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As President-Elect Trump builds out his forthcoming second administration, the changing colors of the leaves and cooler temperatures aren’t the only signs of change this autumn. Washington is still reeling from some surprising picks, such as former Rep. Matt Gaetz (R-FL-1) for Attorney General, Robert Kennedy Jr. for Secretary of Health and Human services, and Pete Hegseth for Secretary of Defense. But this Congress and administration aren’t done yet – there is still a lot to track in Washington. So, let’s get into it. Welcome to the Week Ahead!
The Administration
As President Biden plans for the end of his term (and pardons his last turkey), his administration is focused on immigration and reproductive health care. At this point, however, there is not much that they can do beyond messaging.
But that doesn’t mean everything is quiet on health care.
- On November 15, the Drug Enforcement Agency (DEA) published its intent to extend telemedicine flexibilities for prescribing of controlled medications through December 31, 2025.
- We are also waiting for the proposed Contract Year 2026 Medicare Advantage, Prescription Drug Benefit, and Medicare Cost Plan rule. Expect this one in December. Biden has made addressing concerns about prior authorization in Medicare Advantage a priority and this has also garnered bipartisan interest on Capitol Hill. So, this is definitely an issue to watch for in the new year.
The Senate
Senate Appropriations Committee Ranking Member Sen. Susan Collins (R-ME) wants Congress to focus on wrapping up funding for fiscal year 2025. She noted that congressional leaders need to reach a topline spending agreement by November 22 in order for final bill language to be drafted, reviewed, and passed before the current funding deadline of December 20. Yes, even with all the effort so far, it takes that long! Can Congress come together this week or will they punt the decision once again?
One thing we do know is that the Senate will be working through a long list of judicial nominees. Senate Democrats want to fill as many openings as possible before the Senate and the White House come under GOP control. As of November 17, 2024, there are 45 total vacancies across the court system, with 15 nominations pending. How many can they get across the finish line?
The House
House Republicans held their leadership elections on November 13 with no big surprises. It looks like House Democrats are largely set to follow suit on November 19. Watch the race for chair of the Democratic Policy and Communications Committee as Rep. Jasmine Crockett (D-TX-30) is challenging current chair Rep. Debbie Dingell (D-MI-6). Whoever ends up with the job will have their hands full in determining how the party will message for the next 2 years in the minority.
Another thing to watch for is if President-Elect Trump is done picking House members from the already thin GOP majority to serve in his administration. Even though the members he has picked so far are generally seen as being from safe GOP districts, special elections can be unpredictable.
In addition to counting their members, House GOP leadership is certainly going to be listening for any clues from President-Elect Trump about what he wants in terms of year-end government funding and appropriations deals. Any statements from Trump could have a major impact on how the House GOP decides to move forward.
There You Have it
If you can believe it, next Thursday is Thanksgiving! Check out this website if you are interested in reading up the history of the Holiday. Make it a great week!
On November 14, President-elect Trump named Robert F. Kennedy, Jr. to lead the Department of Health and Human Services (HHS). So what will it mean if Kennedy becomes the administrator of HHS?
In the 2024 U.S. presidential race, Robert F. Kennedy, Jr. introduced a health care platform aimed at reshaping the nation’s health policies under the banner of “Make America Healthy Again.” RFK, Jr.’s approach to health care is rooted in his longstanding commitment to environmental activism and public health advocacy, and a deep skepticism of the pharmaceutical industry.
Let’s explore the key components of RFK Jr.’s “Make America Healthy Again” plan, and whether those components will succeed or fail.
Universal Health care Access
A core tenet of Kennedy’s platform is the commitment to provide universal health care—ensuring that every American has access to affordable medical services, regardless of income or employment status. Knowing how hard it was to pass the Affordable Care Act (ACA), it is extremely doubtful that RFK, Jr. could influence Congress to develop legislation on universal health care. His plans have been criticized by both the right and the left as leading to higher taxes, ballooning federal deficits, or overburdened state governments, particularly without a clear plan for how to pay for such reforms.
Focusing on Prevention and Holistic Health
Kennedy’s plan emphasizes a different approach to health care, focusing on preventive measures and lifestyle changes to reduce the incidence of chronic disease (rather than traditional medicine). His plan emphasizes better nutrition, mental health services, exercise, and education on lifestyle choices as well as integrating alternative therapies such as acupuncture, naturopathy, psychedelics, and holistic treatments.
While some are welcoming the inclusion of additional types of health care, there is great concern in the scientific community that integrating these into the health care system could potentially result in patients choosing ineffective or even harmful treatments over scientifically-backed medical care.
In addition, Kennedy is known for his anti-vaccine rhetoric, which raises concerns about how his stance on alternative medicine might affect the broader public health landscape. Critics are concerned Kennedy could encourage the spread of misinformation and harm public health.
While portions of his ideas are likely to be adopted as they are already in play (better nutrition, increased access to mental health), expect great resistance from Congress, the feeral agencies, and the scientific community over scientifically unproven ideas.
Reducing Industry Influence on Health Care
RFK, Jr. has been one of the most vocal critics of the pharmaceutical industry, particularly its influence on health care policies and practices. Kennedy proposes sweeping reforms to the Food and Drug Administration (FDA), the Centers for Disease Control (CDC), the National Institutes of Health (NIH), and the US Department of Agriculture (USDA). Kennedy feels these agencies have become “sock puppets for the industries they are supposed to regulate.” While some proposals in his plan such as greater transparency at the FDA on drug and vaccine approvals could achieve bipartisan support, he will find great bureaucratic and Congressional resistance to his proposals to “fire everyone at the FDA,” implement reference pricing at CMS, or “immediately replace 600 NIH employees.”
Environmental Health Focus
Kennedy’s platform connects public health with environmental policy, acknowledging that many diseases are exacerbated or caused by environmental factors like pollution, pesticide, or chemical exposure. While Kennedy may receive some support regarding banning chemical additives from food, many of his other policies (like taking fluoride out of drinking water and promoting raw milk) will receive significant push back.
While the Make America Healthy Again Plan aims to address many critical issues in the U.S. health care system, these potential downsides highlight the challenges of balancing cost, access, quality of care, and government involvement. The effectiveness of the plan will largely depend on the specifics of his policies and how they are implemented.
With the 2024 elections in the rear-view mirror, let’s talk “health care extenders.” Umm, what’s that, what are they, what’s the outlook? We are glad you asked!
Health Care Extenders
“Health care extenders” is an inside-baseball term in Washington, DC for health care-related policies that are set to expire at the end of December. Absent Congress (or in some cases, the administration) taking up these provisions in the next few weeks, parts of the Medicare or Medicaid statute will expire, leaving critical programs in the lurch.
But Wait, I’ve Heard This Before
Yes, you’re right, you remember. Health care extenders, and the anxiety that comes along with temporary policymaking, is not new. Many of these provisions were extended earlier in March 2024. In fact, some of these temporary policies started as far back as 2003 – I’m looking at you GPCI floor – and have been perennially extended ever since.
So What’s on This Year’s List
With so many extenders lingering out there, we wanted to make sure you had Congress’ “shopping list” at the ready. (Yes, we have holiday shopping on our mind. Maybe it’s retail therapy after this past election cycle?)
Expiring: 12.20.2024
- Pediatric Disease Priority Review Voucher Program
- Programs related to autism and other developmental diseases
Expiring: 12.31.2024
- Teaching Health Center Graduate Medical Education (THC GME) Program
- National Health Service Corps (NHSC) Program
- Special Diabetes Program (SDP)
- Special Diabetes Program for Indians (SDPI)
- COVID-19 Telehealth Flexibilities
- Moratorium on disproportionate hospital share cuts
- Community Health Center Program
- Acute Hospital Care at Home Program
- Medicare Low-Volume Hospital Adjustment
- Medicare Dependent Hospital
- Add-on payments for ambulance services
- Work Geographic Index Floor Under Medicare
- Sexual Risk Avoidance Education Program
- Personal Responsibility Education Program
- Waiving in-person visits to prescribe controlled substances (this is a pending rule at DEA)
- Emergency Medical Services for Children State Partnership Program
- Bring Education & Awareness to Encourage the Use of Mental Health & SUD Services/Health Care Professionals
- Mental Health Programs Among the Health Professional Workforce
What’s the Outlook
Now that you have the list, you probably want to know what’s gonna happen. There’s good news and bad news. Let’s go with the bad news first. Bad news is that savvy Congressional committee staff are always scrutinizing these policies to see which ones really need to be extended and which ones don’t. So the adage of – always on a list, always extended – doesn’t hold true for extenders. Good news is that lawmakers on both sides of the aisle and both sides of the Capitol support extending these provisions.
We expect Congressional action on these provisions in December, likely tied to a much larger piece of legislation that must go through before Congress closes out this session. The big question is how long will they be extended this time? Part of that answer depends on Congressional mood when members come back. We see 2 scenarios. The first scenario is that Congress extends the policies for a handful of months – maybe end of March – just to get by for a few weeks and not run up a big price tag on how much spending Congress would have to approve. Extending tiny policies, even for a few months, is expensive. The second scenario is a “clear the deck” scenario where Congress extends the policies through 2025 so that the new administration and new Congress have more time to either tend to other non-health care-related business (like tax reform) or to dig in on these provisions and make more thoughtful decisions on policy (like telehealth).
So there you have it. Let the lame duck sausage-making begin!
After what can only be described as an historic campaign and election, members of Congress are returning to Washington with mixed emotions. Republicans return celebrating what has turned out to be a rout for their side, and Democratic members come back trying to figure out how they will respond to the disheartening results. Let’s dig into everything happening this week in Washington. Welcome to the Week Ahead!
The Administration
One name above any other is surfacing among Democratic officials and staff in conversations about who is to blame for the election results, and it’s not Vice-President Kamala Harris, Sen. Chuck Schumer (D-NY), or Vladimir Putin. It’s President Joe Biden. Former House Speaker Nancy Pelosi (D-CA-11) summarized these feelings in a podcast interview with the New York Times saying “had the president [Biden] gotten out sooner, there may have been other candidates in the race.” The only thing President Biden can do now is use his remaining time in office, and his bully pulpit, to advocate for the preservation of his policies.
Meanwhile, President-elect Trump and his team are looking to fill out his forthcoming administration as quickly as possible. Former Presidential Campaign Co-Chair Susie Wiles will be his chief of staff and the first woman to hold this position, and Stephen Miller will be re-joining as deputy chief. Additionally, President-elect Trump has announced that he intends to nominate Rep. Elise Stefanik (R-NY-21) to be the U.S. Ambassador to the United Nations, along with selecting former Acting Director of Immigration and Customs Enforcement Tom Homan as the administration’s border czar. He also reportedly will ask Sen. Marco Rubio (R-FL) to serve as Secretary of State.
The Senate
All eyes are on the November 13 vote for Senate Majority Leader, when Republicans will hold a secret ballot to name either Sens. John Thune (R-SD), John Cornyn (R-TX), or Rick Scott (R-FL) to the top spot. (We have our preference for sure!) As of this writing, President-elect Trump has not endorsed a candidate. His signaling to Senate Republicans whom his preference is to govern with could tip the scales for the intra-caucus vote.
The loss of the Senate majority for the Democratic party means Democrats will lose committee seats and funding for committee offices and staff.
The initial focus of the Senate in 2025 will be confirming the new administration’s cabinet. And while 53 seats is a more comfortable majority than recent Congressional sessions, Senate Republicans don’t have the 60-seat majority needed to overcome the new best friend of Senate Democrats, the filibuster. The fact that Senate Republicans will need Democratic votes to move most major legislative initiatives certainly gives a shot of bipartisan hope through the shrunken Democratic caucus.
What else will we be watching for in the upper chamber this week? Democratic leaders will also be holding their leadership elections but those are looking likely to maintain Sen. Chuck Schumer (D-NY) as Minority Leader. Senate Democrats will also be developing a plan to get as many of their judicial nominees through before the end of the session.
The House
At the time of writing, Republicans are sitting at somewhere around 214 to 219 seats and they need 218 to maintain the majority. Looking at the races that have yet to be called, it looks like Republicans will beat expectations and hold the House.
With Republicans looking to have control over the White House and both Houses of Congress for the first time since 2017, we will be watching to see if some House Democrats start seeing greener grass off the Hill. House Democratic leadership will want to prevent as many of these resignations as possible, since they will need every vote to oppose the Republican White House and Senate.
However, just like in the Senate, Democrats have reasons for some optimism. If past is prologue, a slim Republican majority could cause headaches for Speaker Johnson (R-LA-4), and he may have to depend on Democratic members to get must pass bills over the finish line. House Democrats may also look to assist their counterparts in the Senate by vocalizing opposition to Trump appointments and legislation moving in that chamber.
A slim majority for Republicans means that there is little room for defections, retirements, or the accepting of appointments in a Trump Administration without putting control of the House in jeopardy. And with Rep. Elise Stefanik (R-NY-21) and Rep. Michael Waltz (R-FL-6) likely heading to the new administration, Speaker Johnson (R-LA-4) may want to start stocking up on aspirin.
Both sides of the aisle are also looking ahead to leadership elections with Republicans set to meet on November 13 and Democrats on November 19. The Republican leadership elections were looking like they’d be uneventful, but with Rep. Stefanik’s impending departure as House Republican Conference Chair, there are already three declared candidates for the position (Rep. Lisa McClain (R-MI-9), Rep. Kat Cammack (R-FL-3), and Rep. Erin Houchin (R-IN-9)). Republican Conference Vice-Chair Rep. Blake Moore (R-UT-1) is also rumored to be throwing his hat in the ring. Committee seats and committee leadership won’t be decided this week – those decisions will happen closer to December when the House Republican Steering Committee and Democratic Steering and Policy Committees meet.
And hey, let’s not forget about that upcoming December 30 deadline to fund the government!
There You Have It
No matter who you voted for on November 5, one thing we can all agree on is honoring our Veterans. We at Chamber Hill Strategies are grateful to those who have served our country and for those who wear the uniform even now. Make it a great week!
