The Most Bipartisan Committee in Congress You’ve Never Heard Of

Gridlock, gridlock, gridlock.  Thanks to deeply embedded polarization, Democrats and Republicans in Congress hardly work together in a bipartisan manner to pass legislation.   However, there’s one committee that has a proven track record of members working together across the aisle: the House Select Committee on Modernization of Congress.

What it is: A bipartisan committee with an equal number of Democratic and Republican members, the House Select Committee on the Modernization of Congress was established in January 2019 to investigate, study, hold hearings, and develop recommendations to make Congress more effective, efficient, and transparent.  The committee’s members are appointed by Speaker Nancy Pelosi (D-CA) and House Republican Leader Kevin McCarthy (R-CA), and two committee members are each chosen from the House Rules Committee, the House Administration Committee, and the congressional freshman class.

While the committee does not have legislative jurisdiction – meaning it lacks the authority to develop or advance legislation – it does release rolling recommendations throughout the year. Nearly 100 recommendations have been issued over the past three years across several key areas, including streamlining and reorganizing the House of Representatives human resources, overhauling the onboarding process for new members, modernizing House technology, and reforming the budget and appropriations process.

Recent moves: On December 8, 2021, the select committee approved 25 new recommendations, 14 of which are designed to create a more civil and collaborative environment in Congress.  Key examples include creating bipartisan websites for committees, hosting bipartisan committee events, and promoting civility and collaboration at a proposed Congressional Leadership Academy and Congressional Staff Academy.  The new recommendations’ focus on civility is likely a reaction to the institution’s increasingly polarized environment that has only gotten worse since last year’s riot at the Capitol.

Recommendations do become policy. Even though the select committee can’t develop its own legislation, nearly 60% of the 97 recommendations been implemented by Congress to some degree.  Key examples include:

  • Creating a one-stop shop Human Resources HUB dedicated to Member, committee, and leadership staff.
  • Making permanent the Office of Diversity and Inclusion.
  • Allowing newly elected members to hire and pay one transition staff member.
  • Providing more financial stability for congressional staff enrolled in the federal student loan program.
  • Establishing a Community Project Funding process to allow non-profit entities to apply for competitive grants from a member of Congress (House only).  Community Project Funding requests are similar to earmarks in that they allow members to allocate funding to projects in their district, although the newest iteration has more rules and transparency requirements.

But unfinished business remains.  Many of the committee’s recommendations that have been adopted by Congress amount to non-partisan, low-hanging fruit intended to improve the workplace environment for congressional staff and members.  In contrast, the committee’s more sweeping, structural recommendation on budget and appropriations haven’t seen much movement, with the exception of the committee’s Community Project Funding recommendation.  These include:

  • Requiring an annual Fiscal State of the Union with a presentation of baseline budgetary facts to provide a common set of numbers on which to base decisions;
  • Requiring a biennial budget resolution with annual appropriations bills, which would provide appropriators more time to plan; and
  • Limiting use of the budget reconciliation process to only deficit reduction and require an explanation of changes in direct spending or revenue that have not been reconciled.

While the Select Committee on Modernization of Congress certainly seems to have a bipartisan track record, the polarized environment of the legislative branch limits how far the committee’s recommendations can go, especially when they pertain to larger, structural changes.  However, the committee’s work is far from done – the House voted in January 2021 to reauthorize the select committee through 2023 – meaning the bipartisan group will continue to have time to put out new recommendations to create a more efficient and productive Congress.

2022 Midterm Primaries Feature Incumbents versus Incumbents

Redistricting has made for strange bedfellows. Thanks to population losses reported in the 2020 Census, seven states lost one seat apiece in the US House of Representatives.  Individual states redraw their district boundaries to create a new map of congressional districts, and the states that lost a congressional seat have their own set of unique challenges.  On top of that, several states where one party has a supermajority are using their leverage to redraw district lines to bump out House members from another major party.  Therefore, the results of these newly drawn district lines have made for five strange matchups that involves two incumbents from the same party. 

Lucy McBath (D-GA) versus Carolyn Bourdeaux (D-GA)

Both congresswomen are new to Washington – McBath was elected in 2018, and Bourdeaux in 2020.  On December 30, 2021, Georgia’s Republican Governor Brian Kemp, signed into law a Republican-drawn congressional map that shifts most of McBath’s 6th Congressional District to the exurbs west of Atlanta where Republicans dominate the electorate.  As a result, McBath is now running in the 7th Congressional District, which is currently held by Bourdeaux.  Each congresswoman has her own advantages, so the race is likely to be close.  While McBath has gained national recognition for her story as a gun control advocate and cancer survivor, Bourdeaux’s old district represents most of the new district, and she has repeatedly touted her ties to the district on the campaign trail.

Marie Newman (D-IL) versus Sean Casten (D-IL)

Democrats currently control 13 of Illinois’ 18 congressional seats, and Democratic Gov. J.B. Pritzker signed into law in November 2021 a new congressional map that aims to give Democrats a total of 14 seats out of 17 seats since the state will lose one due to a drop in population.  To accomplish this, however, state legislators had to put Rep. Newman and Rep. Chuy Garcia (D-IL) in the same district.  Rather than run against a fellow progressive, Newman has opted to run in the neighboring 6th Congressional District, currently held by Rep. Casten.  While Casten has been touting his work on climate an infrastructure, much of Newman’s old district lies in the new one, and she has been emphasizing her longtime Chicagoland roots to contrast herself with her opponent, who moved to the area as an adult.

Mary Miller (R-IL) versus Rodney Davis (R-IL)

Illinois Democrats’ “sacrifice” of Newman was intended to thin the herd of GOP-held seats.  For instance, the new map puts Rep. Miller’s hometown in a new seat held by Rep. Mike Bost (R-IL) that covers the southern third of the state.  Rather than fight against Bost, Miller opted to seek run against Rep. Davis in the primary, whose central Illinois district contains portions of Miller’s old district.  While Davis has represented his district in Washington for five terms, Miller brings to the table an endorsement from former President Donald Trump, although she recently faced controversy for quoting Hitler.

Andy Levin (D-MI) and Haley Stevens (D-MI)

Michigan lost a congressional seat in 2020 Census.  The state’s new congressional map is the product of an independent commission, and while the commission has been successful in avoiding partisan gerrymandering, it wasn’t enough to stop a race between two incumbents.  Both Rep. Levin and Rep. Stevens could have opted to run in the new 10th Congressional District, which leans slightly Republican and contains suburban communities northeast of Detroit.  But instead, both Democratic incumbents chose to seek reelection in the 11th Congressional District, which features a more Democratic-leaning electorate in the suburbs northwest of Detroit.   While Levin resides in the new district, Stevens’ current district includes much of the new one she’s running in.

David McKinley (R-WV) versus Alex Mooney (R-WV)

West Virginia’s House delegation will shrink from three to two members in the next Congress.  A new congressional map signed into law by Republican Gov. Jim Justice last fall means Rep. McKinley and Rep. Mooney will have to square off to see who will represent the state’s northern 2nd Congressional District next year.  While two-thirds of McKinley’s old district is included in the newly formed district, Mooney is a staunch supporter of former President Trump, meaning whoever wins the May 10th primary is anyone’s guess.

Members of Congress Who Switched Parties

Will Joe Manchin leave the Democratic Party?  Ever since the Democratic Senator from West Virginia blew up negotiations on the Build Back Better Act, pundits have been speculating that Manchin will leave the party to become an independent.  While Manchin has bluntly thrown cold water on the idea of leaving the party in the past, such a move wouldn’t be without precedent.  Here are some examples of the dozen or so legislators who have made the uncommon decision to switch party affiliations in the last two decades.


  • Arlen Specter (Republican to Democrat).  First elected to the Senate in 1980 as a Republican, Specter was a staunch centrist.  The Pennsylvania Senator switched over to the Democratic Party in 2009 due to what he viewed as the Republican Party moving “farther and farther to the right.”  Specter ultimately lost the 2010 Democratic primary race to Joe Sestak, who went on to lose the general election to current Sen. Pat Toomey (R-PA).  Specter died of non-Hodgkin’s lymphoma in 2012. 
  • Joe Lieberman (Democrat to Independent).  Lieberman was the Democratic nominee for Vice President in the 2000 general election, but then he  ran under the independent “Connecticut for Lieberman” party in his 2006 Senate reelection bid after losing the Democratic primary to current Connecticut Gov. Ned Lamont.  After winning reelection, Lieberman was officially listed as an independent but continued to caucus with the Democratic Party in the Senate. 
  • Jim Jeffords (Republican to Independent).  Elected to the Senate in 1989 as a Republican, Jeffords became an independent and caucused with the Democrats in 2001 due to disagreements over the Bush tax cuts.  Jeffords’ switch was particularly consequential because it changed control of the senate from a Republican majority to a Democrat majority. This was the first time such a switch had changed party control.  After his retirement in 2007, Jeffords was succeeded by Sen. Bernie Sanders (I-VT), an independent who also caucuses with the Democrats. 


  • Jeff Van Drew (Democrat to Republican).  The New Jersey State Senator was elected  to Congress in the 2018 midterm elections that saw Democrats flip nearly 40 seats in the House.  However, in late 2019, Van Drew became a Republican due to his opposition to then-President Trump’s impeachment.  Van Drew won reelection in 2022 and continues to represent his purple district in southern New Jersey as a Republican. 
  • Justin Amash (Republican to Independent to Libertarian).  First elected in 2011, Amash announced in a 2019 op-ed his decision to leave the GOP and become an independent after becoming “disenchanted” and “frightened” by party politics and saying that he did not feel “well represented” by either major party.  The Michigan Congressman later joined the Libertarian Party in April 2020, becoming the first Libertarian to serve in Congress.  However, Amash declined to seek reelection in 2020.
  • Paul Mitchell (Republican to Independent).  Mitchell took office in 2017 to represent a solid Republican district near Detroit, Michigan.  However, in July 2019, Mitchell announced he would not seek reelection in 2019, namely due to the “rhetoric and vitriol” in the federal government and a desire to spend more time with family.  Just a year later, Mitchell formally became an independent out of disagreement with then-President Trump’s efforts to overturn the results of the 2020 presidential election.  Mitchell died in August 2021 after a long battle with cancer.

What Will Congress Tackle in 2022?

2022 is shaping up to be a busy year for Congress, with potential implications for health care policy.  Lawmakers’ challenging agenda is partly due to unfinished business from 2021, including spending for Fiscal Year (FY) 2022 and the Democrats’ $1.7 trillion social and climate spending package, the Build Back Better Act.

At the top of the 2022 agenda are must-pass items tied to specific deadlines.  Here’s an overview of what Congress must take care of in the new year, no matter what.

  • FY 2022 Appropriations.  The short-term spending bill that’s keeping the federal government running is set to expire on February 18, 2022.    The House has already passed most of its FY 2022 spending bills, including a bill that provides a nearly 20% increase in funding for the Department of Health and Human Services (HHS) compared to the FY 2021 level.  However, the Senate Appropriations Committee has only approved three spending bills for FY 2022.  Going forward, lawmakers are hoping a bicameral and bipartisan deal comes together quickly to avoid passing another Continuing Resolution and can finalize FY 2022 appropriations.
  • MACRA.  A 5% bonus for providers participating in an Advanced Alternative Payment Model (A-APM) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is set to expire at the end of 2022. To circumvent the provisions in MACRA from expiring, the Senate Finance Committee is expected to hold hearings to review implementation of MACRA in 2022, and health care providers have been pushing for the bonuses to be extended.  On a related note, legislators are also planning to hold hearings on how MACRA has affected the Physician Fee Schedule.    
  • Medicare Cuts.  In December, President Joe Biden signed into law a bill to extend the moratorium on 2% Medicare sequester cuts until April 1, 2022 and reduce the cuts to 1% from April 1 to June 30, 2022.  Providers will likely advocate for an extension of the moratorium due to continued stress from the COVID-19 public health emergency but are also looking to work with Congress to find a longer-term solution regarding the Medicare pay system.
  • PDUFA VII.  The current Prescription Drug User Fee Act (PDUFA VI) expires at the end of September 2022.  Regulators and industry stakeholders spent 2021 negotiating the details of PDUFA VII, which will determine drug user fees in FY 2023-2027.  It will be up to Congress to reauthorize the next iteration of PDUFA by October 1, 2022, and lawmakers are expected to hold hearings on PDUFA VII in spring 2022.

Other items on the 2022 legislative agenda are top policy and political priorities, particularly for Democrats, who will be fighting to retain their majority in Congress in the upcoming midterm election.  Additionally, health care stakeholders are urging legislators to make progress on pressing health care issues that saw little movement in 2021.

  • Build Back Better.  The White House and congressional Democrats had initially hoped to pass a $1.7 trillion social and climate spending package know as Build Back Better before the end of 2021, but progress halted after Sen. Joe Manchin (D-VW) rejected the measure due to concerns over its cost.  However, Democrats are hoping to pass a scaled-down version of Build Back Better that Manchin can support, with the hope that a revised measure will retain some of the original proposal’s health care provisions, including expanded eligibility for Affordable Care Act (ACA) subsidies and expanded Medicaid coverage in 12 states.
  • Cures 2.0.  In November 2021, bipartisan members of the House Energy and Commerce Committee introduced the Cures 2.0 Act, which would build on the success of the 21st Century Cures Act that passed in 2016. CURES 2.0 would authorize the Advanced Research Projects Agency-Health (ARPA-H), streamline the Food and Drug Administration (FDA) review process, enhance Medicare and Medicaid coverage of new technologies, and expand access to telehealth.  Lawmakers initially hoped to advance Cures 2.0 by the end of 2021, but a busy congressional agenda pushed work on the measure into the new year.  Since legislators expect 2022 to be just as busy, it’s possible elements of Cures 2.0 may find their way into PDUFA VII.
  • Behavioral Health Care.  In September 2021, bipartisan leaders of the Senate Finance Committee issued a request for information (RFI) on policy proposals to boost access to mental health care services.  Some of the reforms mentioned in the RFI include strengthening the health care workforce, improving parity laws, and increasing the use of telehealth.  Underscoring the need for behavioral health care reform is the upsurge in demand for mental health care during the COVID-19 public health emergency.  The Finance Committee may incorporate responses to the RFI in a potential bipartisan bill in the new year.
  • Prior Authorization.  In a bipartisan fashion, 246 House members cosponsored legislation to streamline prior authorization in Medicare Advantage and require rapid determination of the services that plans generally approve.  The Trump administration proposed to streamline prior authorization requirements in Medicaid (but not Medicare Advantage), but the Biden administration has since paused the initiative. Provider groups are advocating for new rulemaking or legislation to include Medicare Advantage in any push to improve prior authorization.

Why Is Congress Always Delaying Medicare Cuts?

Health care providers breathed a sigh of relief nearly two weeks ago when President Joe Biden signed into a law a bill to override certain Medicare payment cuts scheduled to take effect next month.   Congress taking action to prevent Medicare cuts isn’t exactly new – in fact, it seems to have become a regular occurrence. 

What’s in the bill?  On December 10, President Biden signed into law S. 610, the Protecting Medicare and American Farmers from Sequester Cuts Act.  The bill specifically extends the moratorium on 2% Medicare sequester cuts until April 1, 2022, and reduced the cuts to 1% from April 1 through June 30, 2022. Additionally, the measure provides a one-year increase in the Medicare physician fee schedule of 3%, less than the 3.75% increase for 2021. The bill also delays the 4% statutory Pay-As-You-Go (PAYGO) sequester from taking effect early next year and now cuts won’t go into effect until 2023. 

Medicare Sequestration, in Brief

Medicare sequestration began under the Budget Control Act (BCA) of 2011, which required a mandatory 2% reduction in Medicare provider payments, also known as sequestration.  The sequester was originally intended as an incentive for the so-called “super committee” of congressional leaders who convened that year to design a bipartisan plan to reduce the budget deficit by $1.5 trillion from Fiscal Year (FY) 2011 to FY 2021.  However, Congress failed to reduce the deficit, thus setting the stage for automatic spending cuts. 

But the Medicare cuts never came.  The Medicare sequester was originally set to end in 2021 under the BCA, but cuts have delayed and the sequester period extended a total of seven times.  More recently, the Coronavirus Aid, Relief, and Economic Security (CARES) Act delayed the 2% automatic cuts to Medicare through March 2021, and the American Rescue Plan Act subsequently delayed the cuts until the end of 2021 until the Protecting Medicare and American Farmers from Sequester Cuts Act was signed into law earlier this month.

So why hasn’t the Medicare sequester ever gone into effect?  Medicare is extremely popular among voters. Also, generally lawmakers from both parties are especially hesitant to cut payments to doctors and nurses, especially now during a public health emergency. 

PAYGO, In Brief

The current version of Statutory Pay-As-You-Go (PAYGO) was signed into law on February 12, 2010 under the Statutory PAYGO Act of 2010.  While PAYGO also uses sequestration to reduce government spending, it differs from the Medicare sequester in that it only applies to new government spending that increases the deficit.  Increased deficit spending under the American Rescue Plan Act of 2021 triggered PAYGO cuts that recently signed legislation delayed until 2023.  While the Medicare sequester is capped at 2%, PAYGO caps Medicare cuts at 4%.   

Kicking the Can Down the Road

Per the BCA, the Medicare sequester was supposed to end in 2021, but that timeline has since been pushed back another 10 years.  To help pay for the delay in Medicare cuts, and in the case of the need for offsets for the Infrastructure Investment and Jobs Act, Congress has added additional years to the duration of the sequester.  An exception to this is the recently enacted law, the Protecting Medicare and American Farmers from Sequester Cuts Act, which paid for the delay by increasing the percentage of sequester for the last year of the cuts.  These actions by Congress to continually delay or extend the sequester could be interpreted as little more than a “budget gimmick” to ensure that Medicare cuts to providers never actually occur.  

So… is there a long-term solution on the horizon to fix these cuts?

Medicare sequestration and PAYGO sequestration cuts cannot be fixed in the Build Back Better Act (BBBA), as these provisions cannot go through the reconciliation process. Therefore, both parties would need to negotiate on passing a whole different bill.  However, Republicans think overriding the PAYGO sequestration cut could be meaningless if the BBBA is enacted later and PAYGO is triggered again. Additionally, providers are starting to grow tiresome of the “budget gimmick” feel when addressing Medicare sequestration and the American Medical Association President Gerald Harmon in a statement urges Congress to find  “more in-depth reforms to the Medicare pay system.”

Nothing is ever certain in Congress, but both parties will have to come together at some point and address these issues.  Could Congress take up these fixes during 2022 and create a longer-term solution? It’s a possibility, but currently Senate Democrats are facing a heavy lift on passing a version of the BBBA and voting rights legislation early next year. Also, don’t forget Congress is heading into an election year, so whether they provide a longer-term solution is still up in the air, which in turn could lead to continuing to kick the can down the road.

Can Members of Congress Get Christmas Presents?

It’s tradition for many Americans to swap gifts during the holidays. But does the tradition of holiday gift-giving also apply in Congress, where Senators, Representatives, and their staff face ethics rules on the kinds of presents they can receive?

In short, members of Congress can receive Christmas presents, although there are a lot of limitations. According to ethics rules, members can receive gifts valued at no more than $50, as long as the gift isn’t from a registered lobbyist or foreign agent.  A notable exception to this rule is family members, so members of Congress have nothing to worry about when it comes to exchanging gifts at home on Christmas morning.

However, the rules get a little tricky when involving gifts from non-familial relationships. Friends and romantic partners, like boyfriends and girlfriends, can give gifts valued at up to $250 to members and staff. Beyond this amount, any gift is subject to approval from the House and Senate ethics committees. To receive approval, a legislator or staff member must disclose the approximate value of the gift, the relationship to the gift-giver, and the gift-giver’s occupation. A notable exception to this rule is fiancés and fiancées, who are considered to be in the same category as family members under ethics rules.

While punishments for violating gift-giving rules can range from a warning to a fine, no lawmaker has been punished for accepting a Christmas gift since current rules were first adopted in 2007.

A Forgotten Gift-Giving Tradition in the Senate

Long before ethics rules were imposed, there was once a strong tradition of exchanging Christmas presents among Senate staffShortly after Christmas was made a national holiday in 1857 and the Senate began to take a brief holiday recess, Senate staff began a tradition of exchanging gifts. Key examples from the early days of gift-giving include a gold-topped cane for a longtime Senate page supervisor in 1862 and a lump of coal for the Senate Sergeant at Arms in 1902, which was actually used to heat the Capitol.

Towards the end of the 19th century, the Christmas gift-giving tradition in the Senate became more focused on pages.  California Senator Leland Stanford gave each Senate page a five-dollar gold coin each Christmas during the 1880s and 1890s, and Vice President Thomas Marshall began a tradition in 1913 hosting an annual Christmas dinner with Senate pages in the Senate dining room. This tradition continued for 20 years and generally involved a gift exchange between the pages and the Vice President.

However, the tradition came to an end in 1933 with the adoption of the 20th Amendment to the Constitution, which moved the start of the annual congressional sessions from December to January.  As a result, pages were no longer on duty in the Capitol during the holidays, and the Senate’s gift-exchange tradition faded into history.

Is Daylight Saving Time Bad for Your Health?

Spring ahead, fall back.  Twice a year, we adjust our clocks to accommodate the shift between Standard Time and Daylight Saving Time (DST).  While the change on your wristwatch or phone may seem innocuous, the change for your internal clock may have bad implications for your health.

A Brief History of Daylight Saving Time

Daylight saving dates back to the ancient world, when the Romans adjusted the length of hours to account for the amount of daylight.  In 1784, Benjamin Franklin suggested the concept of daylight saving in a satirical essay where he recommended that people get out of bed earlier to save on candles by taking advantage of more daylight hours.  The US briefly adopted DST during the First and Second World War, and the post-war period saw a patchwork of DST policies that varied between different states and jurisdictions.   Confusion in the transportation industry led to enactment of the Uniform Time Act of 1966, which was the first step in establishing a federal DST standard.  Currently, DST starts on the second Sunday in March and ends on the first Sunday in November, with the time changes taking place at 2:00 a.m. local time.

What’s Wrong with DST?

A major consequence of the annual loss of an hour’s sleep in March is forced sleep deprivation.  While the change in clocks only takes place in the early hours of Sunday, people can experience a 30-minute reduction in sleep time each night for the remainder of that week.  Sleep deprivation has many negative implications, including higher risk of stroke or heart attack, and performance deficits on reflex and attention.

Health practitioners, take note: A study found sleep deprivation in health care workers caused by the springtime change led to a 18.7% increase in patient-safety related incidents in health care settings.

It’s not just the spring.  Gaining an hour’s sleep with the fall shift to Standard Time can disrupt the circadian rhythm, desynchronizing the body’s internal hormonal balance and causing symptoms similar to jet lag.  Additionally, the number of patient safety-related incidents in health care settings increased by 5% after the fall clock adjustment. 

There are implications for health care technology, too.  Not all electronic health records software systems can handle shifts between DST and Standard Time, requiring health care facilities to implement burdensome workarounds or requiring clinicians to switch to paper charts for one hour.  Unfortunately, these inconveniences can result in longer wait times in emergency departments or records to be inadvertently deletedThere are also examples of DST affecting medical devices like pacemakers, defibrillators, and glucose monitors.

What’s Being Done to Fix DST?

In recent years, momentum has been growing at the state-level to do away with the biannual time shift by making DST permanent year-round.  Since 2018, nearly a dozen states including South Carolina, Arkansas, Delaware, Maine, Oregon, Tennessee, Washington and Utah have approved or enacted legislation on permanent DST, while several other states including Alabama and Maryland have considered similar legislation.   However, congressional approval is required for states to implement permanent DST legislation, and to date, Congress has yet to sign off.  (While Hawaii and most of Arizona do not observe DST, they were able to opt out or get an exemption from the Uniform Time Act shortly after the bill’s enactment.)

However, Congress is paying attention.  On November 4, 2021, Sen. Patty Murray (D-WA) introduced the Sunshine Protection Act, which would allow states to make DST permanent.  In an op-ed coauthored with Sen. Marco Rubio (R-FL), Murray cited the negative health effects of resetting clocks twice a year, and she pledged in a floor speech to press the Biden administration for executive action to grant states the authority to move to permanent DST. 

The Sunshine Protection Act has 14 cosponsors in the Senate, but given the busy agenda facing Congress this fall, the bill is unlikely to see any movement in the 117th Congress.  However, as more and more states pick up on the idea that ditching biannual time changes could lead to better health outcomes, a growing number of federal lawmakers could one day take proposals to make DST permanent more seriously. 

What Will Congress Do about Pending PAYGO Cuts?

The debt ceiling, appropriations, infrastructure, reconciliation – Congress has a lot on its plate right now.  On top of that, Congress has another item to address that health care stakeholders have been watching closely: an automatic 4% cut to Medicare starting on January 1, 2022.

What’s going on?  In March, the $1.9 trillion American Rescue Plan Act passed and raised the deficit. This triggered automatic PAYGO cuts to Medicare and other programs because of a law signed in 2010, the Pay-As-You-Go (PAYGO) Act, which prohibited new legislation from increasing the federal budget deficit. 

What’s Congress doing?  Congress has always acted to waive PAYGO cuts, but not in March of 2021 when lawmakers failed to reach an agreement. At the time, the House overwhelmingly voted to waive PAYGO, but a similar proposal in the Senate failed to garner enough votes to override a filibuster.  So far, there has been little word from lawmakers about the plans to address PAYGO as the end of the year approaches.

Why does it matter?  The American Hospital Association (AHA) estimates that a 4% reduction in Medicare spending, or about $36 billion, would result in $9.4 billion in cuts to hospitals provider for fee-for-service (FFS) Medicare reimbursement in calendar year 2022.  These losses would come at a time when hospitals and other providers are still grappling with revenue losses related to the COVID-19 pandemic.

It’s not just PAYGO: Health care providers are facing other cuts at the year’s end that, combined with PAYGO, could prove devastating.  These include:

  • Medicare sequestration.  Congress passed legislation back in April to extend the moratorium on 2% cuts to Medicare payments, known as sequestration, through the end of 2021.  The 2% cuts were initially postponed by Congress as a part of the CARES Act in 2020 to help providers struggling with the financial burden of the pandemic.
  • 2021 Physician Fee Schedule.  Finalized in July, the 2021 Physician Fee Schedule will cut payments to physicians next year by 3.75%.  The cut was initially set to go into effect in 2021, but Congress provided an extra $3 billion in funding in late 2020 to hold on the cuts until the beginning of 2022.

The bottom line: The combination of PAYGO, Medicare sequestration, and the Physician Fee Schedule could mean a 9% reduction in Medicare physician payments next year.

What’s being done?  Leading stakeholder organizations including the AHA and the American Medical Association (AMA) have sent letters to congressional leadership urging action to waive pending PAYGO cuts, as well as the coming Medicare sequester and Physician Fee Schedule cut.  Furthermore, on October 14, 245 bipartisan House members sent a letter to congressional leaders on the aforementioned Medicare cuts.  Congress has provided much assistance to health care providers over the course of the pandemic, and providers are urging Congress to take action once again to help the industry make it through what is hopefully the final stage of the pandemic.   

Where Members of Congress Live These Days

A group of West Virginians had something to say to Sen. Joe Manchin (D-WV) about the $3.5 trillion budget reconciliation bill, so they took their message directly to the Senator’s Washington, DC residence – by kayaking up to his houseboat on the Potomac River.  When legislators are conducting their business in our nation’s capital, just like anyone else, they need a place to stay.  And where members of Congress choose to stay has changed over the years, with potential consequences for how lawmakers do their job.

A Brief History

For much of the 19th century, members of Congress lived in boarding homes in the Capitol Hill neighborhood.  Senators and Representatives usually chose which house they lived in based on their political affiliation or state.  Known as “messes,” these groupings often included one or two members from a different state or party, allowing lawmakers the chance to build relationships across state or party lines.

As the US entered the 20th century, a growing federal government required members of Congress to be present more regularly in Washington.  Soon, it became the norm for legislators to have their homes and their families in the Washington, DC area.  By living in the same metropolitan area for most of the year, Representatives and Senators hailing from different political affiliations naturally found ways to form connections outside of legislative business through activities and institutions like schools, playgrounds, sporting events, and places of worship. 

1995 marked a major turning point, when then-Speaker Newt Gingrich (R-GA) reduced the workweek in the House from five to three days in order to allow more days for members of his caucus to engage in fundraising.  As Congress entered the new millennium, it became increasingly rare for members to spend their time outside of the halls of Congress in DC.   Instead, many lawmakers now head right to the airport or hit the road once the workweek ends or recess begins to make the journey back to their home states or districts, where they meet with constituents and fend off potential challengers.

With so many legislators going back and forth, what kind of places do they call home when they’re in Washington?

  • Congressional offices.  In recent years, dozens of members including former Speaker Paul Ryan (R-WI) and former House Majority Leader Dick Armey (R-TX) have opted to live rent-free in their offices, opting to sleep on sofas or foldable mattresses.  While supporters say office living allows them to focus on their work and ignore the distractions of Washington, DC, detractors say the practice unfairly uses taxpayer-funded housekeeping services.  Members who live in their offices are most likely to travel frequently between Washington and their state/district.
  • Group homes or apartments.  Renting a room in a DC rowhouse or apartment isn’t only popular with staffers – members of Congress do it, too.  Similar to congressional offices, apartments are popular with members who travel routinely to and from Washington.  Echoing back to the days where lawmakers lived in boarding homes, some members opt for a group-home style set-up.  A notable example of this is Senate Majority Leader Chuck Schumer (D-NY), Sen. Dick Durbin (D-IL), and former Rep. George Miller (D-CA), who shared a Capitol Hill rowhome until 2014.
  • Property ownership in the DC area.  A smaller portion of Senators and Representatives reside on property they own in the Washington, DC area.  This can range from condominiums or rowhomes in the District to single family homes in the suburban communities of Maryland and northern Virginia.  Members in this category generally do not travel as frequently to their home district or state as their fellow legislators, and some even raise their families in the DC area.  Examples of current lawmakers who relocated their families to the DC area following their election to Congress include Sen. Josh Hawley (R-MO) and Rep. Jodey Arrington (R-TX).  A notable exception within this group is lawmakers from Maryland, Virginia, and other jurisdictions in the Mid-Atlantic who already reside withing commuting distance of Washington.

There are several factors that determine where members of Congress choose to live – and how often they travel to and from Washington.

  • Cost of living.  Real estate costs have soared in the Washington, DC area over the past decade, with the median price of a rowhouse in the District climbing from $420,000 in 2009 to $760,000 in 2020
  • Competitiveness of seat.  Members who expect to face serious primary or general challenges from an opponent  are incentivized  to return more frequently to their home district or state to campaign or fundraise.  Due to frequent travel, they are more likely to keep their housing footprint in the District limited.  In contrast, members who hold a “safe” seat might opt to spend more time and put down roots in the District.
  • Personal preference.  Some members, regardless of their geographic proximity to Washington, choose to bring their families to the Washington, DC area to “keep them grounded” and maintain relationships with children and spouses.  These members more likely own property and spend more time in the National Capitol Region.

Why does a member’s housing situation matter?  The growing polarization in Congress over the last 20-plus years has coincided with the trend of members not putting down roots in the Washington, DC area.  When Representatives and Senators are constantly jetting out of DC, it limits the chances for them to bond, socialize, and see one another as peers.  If more members spent more time living in the DC area, could this shift the current political climate and contribute more to bipartisanship?

The Senate Parliamentarian, Explained

On September 19, Democrats’ plans to offer undocumented immigrants a legal pathway to permanent residency was torpedoed when the Senate Parliamentarian ruled against including immigration reform in their $3.5 trillion human infrastructure package.   As Democrats attempt to advance key priorities via budget reconciliation, the role of the Senate Parliamentarian has garnered much attention. 

Background: Democrats have long been seeking a way to offer permanent residency to Dreamers, who are undocumented immigrants who were brought to the US at a young age and have lived most of their lives in America. Currently, many Dreamers do not have a clear path to gain legal permanent residence status, which would then allow them to pursue citizenship.   

The role: The Senate parliamentarian interprets the Senate’s often complicated rules.  The position of the Senate Parliamentarian is strictly non-partisan, and individuals are traditionally appointed to the role from senior staff in the Parliamentarian office. There have only been six Senate Parliamentarians since the position was created in 1935.  Senate Parliamentarians have no defined term length and serve at the pleasure of the Majority Leader.  The current Parliamentarian is Elizabeth MacDonough, who was appointed by then-Majority Leader Harry Reid (D-NV) as the first woman to hold the position in 2012. 

Did you know?  The Senate Parliamentarian’s salary is $171,315 per year, as of 2019.

Some of the things the Senate Parliamentarian might do include:

  • Advising the Senate’s presiding officer, or Majority Leader, on the appropriate procedure, statements, and responses of the Senate.
  • Offering written guidance on procedural questions.
  • Recommending the referral of measures to relevant committees.
  • Maintaining and publishing procedural rules.

It’s not just the Senate: The House of Representatives has its own Parliamentarian, too, with a similar salary and responsibilities.  The current House Parliamentarian is Jason Smith (not to be confused with the Missouri Congressman), who was appointed in 2010.

Why the Senate parliamentarian is getting so much attention this year:  The Democratic majority is using the budget reconciliation process to accomplish their policy goals and bypass the need for Republican support. Therefore, enter the Parliamentarian, who decides what can and can’t be included in legislation passed under this process. The Parliamentarian uses the Byrd Rule to analyze legislation and makes a determination on whether a provision produces a change in spending or revenues and does not increase the deficit within a set period

This isn’t the first time where the Parliamentarian says no to a Democrat policy: Back in March, top Senate Democrats were upset by the Parliamentarian’s decision to not include a minimum wage increase in the American Rescue Plan due to an “incidental” impact on the federal budget. 

What Could Senate Democrats Do? The Senate Majority Leader does have the authority to fire the Senate Parliamentarian.  This last happened in 2001, when then-Majority Leader Trent Lott (R-MS) fired then-Parliamentarian Robert Dover after he interpreted Senate rules in way that would have made it difficult to pass then-President George W. Bush’s tax cut proposal through budget reconciliation. 

However, MacDonough’s job seems safe for now.  While Majority Leader Chuck Schumer (D-NY) has expressed disappointment with her recent rulings, he has yet to call for the Parliamentarian to be replaced.  Senate Majority Whip Dick Durbin (D-IL) has similarly indicated he doesn’t think MacDonough should be dismissed.  Instead, Senate Democrats have expressed a willingness to advance immigration reform and other priorities that can’t be included in budget reconciliation through regular order, even if the chances of doing so are slim to none. 

Senate Democrats could also overrule MacDonough’s ruling with the support of all 50 Senate Democrats and Vice President Harris, but this won’t be happening, either.  Both Sens. Joe Manchin (D-WV) and Kyrsten Sinema  (D-AZ) have previously stated they won’t overrule the parliamentarian, while Sens. Dick Durbin (D-IL) and Bob Menendez (D-NJ) have thrown cold water on the idea.

Previewing Congress’s Terrible, Horrible, No Good, Very Bad September

Lawmakers are facing a September like no other.  With only a dozen or days scheduled to be in person in DC, Members of Congress must address a $3.5 trillion “human infrastructure” package, a $1 trillion bipartisan infrastructure bill, last month’s expiration of the debt ceiling, and appropriations for Fiscal Year (FY) 2022Each of these major bills carries several steps of their own, including committee hearings, markups, and behind-the-scenes negotiation.  How will lawmakers on Capitol Hill make it through such a complicated month?

Calendar At-A-Glance

Here’s how the calendar sets up.

Okay, Let’s Break it Down


So, the House committees are meeting to mark-up the $3.5 trillion human infrastructure bill, also known as the reconciliation bill.  Speaker Nancy Pelosi (D-CA) has expressed a desire to pass the entire reconciliation bill by October 1, punting her version over to the Senate.

But what about the Senate?  The Senate is out till September 13. Even though their version of the reconciliation bill is due September 15, the Senate has yet to schedule any committee hearings.  Remember too that the Senate committees are a 50:50 split, meaning it’s harder to pass partisan legislation like this out of committee.  This all leads us to believe that the Senate may only release concepts or principles around what will be included in the legislation to meet the deadline.

We expect that when the House passes their bill, the Senate substitute the bill with their own changes. The Senate floor process includes debate and likely another all-night vote-a-rama session.  With any changes the Senate makes to the bill, the House will have to vote again, meaning the reconciliation bill has a way to go before it reaches President Biden’s desk.

Bipartisan Infrastructure Bill

Speaker Pelosi issued a September 27 deadline for the House to vote on the bill as the Senate approved it by a 69-30 vote on August 10.  If the bill doesn’t get passed in time, the House will have to vote to extend the Highway Trust Fund, which is estimated to become insolvent by October 1.

Debt Ceiling

Oh yeah, and Congress will need to raise or suspend the debt ceiling to avoid the US from defaulting on its loans. Usually, lawmakers generally agree in a bipartisan manner to increase the debt limit, but Republicans have publicly stated they will not support raising the debt limit and could force Democrats to raise the debt limit in a partisan way and without any Republican support.  


Even though the House has passed 9 out of 12 appropriations bills, the work has just begun in the Senate.  This signals the likelihood that Congress will need to pass a continuing resolution before September 30th to keep the government funded past September. 

How Will Things Play Out?

Between a packed schedule, partisan differences in key legislation, and divisions among some Democrats, September is shaping up to be an unpredictable month for Congress.  Below are some key items to watch for.

Will the House pass the bipartisan infrastructure bill by September 27?

Speaker Pelosi announced the September 27 deadline per an agreement with a group of moderate House Democrats who didn’t want to vote on the $3.5 trillion reconciliation bill without voting on the bipartisan infrastructure bill first.  Many moderate Democrats are holding firm on this agreement to pass this bill, even if the Senate is not finished with their reconciliation bill. Therefore, the divide between moderates and progressives on how to move forward with the legislation could create more problems for the Speaker. 

Will Sinema and Manchin demand a lower dollar amount for reconciliation?

However, the main question that is still on everyone’s mind is will the Democrats unanimously support $3.5 trillion in new spending as moderates in both chambers have concerns around this high price tag.

Even though Senate Democrats unanimously approved the budget resolution, two key moderate Democrats have signaled an unwillingness to approve $3.5 trillion in new spending, thus raising doubts about the bill’s future.  In a statement issued after the budget resolution’s passage, Sen. Joe Manchin (D-WV) expressed “serious concerns about the grave consequences” facing Americans if Congress decides to spend an additional $3.5 trillion.  On August 23, a spokesperson for Sen. Kyrsten Sinema (D-AZ) said the Senator would simply not back a $3.5 trillion bill. As the next couple of weeks unfold, all eyes will be on both Senators as the negotiations are ongoing around the reconciliation bill.

September Is Only the Beginning

With September as thorny as it is, Q4 is shaping up to be the biggest legislative fall in a number of years.  And just when they figure out these massive domestic policy issues, 2022 will be just around the corner, and with it a quick transition to campaign season for the midterm elections.

What’s the Point of Congressional Caucuses?

The Congressional Bourbon Caucus.  The Congressional Peanut Caucus.  The Congressional Rodeo Caucus.  It seems like there’s a congressional caucus for every type of issue or policy.  What exactly are congressional caucuses, and do they have any impact on the policymaking process?

All About Congressional Caucuses

Officially known as congressional member organizations, congressional caucuses are voluntary associations consisting of Representatives and Senators who share specific policy goals or interests.  These groups run the gamut of more serious and powerful organizations, such as the Congressional Black Caucus and the Republican Study Group, to ones with a more offbeat or narrow focus, such as the Congressional Bowhunting and Archery Caucus, and the Congressional Candy Caucus.  Importantly, these congressional member organizations are not to be confused with party caucuses and conferences, which are the House Democratic Caucus, House Republican Conference, Senate Democratic Caucus and Senate Republican Conference.

Congressional caucuses date back to the early 1800s and have grown in number in recent years.  There are currently 460 caucuses in the 117th Congress, compared to only 100 member organizations in 1993.   Any caucus that includes House members must register with the House Committee on House Administration and follow certain rules, which include the following:

  • Caucuses cannot use franking privileges (free mail privileges), although individual members may use official resources for communication related to a caucus.
  • At least one officer or chair of a congressional member organization must be a House member.
  • Members can use personal funds to support a caucus but are not allowed to accept goods or services from private organizations to support a caucus.

The Senate does not have any separate guidelines or regulations for Senators who participate in caucuses and are just subject to follow the Rules of the Senate and the Senate Code of Official Conduct,

Types of Caucuses

Congressional caucuses can fall into one of three categories depending on their constituency and interests. 

  • Ideological Caucuses.  Caucuses based around an ideology can represent certain ideological views within a particular party.  In America’s two-party system, each party tends to have a wide ideological spectrum or a “big tent,” meaning there is room within a party for members with more specific ideologies to gather.  All ideological caucuses are in the House, and current examples on the Democratic side include the Blue Dog Coalition, the New Democrat Coalition, and the Congressional Progressive Caucus.  Republican examples of ideological caucuses include the Tuesday Group, the Republican Study Committee, and the Freedom Caucus.  One group, the Problem Solvers Caucus, contains House members of both parties that seek bipartisan collaboration on key issues.
  • National Constituency Caucuses.  Some caucuses advocate the interests of specific groups of constituents, such as women, racial or ethnic groups, and veterans.   Examples include the Congressional Black Caucus, the Congressional Hispanic Conference, the Congressional Asian Pacific American Caucus, and the Servicewomen and Women Veterans Caucus.
  • Interest Group Caucuses.  The most common caucuses consist of members with a shared policy or interest.  Examples of these generally bipartisan caucuses include the Congressional Bike Caucus, the Congressional Coal Caucus, the Congressional Dairy Farmer Caucus,  Congressional Fire Services Caucus, and the Congressional Cyber Security Caucus.  A number of interest group caucuses focus on medical issues or diseases, such as the Congressional Cystic Fibrosis Caucus, the Congressional Telehealth Caucus, the Congressional Lupus Caucus, and the Rare Disease Caucus.

Do Caucuses Matter?

On paper, caucuses have no real authority.  Unlike committees, caucuses lack the ability to markup bills or hire their own staff, for instance.  However, they do serve a function by providing a way for like-minded Representatives and Senators with mutual interests and goals to get to know one another.  Through these relationships and associations, caucuses members often work together to develop specific ideas that can become legislation.  During the 115th Congress and 116th Congress, members of the Problems Solvers Caucus periodically released proposals and legislation on important issues where caucus members believed Democrats and Republicans could find common ground.  For example, some of the Problem Solvers Caucus’s ideas eventually became law, including a proposal to repeal the medical device tax. At the moment, the Problem Solvers Caucus has been active during the 117th Congress around the bipartisan infrastructure framework.

Additionally, caucuses formed around diseases and medical issues are particularly active on creating health care legislation.  For instance, Reps. Diana DeGette (D-CO) and Tom Reed (R-NY), who co-chair the Congressional Diabetes Caucus, have introduced legislation to address high insulin prices and expand diabetes prevention programs.  Additionally, members of the Congressional Telehealth Caucus have introduced legislation to ensure some telehealth services temporarily expanded under the COVID-19 public health emergency are made permanent.