Check out our expert take on key activity shaping health care policy
Insights
Featured Blogs
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!
On January 25, 2024, the Senate Special Committee on Aging held a hearing to examine challenges seniors and assisted living facilities experience in caregiving. The Committee discussed issues around workforce, safety, and private equity ownership in assisted living facilities.
Medicaid has been a hot topic in previous elections – but is it in 2024? The previous blog in our series on health care and the 2024 elections discussed the Affordable Care Act (ACA) and the 2024 election. Today’s post will focus on Medicaid expansion and the 2024 election.
Medicaid Expansion Has Grown Steadily
The ACA authorized the expansion of the Medicaid program to include working-age adults without children or disabilities. Although the Supreme Court ruled against mandating expansion, the battles over this policy did not end. They only shifted to the states.
- 25 states and the District of Columbia (D.C.) implemented Medicaid expansion as soon as possible (January 1, 2014).
- Michigan and New Hampshire waited until later in 2014.
- Pennsylvania, Indiana, and Alaska joined the ranks of expansion states in 2015.
- Montana and Louisiana jumped on board in 2016, and Virginia and Maine implemented expansion in 2019.
- Idaho, Utah, and Nebraska joined the list in 2020. Oklahoma implemented expansion in 2021, and Missouri began processing applications that same year.
- South Dakota and North Carolina implemented expansion in 2023 and are the most recent editions to the list. You can see how the number of Medicaid expansion states has grown by comparing the two maps below from 2013 and 2023.
These 2 charts show you the change. Blue is yes to Medicaid expansion. Orange is no to Medicaid Expansion. See how the blue grows over the time period between 2013 and today.
Medicaid Expansion as of 2013: 25 States Plus DC
Medicaid Expansion in 2024: 35 States Plus DC
Big Growth, Big Political Implications
It’s worth noting that the growth in Medicaid expansion and the 2024 election intersect in a big way. As more states decide to expand Medicaid, the pathway to 270 electoral votes increasingly depends on appealing to voters who have gained health insurance coverage because of Medicaid expansion.
For example, let’s look at North Carolina. According to a press release from the North Carolina Department of Health and Human Services, more than 600,000 North Carolinians are now newly eligible for Medicaid coverage.
In 2020, North Carolina went for former President Trump, but his margin of victory was less than 100,000 votes. It begs the question of how many of these voters could flip to President Biden in 2024 and whether it could be enough to flip the state.
Even among more Trump-friendly states, the growth of Medicaid expansion could impact returns in 2024. For example, President Trump won 61.8% of the vote in South Dakota in 2020 with 261,043 votes compared to Biden’s 150,471. According to the U.S. Department of Health and Human Services, more than 52,000 South Dakotans can now enroll in Medicaid. Might more South Dakotans vote for Biden in 2024? Maybe. We don’t expect South Dakota, whose state government is redder than red to give Biden any votes in the electoral college. South Dakota has not voted for a Democratic presidential nominee since 1964. But post-election polling in November may provide some insight into how Medicaid expansion played into voters’ behavior this year.
What, if any, implications are there in states that have not expanded Medicaid. Interestingly, the Kaiser Family Foundation conducted a poll in March 2023 showing that two-thirds of residents in non-expansion states are supportive of expansion.
Where Do the Candidates Stand?
Biden is Pro-Medicaid
- President Biden strongly supports the ACA, including the Medicaid expansion provision.
- The president included language in his proposed budget for fiscal year 2024 calling for “Medicaid-like coverage” for those who live in states that have not expanded Medicaid.
- The president’s budget proposal also called for “financial incentives to ensure states maintain their existing expansions.” President Biden’s decision to include these provisions in the proposal shows his strong support for getting all states to adopt Medicaid expansion.
- President Biden continues to highlight his record on protecting and expanding Medicaid in contrast to former President Trump.
Where is Trump on Medicaid?
- Meanwhile, Former President Trump has not yet talked much about Medicaid expansion in his 2024 campaign. However, we can look at his time in office to see what we might expect if he won reelection.
- In 2020, the Trump Administration offered a demonstration program they argued would provide more flexibility to states in providing benefits to working-age adults without disabilities. However, critics of the plan, such as Senator Tim Kaine (D-VA), charged that it threatened the health care of the Medicaid expansion population.
- The Trump Administration also supported allowing states to impose work requirements on the Medicaid expansion population. Vox Senior Correspondent Dylan Scott argued at the time that these policy changes were part of an effort to undo the expansion of Medicaid under the ACA.
Medicaid Expansion and the 2024 Elections
President Biden and former President Trump have a record regarding policies related to Medicaid expansion. As the list of Medicaid expansion states grows, so does the importance of how the leading presidential candidates talk about this issue. Ultimately, it will be up to the candidates to decide how much to talk about the issue of Medicaid expansion and what to say. And, of course, the American people have the final say. As Alexander Hamilton put it, “Here, sir, the people govern; here they act by their immediate representatives.”
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!
