The Week Ahead

We’ve reached the week of the March 14 deadline for when the current continuing resolution to keep the government open expires. Meanwhile, the House and Senate remain far apart on budget reconciliation, the Senate continues churning President Trump’s nominees, and the White House seeks to clarify Elon Musk’s role in the administration. So, with that, let’s get into it. Welcome to the Week Ahead!

The Administration 

To say Elon Musk’s Department of Government Efficiency (DOGE) has disrupted Washington is about as much of an understatement as saying Elon Musk is a car salesman. From prompting mass protests to filling up the chairs in town hall meetings across the country, DOGE is making itself known. But there are still a lot of questions about what DOGE’s role is. President Trump sought to clarify that role with a Truth Social post in which he praised DOGE but also said he was instructing DOGE to work with cabinet secretaries to be “very precise” about future staffing decisions, stating a preference for the “scalpel” rather than the “hatchet.”

We don’t know how things will play out if Musk and cabinet secretaries disagree about distinguishing the scalpel from the hatchet. We do know that DOGE continues to disrupt things in Washington, and we don’t expect that to change. Case in point, the Department of Health and Human Services (HHS) sent most of its employees a $25,000 buyout offer. Responses are due March 14.

In non-DOGE news, we are watching the Office of Management and Budget (OMB), which as of March 7, has received 7 rules including hospital inpatient, inpatient psych, inpatient rehab, skilled nursing, hospice, Medicare Advantage, and the Affordable Care Act Health Insurance Exchange Marketplace. That last one could set off a firestorm if it makes major changes to the Marketplace that are seen as weakening protections put in place by the Biden administration to help people sign up, or stay on, ACA plans.

The Senate 

All eyes are on Dr. Mehmet Oz’s nomination hearing on March 14 for the Centers for Medicare and Medicaid Services (CMS) Administrator. Expect questions about DOGE and access to agency data to be a top question from Democrats. Additionally, Medicare Advantage should come up, given his past support of the program as a Senate candidate.
The Senate HELP Committee is cranking through its noms. The Committee will vote on Dr. Jayanta Bhattacharya for National Institutes of Health (NIH) and Dr. Martin Makary for the Food and Drug Administration (FDA) on March 13, giving them a shot at being confirmed by the Senate before their recess week of March 17. Additionally, the Committee will consider the nomination of Dr. David Weldon to be Director of the Centers for Disease Control and Prevention (CDC) on March 13. Watch for vaccine policy to dominate this hearing, including a review of Dr. Weldon’s past statements about the possible connections between certain vaccines and autism.

Another hearing to watch this week is the Senate Special Committee on Aging March 12 hearing on “breaking the cycle of senior loneliness.”  Pay attention to any comments related to the administration’s recent Medicaid bulletin pulling back on health-related social needs.

The House 

House Republicans unveiled bill text for a continuing resolution (C.R.) to keep the government funded through the rest of the fiscal year (September 30). The bill also extends certain health care policies, including telehealth flexibilities, through September 30. Notably, the bill does not include anything to address physicians’ concerns about Medicare reimbursement cuts. The House Rules Committee is scheduled to meet to consider the bill on March 10, and House Speaker Mike Johnson (R-LA) is planning to have the House vote on the bill on March 11. The Speaker can only lose one Republican if Democrats unite against the bill. Two Republicans, Reps. Thomas Massie (R-KY) and Tony Gonzalez (R-TX), have expressed opposition to the C.R., but the bill does have the support of House Freedom Caucus Chair Andy Harris (R-MD). House Democratic leadership has expressed opposition to the bill, but individual Democrats could decide to vote for the bill if the alternative is shutting down the government.

A bill also must pass in the Senate with 60 votes before it makes it to the President’s desk. A big question that remains unanswered is if passage of a “full-year C.R.” triggers mandatory spending cuts under the Fiscal Responsibility Act (FRA) of 2023 (1% below FY 2023 appropriations). It will be up to the Congressional Budget Office (CBO) and the Office of Management and the Budget (OMB) to report on any breaches of the FRA’s enforcement caps.

We are also tracking some House health care hearings scheduled for March 11. The House Ways and Means Health Subcommittee is holding a hearing on access to post-acute care and the House Veterans’ Affairs Health Subcommittee is a holding a legislative hearing on 15 bills.

There You Have It 

NCAA basketball’s Selection Sunday is coming up on March 16. Who are you rooting for? Will you be filling out a bracket? Let us know. Make it a great week!

Valentine’s Day may be past, but congrats to our very own Zach Schulz who got married over the weekend!  With tensions high on Capitol Hill, we could use some newlywed love around here.  Let’s get into it, welcome to the Week Ahead!  

The Administration 

We have two questions for President Trump on the budget reconciliation debate.  (Well, we have a lot more than 2 questions, and want to know way more than just what he thinks about the budget, but let’s stay focused, people.)  

First, about that “one big, beautiful bill.”    The President surprised a lot of folks – including Senate Majority Leader John Thune (R-SD) and Budget Chairman Lindsey Graham (R-SC) – when he publicly endorsed the House bill over the Senate bill.  At this point, he has expressed openness to multiple different budget bills to finance $4.5 trillion in tax cuts and achieve his domestic agenda.   

The Senate approach takes 2 bites at the apple and is ostensibly an easier path.  The Senate bill that passed February 20 is much cheaper ($340 billion), requiring less government spending offsets.  The House takes 1 bite and loads up on Medicaid cuts to offset the costs of making the 2017 tax cuts permanent. 

Second, where is he on Medicare and Medicaid?  In a statement to Politico on February 19, the White House said they were “committed to protecting Medicare and Medicaid while slashing the waste, fraud, and abuse within those programs.”  Later that day, an updated statement was released leaving out the word Medicare.  Then the endorsement of the House bill which contemplates an eye-popping $880B of changes to Medicaid.   

Feeling some whiplash?  So are we.  

So where is his head?  The President wants what he wants right away.  While complicating the legislative process, he’s been completely consistent about driving the conversation and letting the Republican Congress deal with the mess.  Expect more unexpected. 

The Senate  

The Senate budget has no explicit reforms to Medicaid and Medicare but does include direction to the Senate Finance Committee to identify at least $1billion in savings.  While Senate Republicans point to their fervent interest in repealing the minimum staffing rule for nursing homes to achieve their budget target, Senate Democrats and advocates warn the Senate approach may lead to cuts in Medicaid and Medicare. 

Now what?  The Senate moves on this week to nominations – noms, noms, and more noms – as they eagerly watch the drama over in the House.  In case you missed, Sen. Mitch McConnell (R-KY), the strategist behind Senate judicial nominations – announced he won’t seek re-election in 2026. 

What about the March 14 government funding deadline?  With rumors that the Senate and House Appropriations leads have reached a deal on the overall dollar figure, Ranking Member Patty Murray (D-WA) warned against a long-term continued funding resolution where Congress would relinquish the power of the purse to President Trump and Elon Musk. 

Senate hearings this week 

• 2/26:  Senate Aging Committee hearing on Combating the Opioid Epidemic 

The House 

The House is coming back to DC from time in their districts hearing from constituents about President Trump’s recent actions and the House budget.  They are getting an earful about the impact that potential cuts could have on access to health care for the millions who rely on the Medicaid safety net. 

Speaker Mike Johnson (R-LA) and House Republican leadership don’t seem deterred and are set to vote on the budget February 25.  

Will it pass?  Well, that President Trump endorsement certainly will help. 

With 218 Republicans in the House, they can only afford one Republican defection if they want to pass the bill. Even Republicans who have aired concerns about the impact on Medicaid and Medicare are expected to vote to pass the budget to move the process forward 

Don’t expect House Republicans to hold together for long.  Keeping Republicans on board with that plan will only get more challenging as the House and Senate try to iron out the differences in their budget approaches, and then craft the program changes the budget requires. 

House hearings this week 

• 2/24:  House Rules Committee hearing on the House budget bill  
• 2/26:  House Energy and Commerce Health Subcommittee hearing on Pharmacy Benefit Manager Practices 

There You Have It 

What advice do you have for Zach and Debra?  ChatGPT advises learning to compromise, communicating openly, and supporting each other through conflict.  What’s yours?  Let us know! Make it a great week!  

Valentine’s Day is just around the corner, and there are signs of a lover’s quarrel between House and Senate Republicans over who gets to be first to move forward with the budget reconciliation process.  There is certainly no love lost between President Trump and congressional Democrats!  What does this week hold in DC?  Let’s get into it. Welcome to the Week Ahead! 

The Administration   

Elon Musk and his “Department of Government Efficiency (DOGE)” have turned their attention to the Department of Health and Human Services (HHS). The Centers for Medicare and Medicaid Services (CMS) confirmed in a February 5 statement that “two agency veterans” are working with DOGE staff to find “opportunities for more effective and efficient use of resources in line with meeting the goals of President Trump.” Democratic leaders of the congressional committees with jurisdiction over CMS have called for an investigation highlighting their concerns about DOGE having access to Americans’ personal health information.  While the big dollars of waste, fraud, and abuse come from Medicare and Medicaid, you know DOGE will be digging into the Centers for Disease Control and Prevention and Food and Drug Administration soon enough.  

The administration is also looking to trim the federal government by buying out federal employees.  The deadline for federal workers to take deals was February 6, but a federal judge extended that deadline to February 10, when a hearing is scheduled to consider the legality of the buyout. Regardless of what happens with the buyout and DOGE, the administration’s actions related to federal agencies and the federal workforce have already led to massive disruption at the agencies, including their unwillingness to hold meetings and respond to normal government requests. 

The Senate   

Senate Budget Committee Chair Lindsey Graham (R-SC) has released a Fiscal Year 2025 budget resolution to advance Trump Administration priorities on defense, border security, and energy. Although health care isn’t the focus, the resolution does call on the Senate Finance Committee to produce at least $1 billion in savings. Senate Finance Committee Ranking Member Ron Wyden (D-OR) sees this as a sign that Republicans will look to make cuts to public health programs to pay for their priorities. However, President Trump has communicated that he does not want to see cuts made to Medicare and Medicaid. Of course, what is and what is not a “cut” is in the eye of the beholder. The Senate Budget Committee is scheduled to consider the budget resolution on February 12 and February 13.  

Senate Majority Leader John Thune (R-SD) has filed for cloture on several cabinet nominees, including RFK Jr. to be Secretary of HHS. A vote on his nomination could come as soon as February 14.  Trump’s nominee to lead CMS, Dr. Mehmet Oz, is still working on getting his paperwork in order, but his committee hearing is in the offing.  Dr. Oz has recently met with Senate Finance Committee Chair Mike Crapo (R-ID) and Senate Health, Education, Labor, and Pensions Chair Bill Cassidy (R-LA), a critical step in the confirmation process.  

The House  

House Republicans had reportedly been close to unveiling a budget resolution for markup ahead of the Senate Budget Committee’s hearings on February 12 and 13. Accomplishing this would’ve been a nice win for House Speaker Mike Johnson (R-LA) and would’ve sent a message to his caucus that he can move on to the President’s agenda. However, Speaker Johnson called a time out at the Super Bowl last night when he said that markup may need to be postponed in order to get the details right.  

The House Ways and Means Health Subcommittee has scheduled the first hearing of the 119th Congress for February 11 to “examine ways to promote healthy living with more options, greater flexibility, and better incentives for patients.”  This hearing will focus on employer-sponsored health plans and chronic care, highlighting Buchanan’s recently introduced a bill to allow for employers who offer high-deductible health plans the option of including pre-deductible coverage for certain chronic disease treatments.  This bill has also been a priority for Senate Majority Leader Thune, boosting its chances of becoming law this session. 

There You Have It 

What was your favorite Super Bowl ad?  We are posting our favs on LinkedIn!  Let us know. Make it a great week!