Insights^

We spoke with Stacey Rampy, Principal at Chamber Hill Strategies, about the value of bipartisanship, the current political environment, and what she is tracking as we start the new year.

You have several years of experience working on health care policy, both in Congress and in the private sector. What professional accomplishments are you proudest of?

There are a couple of accomplishments that come to mind. Both have shaped my understanding of how bills with bipartisan and bicameral support have the best chance of becoming law.

For example, I helped a trade association that represents managed care pharmacies convince policymakers to enact legislation clarifying a safe harbor for the pre-approval exchange of health care economic information between payors and pharmaceutical manufacturers about therapies in the pipeline. This information is critical for plans to make timely coverage decisions when new treatments come to

market. Key to our success was the use of a partnership forum to bring together diverse stakeholders to inform our legislative “ask” and convince key Members of Congress and the committees of jurisdiction to intervene with a legislative safe harbor to foster this integral exchange of information.

Another example from my career comes from the more than 17 years that I represented the American Clinical Laboratory Association (ACLA). One of their most pressing issues recently has been addressing a Medicare payment policy that exacts deep cuts to clinical lab reimbursement rates. I helped develop and implement a legislative strategy to convince Congress to delay implementation of that law, and we successfully secured three consecutive delays of that damaging policy.

You mentioned bipartisanship. Tell us more about the value of bipartisanship to achieve success?

I would tell anyone who wants to know more about the value of bipartisanship to look at examples in Congress and in the private sector. When I worked for Rep. Anna Eshoo (D-CA), I saw how she worked with Republicans to advance health policy that she knew would benefit her constituents. When I started my career in multi-client consulting, I worked for a mid-sized bipartisan firm where our best chance of achieving success on behalf of a client centered around a bipartisan strategy. When I decided to strike out and start my own government affairs shop, I knew I would be my most effective with a strong GOP partner. I know Democrats: how they think, how they prioritize issues, and what they care

about. I rely on smart GOP partners to provide insights on Republicans and to help inform my strategy when meeting with Democrats. For example, I’ve adjusted how I approach an issue and which Members to target for support based on what I learn from my GOP colleagues. The bipartisan makeup of Chamber Hill Strategies was a driving motivation for my decision to join the team.

How, if at all, has the political environment changed in DC during your career? How have you adapted to changes to best do your job?

One of the biggest changes I have observed in DC during my career is how the pressure has increased on Members of Congress on both sides of the aisle to tow the party line. In response, I have found that health policy issues often require a diverse group of stakeholders to convince a Member that a policy makes sense for their constituents. It can be more challenging to get a Member to take action, especially if it is something that antagonizes their party’s leadership, or if there is only one stakeholder asking for their support. It is also helpful for stakeholders to be based in the Member’s district or state. Finally, it is imperative to be strategic about which Members you are seeking out to lead an issue. Prioritizing those who sit on committees with jurisdiction over the issue, is paramount and finding those willing to engage their party’s leadership, even if it means bucking it, is also really important.

As we begin the new year, what issue(s) in the health care space do you think are the most important to watch?

The issue that comes to mind for me as being the most important to watch is the use of Artificial Intelligence, or AI, in health care. This issue has been a focus for the White House as well as key committees such as the House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee. Bipartisan leaders, as well as health care stakeholders, have called for greater regulation given the potential impact on patient safety and security. For instance, concerns have been raised about how the use of AI in health care can lead to discrimination based on certain demographics. So, I think there is going to be a growing focus on this coming from policymakers in 2024.

Can you talk about any experience you have lobbying federal agencies?

I have significant experience lobbying federal agencies, including the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), the Office of Management and Budget (OMB), as well as the White House. I served as the Executive Director of the Essential Health Benefits Coalition (EHBC), an alliance of employers, insurers, and providers, focused on establishing guardrails around the essential health benefits requirement under the Affordable Care Act (ACA). The bulk of our advocacy was focused on senior staff at HHS and the White House.

When lobbying federal agencies and the White House, you generally are dealing with very senior staff, so you need to use those meetings judiciously and be really prepared. You

can’t just depend on talking points and you need to be ready to answer questions on deep policy considerations. The use of reliable and meaningful data to support your position can be enormously helpful, and often required, in order to convince them to take action on your behalf. Finally, unlike lobbying before Congress, you can’t rely on arguing that a policy will be beneficial to constituents in a specific state or district because federal agencies and the White House have a national constituency. You really need to depend on the merits of the argument for the policy itself.

Are there any other things you think clients or prospective clients should know?

I would want clients and prospective clients to know that even though I am, first and foremost, a health care policy and advocacy specialist, I do have experience in other areas as well. I have worked on behalf of health care clients who do not have representation on other issues, such as those related to tax and education. I have also worked on appropriations both on off and Capitol Hill. I have used both the community project funding (or earmark) process and accompanying report language to achieve policy victories on behalf of clients. For example, I employed the community project funding mechanism to achieve $10 million in programs for a leading academic medical center in FY 2023.

Good morning from Washington where a Sunday bipartisan deal was announced of $1.7 trillion to fund the government through September 30^th with $886 billion to defense and $773 to non-defense amounts. Both parties are spinning wins to their members. We remember the good old days when billions were enough to fund the government.  We also remember the Fiscal Responsibility Act, last year’s deal between President Biden and then Speaker McCarthy which angered Freedom Caucus members and others and helped propel McCarthy out of his leadership post.  The deal announced yesterday adheres largely to the Fiscal Responsibility Act with minor revisions. Will Republicans in the House make Speaker Johnson pay for this agreement?  We know with the small two vote margin the Speaker currently enjoys; it is likely bipartisanship (Dem support) will be needed to get this through the House. With the difficulties presented by the right on this deal, coupled with impeachment season – can Majority Leader Schumer and Speaker Johnson navigate this topline budget number through their respective legislative bodies?  Or will partisanship rear its ugly head once more in this incredibly unproductive 118^th Congress?  In this Week Ahead, we tackle both houses together as we examine the ramifications of the upcoming funding deadlines.

The Administration

The President and his negotiators continue to push for a war supplemental for Ukraine and Israel, and as previously reported, the request is being tied into border security reforms. The bipartisan group working on a border security deal, including Secretary of Homeland Security Mayorkas, said they made progress over the weekend and hope to have language later this week.  Of course, Secretary Mayorkas is going to be impeached shortly by House Republicans, and it appears the impeachment will be successful in the House, and he will be acquitted in the Senate. Any border negotiation language comes at a time with congressional elections around the corner, and some vulnerable House Democrats may be interested in supporting any reform language.

Congress

The House is back this week after recess. As mentioned, yesterday evening Speaker Johnson, Leader Schumer, and the White House struck a deal for the 2024 Budget topline numbers. Speaker Johnson worked an additional $16 billion worth of cuts beyond the initial McCarthy / Biden 2023 deal, but it will not be enough to appease the far right of his party. The Budget is just the framework for the overall government spending. Speaker Johnson has a narrow majority, and the House Freedom Caucus is surely going to oppose this measure leading the Speaker to rely on Democrat support to get across the finish line.

When members return, they are going to have to work quickly to ensure the departments of Agriculture, Transportation, Energy, Veterans Affairs, and more are funded by January 19^th. Then on February 2^nd, Department of State and other important agencies will also need to be funded before they run out of money. With the MLK holiday and less than eleven days before the first deadline, a shutdown could still happen. Rumors are swirling from short-term extensions to a longer funding mechanism that ensures both parties do not have to vote on these measures respectively over the next several months. At this point it is only a guessing game of what the government funding solution will be. The Senate wants the House to work with Senate passed appropriations bills, but it is unlikely the House will concur.

Congress will be also examining the border, Ukraine, Israel, and Taiwan funding, which are thorny political issues with both parties. Who says a Presidential election cycle is quiet? There will not be a shortage of fireworks as we kick off this Presidential election year with what Congress needs to accomplish.

Health

Even though much attention will be paid to the progress of deliberations to fund the government and address certain health policy issues, there will be other work on Capitol Hill as well. On Thursday, the House Committee on Veterans Affairs’ will hold a hearing titled: “Rural Access: Is VA Meeting All Veterans Where They Live?”

While an agreement was reached on topline spending numbers over the weekend, uncertainty around what Congress will agree on funding measures extends to health care as well. Multiple health extender deadlines are coming on either January 19 or 20, and questions remain as to what agreement can be reached on any of these expiring programs. Expiring provisions 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). In addition, authorization for the Pandemic and All Hazards Preparedness Act (PAHPA) also expires, and the House and Senate still seem to be a way off from reconciling their differences, which includes opposing views on whether to include measure to address drug shortages.

In addition, while the House acted on both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act before adjourning in December, it also remains to be determined if these measures might be in play for inclusion in one of the funding bills that Congress must pass in the coming weeks.  The Senate remains content to work on its own health care package this year more focused on primary care.

Before Congress adjourned in December, there was momentum building for Congress to provide some relief from the 3.37% cut in Medicare payments that hit physicians and other clinicians on January 1. While full relief is not expected, if provided, the partial relief is expected to be retroactive to January 1, and to closely align with 1.25% offset of 3.37% cut that was passed by the Senate Finance Committee and by the House Energy and Commerce Committee and in separate measures late last year.

Create a great week!

Join us for an insightful conversation with Jen Holland, Chief of Staff at Chamber Hill Strategies, as she reflects on leadership philosophies and her unique journey to the dynamic world of politics and advocacy. 

What drew you to Chamber Hill Strategies?  

I was attracted to the firm by its founding partner Jennifer Bell, her vision, and the award-winning advocacy services that Chamber Hill Strategies provides for our clients. Jennifer embodies the qualities I value in a leader – integrity, passion and a deep commitment to excellence.  

The prospect of working for a woman-owned firm particularly appealed to me. As the firm expands into new service offerings, I am excited to play a central role in the firm’s continued growth and client success. 

What leadership styles do you value the most and how have they impacted you?  

Throughout my career, I’ve been fortunate to hold diverse positions that have provided me with an up-close perspective on senior leadership in various organizations. A valuable lesson I’ve gained is that the traits of a strong leader transcend industries. Excellence resides in the attention to detail and effective communication. Successful leaders articulate their vision with clarity and kindness. When combined, these qualities not only empower teams but also serve as powerful motivators. 

What’s some of the best career advice that you’ve received?  

Always recognize the significance of relationships. The most fulfilling aspects of my professional journey have revolved around connections—some developing into long-standing professional relationships, and some being brief and seemingly inconsequential, yet profoundly memorable. The world is teeming with fascinating individuals, and by taking the time to understand their stories, your life will be enriched. 

What do you like to do in your free time? 

I love kicking back with a good book in my free time—whether it’s a lazy weekend or a chill evening. It’s my go-to way to unwind and escape into different worlds, bringing a bit of joy and relaxation to my days. I especially like biographies which permit me to learn in detail about accomplished people. I also love to travel and recently traveled to Portugal, a lovely country with amazing food, centuries of history, and friendly people. (Canada Pharmacy)  

Good morning from Washington as we embark on a New Year filled with resolutions, hopes, and a return to a Congress challenged with budget deadlines, supplemental war funding, and border security reform. As Congress returns to Washington next week, this week we look examine some of the upcoming challenges for 2024 from an electoral and policy perspective. Many of us make resolutions for the New Year, we can only hope Congress will resolve to remove its mark in this second session as one of the least productive legislative bodies in history.  Welcome to the Week Ahead!

The Administration

Surely the biggest storyline in 2024 will be President Biden’s quest for reelection.  He will have to overcome concerns about his polling numbers, as well as his age. In recent days, Democrats have rallied behind President Biden arguing the nation has beaten back COVID, the economy is strong, and so is our nation’s standing. Many Americans have yet to give Biden credit for avoiding a recession and having low unemployment numbers which defy expectations. President Biden and his team have dismissed low polling numbers as not being relevant 10 months away from any real election. One thing which is real, is the President never has been popular with high polling numbers. If anything, Biden’s career has been one with consistent low comeback numbers, but one thing can be said: he previously beat the expected Republican challenger, Donald Trump.

For 2024, Health and Human Services will continue to drive home its work on lowering drug costs through Inflation Reduction Act. As discussed last year, the administration will continue to work on drug pricing, mental health, and reproductive health as some of its top priorities for 2024. Key administration officials will continue to discuss the IRA’s impact on Medicare drug pricing, as President Biden’s campaign works to influence seniors prior to the election.  Additionally, the agency will have to form an artificial intelligence task force by the end of the month per President Biden’s Executive Order.

In the meantime, officials from the Biden administration will continue to be involved In budget talks and pushing for war funding for our allies – both of which are tied to border security. With looming deadlines in January and February, President Biden’s team will have to walk a tightline between needed border reforms and not upsetting his Democrat colleagues on the issue.

The Senate

As we approach the 2024 election, it remains clear maintaining control of the Senate is a challenge for Democrats. Incumbent Democrats are defending seats in red states like Montana and Ohio, while West Virginia flips due to the retirement of Joe Manchin. One of the biggest mysteries remains in Arizona since Senator Sinema has yet to announce if she is running again.

The Senate is in session next week kicking off 2024 with a major role in pending deadlines. Senate appropriators want to take the lead in the funding process – but you know… partisan issues prevail between the two bodies. Senate negotiators have been engaged in border security talks for weeks along with folks from team Biden. The Rubik’s Cube of negotiations ties border security to additional funding for Ukraine. Majority Leader Schumer has tied Ukraine to additional funding for Israel and Taiwan. To make the negotiations even more complex, Speaker Johnson only wants the House bill H.R. 2 to be the only discussion on border security, even though it is a nonstarter in the Senate. Are you tired yet?  The New Year is upon us!

The House

Speaker Johnson is going to have his work cut out for him to hang on to a narrow two-seat majority for this Presidential election year. The Speaker is tasked with funding the government in 16 days, producing a plan for the border, Ukraine, Israel, and Taiwan.  All while trying to sell the American people on increasing the Republican majority and selling another term for the likely presidential candidate Trump.

The funding fight is still a battle where the Speaker will likely need Democratic support. Does Speaker Johnson keep the same deal as the McCarthy cut or does he try and negotiate something new to keep the far right of the party happy? Does he just vote on a clean Continuing Resolution to keep the government running? All questions that we in DC want to answer.

What we do know is the Speaker still would like to finish all twelve appropriations bills this year. The likelihood of this happening is slim to none because of divisions in the party and narrow voting margins. We are predicting the outcome in February will be a year-long continuing resolution to fund the government at current levels through Fiscal Year 2024.

Health

While the House remains in recess, things are expected to pick up quickly next week when the House reconvenes. The House will only have eight legislative days before the first tranche of government funding expires on January 19, and then the House will only have an additional four legislative days before the second government funding deadline hits on February 2.  With the limited timeframe to fund government operations for Fiscal Year 2024, there has also been speculation that the House could extend the appropriations bills set to expire on January 19 to February 2.

With multiple health extender deadlines hitting on either January 19 or 20, whatever package is passed to fund the government past January 19 will include at least some health provisions. Among expiring provisions in need of extension are 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). What remains to be determined in the coming days is what additional health measures might catch a ride with the must-pass January package. With a flurry of activity on health legislation before the House adjourned for 2023, provisions included in both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act could be in play for being attached to government funding legislation in either January or February.

Physicians and much of the provider community will also continue their push for relief from the 3.37% cut in Medicare physician payments that took effect on January 1. While Congress is not expected to provide full relief from the cuts, provisions to provide partial relief, along with an extension of incentive payments for alternative payment models, retroactive to January 1, could be included with the January government funding measure. Should Congress provide some relief from the cuts, it is expected that the relief would closely align with 1.25% offset of 3.37% cut that was passed by the Senate Finance Committee and by the House Energy and Commerce Committee and in separate measures in November and December, respectively.

Create a great week!