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It’s the week before Christmas, and all over Capitol Hill, members are racing to reach a government funding deal. And as 2025 approaches, we are also tracking activity of President-elect Trump’s nominees and advisors related to health care. So, let’s get into it; welcome to the Week Ahead!
The Administration
In a December 4 interview on CNBC, Vivek Ramaswamy shared his thoughts about his plans as a co-leader of the Department of Government Efficiency (DOGE). In that interview, Mr. Ramaswamy shared how getting rid of improper payments in Medicare and Medicaid could help save hundreds of billions of dollars.
Both Republican and Democratic administrations have talked about saving Medicare and Medicaid dollars through various plans in the past. From changing how services are paid for under Medicare to how federal dollars are distributed to state Medicaid plans, there is no shortage of ideas. But the question is, will DOGE be different, and will the Trump administration take heat for proposing ideas that could be seen as cutting the programs?
The Senate
If you walk into any of the Senate office buildings these days, you will likely find more than mice stirring. You may even see some of President-elect Trump’s nominees, such as the nominee for Health and Human Services (HHS) RFK Jr. The pro-choice, former Democrat truly embodies the unconventional vibes we are already feeling from Team Trump 2.0.
RFK Jr. is set to meet with Senators this week. Can he win the votes of certain GOP senators who reportedly have concerns, such as Sens. Collins (R-ME), Murkowski (R-AK), and Cassidy (R-LA)? (https://www.magiklights.com/) Might his views on the health of the nation’s food and skepticism towards big pharma sway any Democrats who have the same concerns? We consistently see Republicans trying to get to “yes” with the President-elect’s nominees and Democrats holding the lines on their concerns.
And don’t forget to watch Dr. Oz (and we aren’t talking about reruns). Even though much of the focus has been on cabinet-level nominees, Dr. Oz would have a lot of power if confirmed as the Centers for Medicare and Medicaid Services Administrator (especially if DOGE starts looking at Medicare and Medicaid).
The House
All of Washington is checking their inboxes with care, with hopes that news of the continuing resolution text will soon be there. House Republicans and Democrats are still working on getting that deal (and themselves) out the door, but they have made a deal on another important question: what the House committee ratios will be in the 119th Congress.
According to a December 13 Dear Colleague letter from House Minority Leader Hakeem Jeffries (D-NY), that agreement will keep the ratios similar to the 118th Congress with some notable exceptions:
- Republicans and Democrats will both gain a seat on Appropriations, Energy and Commerce, Financial Services, Transportation and Infrastructure, and Ways and Means.
- Armed Services will decrease proportionally by 1 seat.
- Education and the Workforce will decrease proportionally by 4 seats.
The Chairs announced the 4 Republican members joining Ways and Means and the 9 Republican members joining Energy and Commerce. Democrats will be looking for current members who previously served on that body to fill their 2 open seats on Ways and Means, according to Leader Jeffries. We are still waiting to hear about who will fill the 5 open Democratic seats on Energy and Commerce. Democratic Members who have expressed interest so far include Reps. Deborah Ross (NC), Melanie Stansbury (NM), Kevin Mullin (CA), Jennifer McClellan (VA), and Gabe Amo (RI).
Also happening this week: The House Veterans’ Affairs Health Subcommittee will hold a legislative hearing on several pieces of legislation at 2:30 PM EST on Tuesday, December 17.
There You Have It
With the holiday season in full swing, our team’s been talking about our families’ holiday traditions, and we want to hear about yours. So let us know, and make it a great week!
We all know this time of year is crazy with holiday parties, shopping for gifts, and getting ready to host or travel to see family or friends. It’s no exception in Washington, where lawmakers are racing to wrap up year-end business and prepare to transition to the new Congress and new administration. So, let’s get into it; welcome to the Week Ahead!
The Administration
Medicaid Waiver Race
The Department of Health and Human Services (HHS) is checking its list and checking it twice to find out which states will get new or amendments to existing Medicaid waivers approved before the new administration comes to town. We expect HHS to get through as many of the 37 requests from 34 states as possible, especially those the incoming Trump administration might deny. For example, both California and Washington waivers are trying to protect reproductive health and family planning services (see more at KFF).
Trump Picks Anti-Trust Chief
President-elect Trump has chosen Gail Slater, an aide to Vice President-elect Vance, to serve as the head of the Antitrust Division at the Department of Justice (DOJ). Ms. Slater’s pick is equivalent to a lump of coal for big tech as she is known to be a foe of that sector. This division also oversees mergers and acquisitions within the health care space. Her pick indicates that the DOJ, under a second Trump administration, may crack down on big health mergers. We are still waiting for Trump’s nominee to head up the Federal Trade Commission, which will provide another clue on how his administration might handle issues related to competition in health care.
The Senate
NDAA Likely on Deck
The Senate will likely begin considering the National Defense Authorization Act (NDAA) this week. With must-pass bills like the NDAA, there is always the potential for lawmakers to engage in a little gift exchange where lawmakers agree to something in the NDAA in exchange for passage of something else, like a yes vote on a government funding bill.
Mr. Musk Comes to Washington
Elon Musk visited with lawmakers at the Capitol on December 6 to discuss his plans for the newly minted Department of Government Efficiency (DOGE). Among others, he met with soon-to-be Senate Majority Leader John Thune (R-SD), the likely incoming Senate Appropriations Chair Susan Collins (R-ME), and Senate DOGE caucus leader Sen. Joni Ernst (R-IA). One interesting note is that Sen. Collins said she was “impressed with his energy and dedication.” That goes a long way since Sen. Collins, who is no stranger to opposing Republican administrations if she disagrees with them, will be someone DOGE will want to keep on their good side if they want her support for cutting government spending.
Senate Organizational Update
As the new Congress fast approaches, we are carefully watching for updates about the Senate’s organization in 2025. We are currently looking at a two-seat majority for most of the top committees. Additionally, the Senate plans to be in session on Fridays in the 119th Congress. That is a sign that Sen. Thune and the Republican caucus have ambitious plans for their new majority.
The House
C.R. Coming Together
Nothing brings Congress together like a government funding deadline right before the holidays. We expect the 118th Congress will follow the traditions of years past by passing a short-term Continuing Resolution (C.R.) to keep the lights on for the next 3 months. Expect a vote the week of December 16, giving the Senate and President Biden enough time to prevent a blue Christmas. We will also be looking for an extension of the Farm Bill, with a one-year extension looking the most likely. Fun fact: Congress last wrote a Farm Bill in 2018 (!) and has only been able to agree on extensions of that since.
Committee News
Both Republicans and Democrats are looking to get their committee leadership and rosters set for the 119th Congress, and the respective steering committees will soon decide the chairs and ranking members that will lead the committees in the new Congress. We are looking at new leadership at the House Energy and Commerce Committee. The race for chair is between Rep. Brett Guthrie (R-KY) and Rep. Bob Latta (R-OH), while Rep. Diane DeGette (D-CO) looks to have the Health Subcommittee ranking member position in the bag. There are also many openings on the Energy and Commerce and Ways and Means Health Subcommittees. Assuming the overall ratios for the subcommittees remain the same; we expect 3 openings for the GOP and 4 for the Democratic party on the Energy and Commerce Health Subcommittee and 2 openings for the GOP and 1 for the Democratic party on the Ways and Means Health Subcommittee.
There You Have It
Although things are busy at this time of year, there are many opportunities to fill your calendar with holiday cheer. Check out some of these events in the D.C. area or look into what’s happening in your community. Make it a great week!
Dr. Marty Makary, a surgeon, health care policy expert, and author, has been nominated for the role of FDA Commissioner in President-elect Trump’s second administration. The appointment is expected to impact drug regulation, health policy, and FDA transparency initiatives if confirmed.
Background and Qualifications
With a medical degree from Thomas Jefferson University and a residency completed at Georgetown University Hospital, Makary currently serves as a surgery and public health professor at Johns Hopkins University. His work focuses on medical ethics and health care reform. As a specialist in gastrointestinal surgery, he emphasizes laparoscopic and minimally invasive techniques, prioritizing safety and reducing medical errors in hospital care.
In addition to his clinical contributions, Makary is a public health advocate and a regular contributor to major media outlets. His commentary often highlights health care transparency, medical errors, and health equity issues. A New York Times bestselling author, his books, The Price We Pay and Blind Spots, examine systemic flaws in the U.S. health care system and suggest reforms.
Policy Positions and Priorities
His policy positions emphasize transparency, affordability, and innovation. Key priorities include enhancing access to health care information, reducing costs, and addressing medical errors. He supports COVID-19 vaccination for high-risk groups while advocating for clear communication about benefits and risks, particularly for younger individuals. He also supports recognizing natural immunity in vaccination policies.
Another critical focus is transparency in the health care system. Makary has called for greater public access to information about hospital performance, costs, and quality of care, as well as increased transparency in clinical trials, drug pricing, and the drug approval process.
His agenda includes significant efforts to reduce health care costs. He has criticized profit-driven practices and proposed reforms to lower spending and expand affordable care. Initiatives include promoting generic drugs to enhance market competition and opposing pay-for-delay agreements that delay affordable medications.
Concerns about regulatory delays at the FDA have led Makary to advocate for streamlining drug approvals while maintaining rigorous safety standards. His focus includes addressing chronic diseases, rare cancers, and emerging pandemics. Strengthening oversight of clinical trials and implementing robust safety protocols for approved drugs are key components of his patient safety initiatives.
Leadership at the FDA: Opportunities and Challenges
If confirmed, his leadership at the FDA could bring a balance between facilitating access to innovative treatments and ensuring safety standards. Challenges may include managing public scrutiny over accelerated drug approvals and navigating resistance from the pharmaceutical industry to proposed reforms. Maintaining public trust will be critical to success, with transparency playing a central role.
In broader health care reform, there may be opportunities for collaboration with figures such as Robert F. Kennedy Jr., despite differing views on vaccine policy. Shared priorities, such as improving transparency in the pharmaceutical industry or strengthening public health systems, could provide common ground.
Conclusion
The nomination of Dr. Makary as FDA Commissioner introduces the potential for significant changes in the agency’s role in public health. If he is confirmed, his ability to address key challenges, implement reforms, and build public trust will determine the impact of his leadership.
