hearing Thursday discussing the promises and pitfalls of AI in healthcare. Stay tuned as we cover this important hearing which will surely be the first of several. Also on Thursday, the Senate HELP Committee will hold a hearing on why the US pays more for prescription drugs than any other country.

The House 

The House reconvenes on Monday, and while there are several bills for consideration, it will be another light week for health policy on the House side of the Capitol. Much of the energy from the House will be focused on leadership’s vocal opposition of the border security bill.  Speaker Johnson has already mentioned introducing a standalone bill with funding for Israel – a measure he is hoping would divide Democrats. 

Health Care

While notable health legislation is not expected on the House floor, the Ways and Means Committee will hold on hearing on “Examining Chronic Drug Shortages in the United States,” on Tuesday. The hearing advisory and witness list have been posted online as well. While it will be relatively quiet in the House committees, House committee activity on health issues is expected to pick up in February and March.

As negotiations pick up on appropriations legislation, the March 8 deadline for several expiring health programs looms. The House Republican Doctors Caucus and physician organizations are continuing their push for relief from the 3.37% cut in Medicare payments that took effect on January 1. While indications point some form of relief being passed by Congress in the coming weeks, nothing has been agreed to and conversations continue.

Create a great week.

Good morning from Washington, where the sun is shining after rain dominated the weekend. With the sun on the horizon, a glimmer of hope remains as a bipartisan deal was announced on border security, tax policy, and appropriations funding for agencies. Could it be that both houses are finally coming together to do their jobs on behalf of the American people?  Or will partisan politics in an election year get in the way of legitimate legislative victories? It may be too soon to tell, but perhaps this underdog Congress is inspired by this weekend’s comeback by the 49ers against the Lions after being down 24-7. Much remains to be seen if congressional leaders will spike the ball in February, but one thing remains certain: drama continues to fill the air!  Welcome to the Week Ahead!

The Administration

President Biden is hoping a bipartisan deal on border security will be what he needs to move forward with the supplemental package for funding to Ukraine, Israel, and Taiwan. As discussed more below, the deal, which legislative text has yet to be released, focuses on allowing the administration the ability to shut down the border should crossings reach a certain amount per day among other provisions. Former President Trump blasted any negotiations as a deal could signal a win for President Biden.  The administration is also facing pressure from both sides after Iranian-backed drones killed three soldiers and injured more than 30 in Jordan this past weekend.  Republicans are calling for direct strikes in Iran while some Senate Democrats are calling for a more measured and proportionate response. Whichever way the administration acts will provide plenty of fodder for election season.

Homeland Security Secretary Mayorkas is set to face the first steps of an impeachment proceeding as the House prepares to markup two articles of impeachment this Tuesday. House Democrats believe the articles are politically motivated and are set to vote against them. Some Republicans have publicly voiced opposition to the articles of impeachment, but much is riding on the upcoming votes for Speaker Johnson and his leadership team. All of this comes at a time when Republicans are rejecting a border security package (for which they have not seen any language) they wished to tie to a supplemental package. The plot thickens as election season motivations show its ugly head in critical policy issues.

The Senate

The Senate returns to business Tuesday considering more nominations. The big news however remains around the border security deal brokered by bipartisan negotiators Sen. Chris Murphy (D-Conn.) and Sen. Craig Lankford (R-Okla.). Both senators took the Sunday talk show circuit pushing for the Senate to pass the package.  A procedural vote could be set for this Wednesday or Thursday. The package includes money for foreign aid and contains border security provisions. Lankford is urging Republicans to support the package since they tied up the supplemental with demands for changes in border policy. The Senate could lead the way in demonstrating bipartisanship by moving forward with the package despite calls from Trump to tank it. 

On the appropriations front, Senate and House negotiators reached an agreement late Friday night on funding allocations for federal agencies. The agreement spells out how they will handle the twelve full-year funding bills. The agreement, led by Senator Patty Murray and Rep. Kay Granger, is another win for women leading by example. Congress has until March 1 to prevent a partial government shutdown.  

Health Care 

The US Senate Committee on Veterans’ Affairs will host a hearing focusing on veteran centers supporting the mental health needs of veterans, service members, and their families on January 31. 

The House 

The House of Representatives is back after the weeklong recess and there is an official stalemate with border security, Ukraine, Israel, and any other legislation besides the tax bill.

Speaker Johnson sent a letter to colleagues that stated he disagreed with the Senate bill, and the President has the right to act with Executive Orders to control the chaos at the U.S. Southern border. The border deal is what is holding up other official funding as House Republicans will not vote on any legislation that funds other countries without border security reform. Former President Trump continues to encourage Republicans not to support the Senate deal as he sees this as a winning political issue. This should make for some exciting fireworks between the House and Senate in addition to government funding till the President’s Day work period. 

In other news… Chairman Jason Smith (R-MO) and Ranking Member Neal (D-MA) continue to make headway with a tax bill. 

Health Care

In addition to addressing the new March 8th deadline for those expiring programs, House leaders are expected to continue a push for legislation that cleared the House with broad bipartisan support late last year—the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act. Added to the mix is the continued push from the House Republican Doctors Caucus and physician organizations for relief from the 3.37% cut in Medicare payments that took effect on January 1. While relief once seemed a distant possibility, some form of relief being passed by Congress in the coming weeks now seems to be within reach of becoming reality.

As the legislative sausage-making conversations ensue, House committees will also hold two health-related hearings on Wednesday with the House Energy and Commerce Health Subcommittee holding a hearing to explore rising health care costs and spending titled “Health Care Spending in the United States: Unsustainable for Patients, Employers, and Taxpayers” (January 31 at 10am) and the House Oversight and Accountability Committee holding a hearing the same day titled “Overseeing the Department of Health and Human Services’ Compliance with Congress.”

While the week back will be relatively light—at least publicly, House committee activity on health issues is expected to pick up in February and March with telehealth, laboratory-developed tests, and efforts to address rare diseases among the topics that are expected for further congressional attention.

As always, please send us your thoughts for this week and what’s next. Create a great week!

Good morning from Washington, where we are looking to get out of the snow to rise again in the sun this week. The last few days of snow caused people to shovel their driveways a few days ago, just to get more snow a day or two later. The whole scene is akin to Congress barely passing a bill in time to fund the government to just punt the real problem down the line to March 1 and March 8. While we can celebrate the baseline accomplishment of well, you know, the ability to keep the doors open – we still know more issues are set to pile on in six weeks. The House is in recess this week because they’ve worked so incredibly hard, and the Senate is in session and looks to roll up their sleeves. Welcome to the Week Ahead!!

The Administration

Last week President Biden signed legislation to avoid a partial government shutdown and continue the laddered approach under the continued resolution Congress passed last year. The President also met with lawmakers to reach mutually agreeable ground on issues surrounding the administration’s supplemental funding request. Issues remain around border security. This past week also marked Republican presidential hopefuls leaving the Iowa caucus and moving their sights onto New Hampshire. It now appears to be a two-person race with former President Trump and Nikki Haley.

Healthcare

The Center for Medicare and Medicaid Services (CMS) will hold a national stakeholder conference call this Tuesday at 1pm featuring CMS Administrator Chiquita Brooks-Lasure to discuss the CMS Strategic Plan. As a reminder, the plan focuses on expanding access to care, advancing equity, and driving innovation, among others. 

The Senate

The Senate is in session this week and will be churning through a few nominations early in the week. The real action will continue behind the scenes as a group of bipartisan senators continue to work on details around a supplemental funding package. As we reported earlier, the package would provide funding to allies including Ukraine, Israel, and Taiwan. The package is also believed to have border security changes included in it, but as we also previously mentioned to what extent remains to be seen. It’s not quite clear yet when Majority Leader Schumer will begin the process of bringing this to the floor as many pieces remain in play. Minority Leader McConnell will work to bring Senate Republicans along to demonstrate support for Ukraine, but he still has a big task ahead of him. Senate Republicans are not in a rush to have this legislation jammed through the process despite these issues being in play for months. In related news, Senate appropriators remain concerned about allocations despite topline numbers being agreed to as part of funding the government. Complicating the matter is whether the supplemental will pass and what money may be included for the Department of Homeland Security.

Healthcare 

The Senate Aging Committee will hold a hearing on Thursday at 10am on long-term care options for older adults. The hearing will focus on assisted living facilities. Lawmakers from both the House and Senate continue discussions on a potential large health care package that would include opioid support programs, doc payments, telehealth, and price transparency.

The House 

After passing legislation (H.R. 2872) to avert a partial government shutdown and extend the government funding deadlines into March, members of the House of Representatives return to their home states for a district work period. Under the legislation, Congress continued the “laddered approach” under the continuing resolution (H.R. 6363) that Congress passed late last year, bumping out the new funding deadlines from January 19 and February 2 to March 1 and March 8 respectively.

Health Care

Under H.R. 2872, multiple health extender deadlines that were previously set for either January 19 or 20 were now extended to either March 8 or 9. Among the expiring provisions that were extended included payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).

It still remains to be seen if Congress will be able to reach an agreement on larger health legislation, but House leaders are expected to push for including provisions that were included in the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act that the House passed with broad bipartisan support late last year.

In addition, as expected, Congress failed to provide relief to physicians and other clinicians who were hit with a 3.37% Medicare payment cut on January 1 in the H.R. 2872, but members of the House Republican Doctors Caucus and physician organizations are continuing the push to include some form of relief in the appropriations legislation and health extenders that Congress will have to address in advance of the March 8 deadline. At the beginning of last week, there appeared to be little possibility for relief from the cuts this year, but physician and allied health groups and their champions in Congress are continuing to hold out hope.

Create a great week!

Welcome from Washington DC, where a few inches of snow canceled schools and closed the federal government leaving parents gazing into the horizon for relief and confirmation schools will open in the next day or so. As we stare into the legislative horizon, we wonder if Republicans and Democrats can come together to fund the government to avoid a shutdown. During the Martin Luther King, Jr. holiday weekend a deal was struck on a stopgap measure to extend spending authority until March 1 and March 8, keeping intact Speaker Johnson’s laddered approach. However, with time being of the essence, can Congress act quickly (not its best trait) to pass the measure through both bodies in time? Welcome to the Week Ahead – where the 118th Congress continues to struggle to meet the most basic legislative tasks.

The Administration

The Border. Negotiations on border security continue but seem to be stuck at the same time. As we reported earlier, border security is being tied into any additional funding for Ukraine, Taiwan, and Israel by Speaker Johnson and other Republicans. The issue at hand appears to be the ability for the administration to continue to use parole authority. This power allows the government to grant the ability for migrants to have temporary permission to live and work in the United States even though a path to citizenship may not exist. Parole authority is a must have for the Biden administration, but Republicans see this tool as a way for immigrants to get around Congress when they otherwise cannot gain access into the country. It remains a sticking point and could tie up foreign aid to America’s allies.

Healthcare 

Medicare Advantage. A MedPAC presentation and report Friday states the federal government will pay $88 billion more than it should this year because they attract healthier lower-cost beneficiaries thus driving sicker beneficiaries into traditional Medicare. The report also mentions complicated upcoding procedures used to drive up payments to plans.

The Senate

The Continuing Resolution. The Senate is scheduled to hold a vote on the legislative vehicle short-term continuing resolution to extend the government funding deadlines to March 1 and March 8. Despite the snow, the vote is on! Senators who wish to oppose the CR can do so until Sunday, but the Senate really needs to move on this to avoid a shutdown. Both Leader Schumer and Senator McConnell will work to address any concerns members have to prevent this from happening. The CR does not address major issues like funding for our allies or the border security issue, but it does give more time for appropriators to pass their bills before automatic spending cuts come to fruition in mid-April.

Healthcare

The Senate Health, Education, Labor and Pensions Committee will hold a hearing addressing long COVID on January 18th at 10am.

The House 

On the Clock. The House is scheduled to hold votes tonight to encourage members to be back in town despite the weather. It is thought Speaker Johnson may have to work this week to get the proposed CR to pass via suspension which requires a two-third majority, Democrats appear to be united behind passing the CR and helping get this across the finish line. However, it will not come without asks from the Democrats – so let the negotiating begin!

Healthcare 

The House returns after the Martin Luther King, Jr. holiday with a slate of bills and resolutions to consider, but the most pressing question as the House reconvenes will be whether enough House Republicans will vote to join Democrats later in the week and avert a partial government shutdown before the first funding deadline under the “laddered” continuing resolution (H.R. 6363) that Congress passed late last year hits on January 19.

While an agreement has been reached between Speaker of the House Mike Johnson (R-LA) and House Majority Leader Charles Schumer (D-NY) on topline spending numbers, much remains to be determined—not only on final appropriations for the rest of the fiscal year but on health policy priorities as well. Under the “laddered” agreement agreed to by Speaker Johnson and Leader Schumer reached late last week, a final agreement on significant health legislation is now not expected until at least March as multiple health extender deadlines that were previously set for either January 19 or 20 will now be extended to either March 8 or 9. Expiring provisions pending to be renewed include payments under the Medicaid Disproportionate Share Hospitals (DSH) Program, the Work Geographic Practice Cost Index (GPCI) Floor, and funding for Teaching Health Center Graduate Medical Education (THC GME), Community Health Centers (CHCs), and the National Health Service Corps (NHSC).

Prior to adjourning in December, the House passed both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act with broad bipartisan support, and House leaders are pushing for inclusion of many of the bills’ provisions including measures on price transparency, pharmacy benefit manager reform, and hospital payments in a final government funding package for 2024.

The largest health policy casualty of Congress failing to reach an agreement on government funding and larger health hit physicians and other clinicians under Medicare. When Congress adjourned in December, momentum appeared to be building for Congress to provide at least partial relief from the 3.37% cut in Medicare physician payments that took effect on January 1, but Congress failed to reach an agreement on additional relief from Medicare payment cuts in 2024. As a result, Medicare payment rates resulting from the 3.37 percent cut are expected to remain throughout 2024.