The Week Ahead

We know many readers may still be working through Thanksgiving leftovers, but this week, Congress is serving up nothing but lame duck. However, this meal could turn into a food fight real fast, with Congress running out of time to make decisions about government funding, the Farm Bill, and the National Defense Authorization Act. So, let’s get into it. Welcome to the Week Ahead!  

The Administration 

The Biden administration proposed its Contract Year 2026 Medicare Advantage and Part D rule on November 26. This rule is one of the last major ways the Biden administration can leave its mark on the MA and Part D programs, and they didn’t hold back.  The rule proposes allowing Part D plans to cover anti-obesity medications in cases where the beneficiary does not have another health condition beyond obesity or being overweight. Under the new proposal, plans would be able to cover these drugs for beneficiaries who are obese but not those who are overweight. Additionally, Medicaid plans would be prohibited from excluding anti-obesity drugs if used to treat obesity. The rule also includes proposals to strengthen prior authorization and utilization management guardrails under the MA program. The rule, if finalized, would also codify previously issued guidance about implementing the provision of the Inflation Reduction Act that will allow Part D beneficiaries to spread out their out-of-pocket costs monthly instead of paying all at once.  

But here is the kicker: it will be up to the Trump administration to finalize the rule, so what can we expect from the incoming administration on this proposed rule? Well, we know that President-Elect Trump’s nominees to head Health and Human Services (RFK Jr) and the Centers for Medicare and Medicaid Services Administration (Dr. Oz) don’t see eye to eye on anti-obesity medication. 

RFK Jr. has criticized these drugs, but Dr. Oz has expressed support for them. We also know Dr. Oz has been a strong supporter of MA, so if he is confirmed, MA plans may have a more friendly voice within the administration.  

As far as how the Trump administration will handle the implementation of the IRA, it’s about as clear as Thanksgiving gravy! Congressional Republicans have criticized the Medicare price negotiations as price controls. However, President-Elect Trump did pursue several proposals to reduce drug prices. Combine that with the unconventional pick of Dr. Oz to run CMS, and you’ve got a recipe for a potential surprise.  

The Senate  

The Senate Democratic Caucus will hold its leadership elections for the 119th Congress on December 3. The most hotly contested race will be between Senator Amy Klobuchar (D-MN) and Senator Corey Booker (D-NJ) to take over leadership of the Democratic Policy and Communications Committee from retiring Senator Debbie Stabenow (D-MI).  

In addition to the Senate Democratic leadership races, we will be watching for any news related to the makeup of key health care committees in the Senate, including the Senate Finance Committee, which has jurisdiction over Medicare and Medicaid.  

Due to retirements and the results of the 2024 elections, 5 Democratic senators currently serving on the Senate Finance Committee will not be returning for the 119th Congress. Even though the Senate Democratic Conference will have fewer seats on that committee, there will still be a need to fill some of these vacancies. Senator Bernie Sanders (I-VT) made news on November 22 by announcing his desire to serve on the Senate Finance Committee, which would be in addition to his service as the ranking member of the Senate Committee on Health, Education, Labor, and Pensions (HELP) in the next Congress.  

Other Democratic senators who have reportedly expressed interest in joining Senate Finance include Sens. Tina Smith (D-MN), Raphael Warnock (D-GA), and Corey Booker (D-NJ).  

We predict the GOP will gain 2-3 seats on the Senate Finance Committee due to the revised committee ratios. No Republicans currently serving on the Senate Finance Committee are retiring or lost reelection.  

We will also be watching to see if congressional appropriators will respond to the letter from Senator Ted Budd (R-NC) and other senators from states impacted by recent hurricanes, requesting approval of the Biden administration’s request for supplemental funding request for disaster relief.  

Additionally, the Senate HELP Committee is holding a hearing on December 5 about what the Food and Drug Administration is doing to regulate the food and beverage industry in light of the diabetes and obesity epidemics in America.  

The House  

Since the House of Representatives is the starting point for appropriations bills, let’s check in on where things stand on that front. From what we are hearing, it sounds like the House will be teeing up a short-term (3-4 month) continuing resolution – delaying any funding decisions for FY 2025 until the new Congressional session. 

We also expect this bill will not include anything related to health care beyond the health care extenders. Based on analysis from recent Congressional Budget Office scores, we estimate extending these health care policies for a few months will cost $2-3 billion. Only acting on health care extenders is bad news for advocacy groups, which have been urging Congress to include other policy changes in any year-end legislation. Physician groups have been hoping that Congress might address concerns about how doctors’ pay under Medicare is calculated, but that seems unlikely to happen.  

Additionally, the House Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic will be holding a markup of their final report on December 4. 

There You Have It 

We recently posted about unique Thanksgiving food on LinkedIn. We’d love to hear if any of these (or any others) made it on your table this year. Make it a great week!  

After what can only be described as an historic campaign and election, members of Congress are returning to Washington with mixed emotions. Republicans return celebrating what has turned out to be a rout for their side, and Democratic members come back trying to figure out how they will respond to the disheartening results. Let’s dig into everything happening this week in Washington. Welcome to the Week Ahead!  

The Administration 

One name above any other is surfacing among Democratic officials and staff in conversations about who is to blame for the election results, and it’s not Vice-President Kamala Harris, Sen. Chuck Schumer (D-NY), or Vladimir Putin. It’s President Joe Biden. Former House Speaker Nancy Pelosi (D-CA-11) summarized these feelings in a podcast interview with the New York Times saying “had the president [Biden] gotten out sooner, there may have been other candidates in the race.” The only thing President Biden can do now is use his remaining time in office, and his bully pulpit, to advocate for the preservation of his policies.  

Meanwhile, President-elect Trump and his team are looking to fill out his forthcoming administration as quickly as possible. Former Presidential Campaign Co-Chair Susie Wiles will be his chief of staff and the first woman to hold this position, and Stephen Miller will be re-joining as deputy chief. Additionally, President-elect Trump has announced that he intends to nominate Rep. Elise Stefanik (R-NY-21) to be the U.S. Ambassador to the United Nations, along with selecting former Acting Director of Immigration and Customs Enforcement Tom Homan as the administration’s border czar. He also reportedly will ask Sen. Marco Rubio (R-FL) to serve as Secretary of State.  

The Senate 

All eyes are on the November 13 vote for Senate Majority Leader, when Republicans will hold a secret ballot to name either Sens. John Thune (R-SD), John Cornyn (R-TX), or Rick Scott (R-FL) to the top spot.  (We have our preference for sure!)  As of this writing, President-elect Trump has not endorsed a candidate.  His signaling to Senate Republicans whom his preference is to govern with could tip the scales for the intra-caucus vote.   

The loss of the Senate majority for the Democratic party means Democrats will lose committee seats and funding for committee offices and staff.  

The initial focus of the Senate in 2025 will be confirming the new administration’s cabinet.  And while 53 seats is a more comfortable majority than recent Congressional sessions, Senate Republicans  don’t have the 60-seat majority needed to overcome the new best friend of Senate Democrats, the filibuster. The fact that Senate Republicans will need Democratic votes to move most major legislative initiatives certainly gives a shot of bipartisan hope through the shrunken Democratic caucus.  

What else will we be watching for in the upper chamber this week? Democratic leaders will also be holding their leadership elections but those are looking likely to maintain Sen. Chuck Schumer (D-NY) as Minority Leader.  Senate Democrats will also be developing a plan to get as many of their judicial nominees through before the end of the session.  

The House 

At the time of writing, Republicans are sitting at somewhere around 214 to 219 seats and they need 218 to maintain the majority. Looking at the races that have yet to be called, it looks like Republicans will beat expectations and hold the House.  

With Republicans looking to have control over the White House and both Houses of Congress for the first time since 2017, we will be watching to see if some House Democrats start seeing greener grass off the Hill. House Democratic leadership will want to prevent as many of these resignations as possible, since they will need every vote to oppose the Republican White House and Senate.  

However, just like in the Senate, Democrats have reasons for some optimism. If past is prologue, a slim Republican majority could cause headaches for Speaker Johnson (R-LA-4), and he may have to depend on Democratic members to get must pass bills over the finish line. House Democrats may also look to assist their counterparts in the Senate by vocalizing opposition to Trump appointments and legislation moving in that chamber.  

A slim majority for Republicans means that there is little room for defections, retirements, or the accepting of appointments in a Trump Administration without putting control of the House in jeopardy.  And with Rep. Elise Stefanik (R-NY-21) and Rep. Michael Waltz (R-FL-6) likely heading to the new administration, Speaker Johnson (R-LA-4) may want to start stocking up on aspirin. 

Both sides of the aisle are also looking ahead to leadership elections with Republicans set to meet on November 13 and Democrats on November 19. The Republican leadership elections were looking like they’d be uneventful, but with Rep. Stefanik’s impending departure as House Republican Conference Chair, there are already three declared candidates for the position (Rep. Lisa McClain (R-MI-9), Rep. Kat Cammack (R-FL-3), and Rep. Erin Houchin (R-IN-9)). Republican Conference Vice-Chair Rep. Blake Moore (R-UT-1) is also rumored to be throwing his hat in the ring. Committee seats and committee leadership won’t be decided this week – those decisions will happen closer to December when the House Republican Steering Committee and Democratic Steering and Policy Committees meet.  

And hey, let’s not forget about that upcoming December 30 deadline to fund the government!  

There You Have It 

No matter who you voted for on November 5, one thing we can all agree on is honoring our Veterans. We at Chamber Hill Strategies are grateful to those who have served our country and for those who wear the uniform even now.  Make it a great week!