The Week Ahead

Good morning from Washington, where the sun is shining after rain dominated the weekend. With the sun on the horizon, a glimmer of hope remains as a bipartisan deal was announced on border security, tax policy, and appropriations funding for agencies. Could it be that both houses are finally coming together to do their jobs on behalf of the American people?  Or will partisan politics in an election year get in the way of legitimate legislative victories? It may be too soon to tell, but perhaps this underdog Congress is inspired by this weekend’s comeback by the 49ers against the Lions after being down 24-7. Much remains to be seen if congressional leaders will spike the ball in February, but one thing remains certain: drama continues to fill the air!  Welcome to the Week Ahead!

The Administration

President Biden is hoping a bipartisan deal on border security will be what he needs to move forward with the supplemental package for funding to Ukraine, Israel, and Taiwan. As discussed more below, the deal, which legislative text has yet to be released, focuses on allowing the administration the ability to shut down the border should crossings reach a certain amount per day among other provisions. Former President Trump blasted any negotiations as a deal could signal a win for President Biden.  The administration is also facing pressure from both sides after Iranian-backed drones killed three soldiers and injured more than 30 in Jordan this past weekend.  Republicans are calling for direct strikes in Iran while some Senate Democrats are calling for a more measured and proportionate response. Whichever way the administration acts will provide plenty of fodder for election season.

Homeland Security Secretary Mayorkas is set to face the first steps of an impeachment proceeding as the House prepares to markup two articles of impeachment this Tuesday. House Democrats believe the articles are politically motivated and are set to vote against them. Some Republicans have publicly voiced opposition to the articles of impeachment, but much is riding on the upcoming votes for Speaker Johnson and his leadership team. All of this comes at a time when Republicans are rejecting a border security package (for which they have not seen any language) they wished to tie to a supplemental package. The plot thickens as election season motivations show its ugly head in critical policy issues.

The Senate

The Senate returns to business Tuesday considering more nominations. The big news however remains around the border security deal brokered by bipartisan negotiators Sen. Chris Murphy (D-Conn.) and Sen. Craig Lankford (R-Okla.). Both senators took the Sunday talk show circuit pushing for the Senate to pass the package.  A procedural vote could be set for this Wednesday or Thursday. The package includes money for foreign aid and contains border security provisions. Lankford is urging Republicans to support the package since they tied up the supplemental with demands for changes in border policy. The Senate could lead the way in demonstrating bipartisanship by moving forward with the package despite calls from Trump to tank it. 

On the appropriations front, Senate and House negotiators reached an agreement late Friday night on funding allocations for federal agencies. The agreement spells out how they will handle the twelve full-year funding bills. The agreement, led by Senator Patty Murray and Rep. Kay Granger, is another win for women leading by example. Congress has until March 1 to prevent a partial government shutdown.  

Health Care 

The US Senate Committee on Veterans’ Affairs will host a hearing focusing on veteran centers supporting the mental health needs of veterans, service members, and their families on January 31. 

The House 

The House of Representatives is back after the weeklong recess and there is an official stalemate with border security, Ukraine, Israel, and any other legislation besides the tax bill.

Speaker Johnson sent a letter to colleagues that stated he disagreed with the Senate bill, and the President has the right to act with Executive Orders to control the chaos at the U.S. Southern border. The border deal is what is holding up other official funding as House Republicans will not vote on any legislation that funds other countries without border security reform. Former President Trump continues to encourage Republicans not to support the Senate deal as he sees this as a winning political issue. This should make for some exciting fireworks between the House and Senate in addition to government funding till the President’s Day work period. 

In other news… Chairman Jason Smith (R-MO) and Ranking Member Neal (D-MA) continue to make headway with a tax bill. 

Health Care

In addition to addressing the new March 8th deadline for those expiring programs, House leaders are expected to continue a push for legislation that cleared the House with broad bipartisan support late last year—the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act. Added to the mix is the continued push from the House Republican Doctors Caucus and physician organizations for relief from the 3.37% cut in Medicare payments that took effect on January 1. While relief once seemed a distant possibility, some form of relief being passed by Congress in the coming weeks now seems to be within reach of becoming reality.

As the legislative sausage-making conversations ensue, House committees will also hold two health-related hearings on Wednesday with the House Energy and Commerce Health Subcommittee holding a hearing to explore rising health care costs and spending titled “Health Care Spending in the United States: Unsustainable for Patients, Employers, and Taxpayers” (January 31 at 10am) and the House Oversight and Accountability Committee holding a hearing the same day titled “Overseeing the Department of Health and Human Services’ Compliance with Congress.”

While the week back will be relatively light—at least publicly, House committee activity on health issues is expected to pick up in February and March with telehealth, laboratory-developed tests, and efforts to address rare diseases among the topics that are expected for further congressional attention.

As always, please send us your thoughts for this week and what’s next. Create a great week!

Welcome from Washington DC, where a few inches of snow canceled schools and closed the federal government leaving parents gazing into the horizon for relief and confirmation schools will open in the next day or so. As we stare into the legislative horizon, we wonder if Republicans and Democrats can come together to fund the government to avoid a shutdown. During the Martin Luther King, Jr. holiday weekend a deal was struck on a stopgap measure to extend spending authority until March 1 and March 8, keeping intact Speaker Johnson’s laddered approach. However, with time being of the essence, can Congress act quickly (not its best trait) to pass the measure through both bodies in time? Welcome to the Week Ahead – where the 118th Congress continues to struggle to meet the most basic legislative tasks.

The Administration

The Border. Negotiations on border security continue but seem to be stuck at the same time. As we reported earlier, border security is being tied into any additional funding for Ukraine, Taiwan, and Israel by Speaker Johnson and other Republicans. The issue at hand appears to be the ability for the administration to continue to use parole authority. This power allows the government to grant the ability for migrants to have temporary permission to live and work in the United States even though a path to citizenship may not exist. Parole authority is a must have for the Biden administration, but Republicans see this tool as a way for immigrants to get around Congress when they otherwise cannot gain access into the country. It remains a sticking point and could tie up foreign aid to America’s allies.

Healthcare 

Medicare Advantage. A MedPAC presentation and report Friday states the federal government will pay $88 billion more than it should this year because they attract healthier lower-cost beneficiaries thus driving sicker beneficiaries into traditional Medicare. The report also mentions complicated upcoding procedures used to drive up payments to plans.

The Senate

The Continuing Resolution. The Senate is scheduled to hold a vote on the legislative vehicle short-term continuing resolution to extend the government funding deadlines to March 1 and March 8. Despite the snow, the vote is on! Senators who wish to oppose the CR can do so until Sunday, but the Senate really needs to move on this to avoid a shutdown. Both Leader Schumer and Senator McConnell will work to address any concerns members have to prevent this from happening. The CR does not address major issues like funding for our allies or the border security issue, but it does give more time for appropriators to pass their bills before automatic spending cuts come to fruition in mid-April.

Healthcare

The Senate Health, Education, Labor and Pensions Committee will hold a hearing addressing long COVID on January 18th at 10am.

The House 

On the Clock. The House is scheduled to hold votes tonight to encourage members to be back in town despite the weather. It is thought Speaker Johnson may have to work this week to get the proposed CR to pass via suspension which requires a two-third majority, Democrats appear to be united behind passing the CR and helping get this across the finish line. However, it will not come without asks from the Democrats – so let the negotiating begin! (https://jensen-jensen.com)

Healthcare 

The House returns after the Martin Luther King, Jr. holiday with a slate of bills and resolutions to consider, but the most pressing question as the House reconvenes will be whether enough House Republicans will vote to join Democrats later in the week and avert a partial government shutdown before the first funding deadline under the “laddered” continuing resolution (H.R. 6363) that Congress passed late last year hits on January 19.

While an agreement has been reached between Speaker of the House Mike Johnson (R-LA) and House Majority Leader Charles Schumer (D-NY) on topline spending numbers, much remains to be determined—not only on final appropriations for the rest of the fiscal year but on health policy priorities as well. Under the “laddered” agreement agreed to by Speaker Johnson and Leader Schumer reached late last week, a final agreement on significant health legislation is now not expected until at least March as multiple health extender deadlines that were previously set for either January 19 or 20 will now be extended to either March 8 or 9. Expiring provisions pending to be renewed 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).

Prior to adjourning in December, the House passed both the Support for Patients and Communities Reauthorization Act and the Lower Costs, More Transparency Act with broad bipartisan support, and House leaders are pushing for inclusion of many of the bills’ provisions including measures on price transparency, pharmacy benefit manager reform, and hospital payments in a final government funding package for 2024.

The largest health policy casualty of Congress failing to reach an agreement on government funding and larger health hit physicians and other clinicians under Medicare. When Congress adjourned in December, momentum appeared to be building for Congress to provide at least partial relief from the 3.37% cut in Medicare physician payments that took effect on January 1, but Congress failed to reach an agreement on additional relief from Medicare payment cuts in 2024. As a result, Medicare payment rates resulting from the 3.37 percent cut are expected to remain throughout 2024.

Good morning from Washington DC where the weather changed from rain, to snow, to warmer temperatures and sun in a matter of 36 hours.  The dramatic shift in weather cycles reminds us of the recently announced retirement of former House Speaker Kevin McCarthy.  Where else can you go from being Speaker, to being removed by your own party, to retiring all in one year?  Here in Washington of course!  Rep. McCarthy is not the only one to announce retirement for this term, and we do expect many more to leave before filing for another term.  With the slight majority Republicans hold in the House, each retirement and expulsion (Santos) makes the holiday season more enjoyable for House Democrats looking to take control next session.  In addition, we only have one week left of legislative business, and we still have no agreement reached on aid for Ukraine and Israel.  Congress returns this week to what could be a very busy time! Welcome to the Week Ahead!

The Administration

President Biden continues to work behind the scenes with Senate negotiators on the White House supplemental request for funding to Israel, Ukraine, and Taiwan.  As previously mentioned, Republicans in Congress want to tie any aid for these countries to increased border security measures.  The administration publicly stated reforms are needed at the border, but at this time, no agreement has been reached for foreign aid. President Biden will host Ukrainian President Zelensky this week.  With time running out and House Republicans becoming increasingly skeptical of funding Ukraine, President Zelensky returns to Congress for a last-minute plea to the Senate.

In health care news, and in line with its priorities, the White House celebrated the announcement that the FDA announced the approval of gene therapies to treat sickle-cell disease via its statement.  To address health inequities and improve on treatment of sickle-cell disease which disproportionately impacts African Americans and Hispanic Americans, the Biden Administration believes this breakthrough can save and improve the lives of millions.

The Senate

The Senate will welcome Ukrainian President Zelensky for a speech on the importance of funding to Ukraine.  The invite was extended by both Majority Leader Schumer and Minority Leader McConnell.  Behind the scenes negotiations will need to resume on border security measures to couple with potential funding on the war supplemental.

With an eye on health care for moving into 2024, the Senate will look to the following this week:

• • Tuesday
    • Senate Health, Education, Labor & Pensions (HELP) Committee is scheduled to consider and expected to approve the SCREENS for Cancer Act of 2023 (S. 1840) and its own version of the SUPPORT for Patients and Communities Reauthorization Act (S. 3393).  In addition, they will also look to pass S.644, The Modernizing Opioid Treatment Access Act.
  • Thursday
    • The Senate Aging Committee will hold a hearing on substance use trends for older adults.

The upper chamber will look to conclude the year by finishing off its health care priorities, although they lack a bipartisan larger “package” which Leader Schumer expressed desire to complete this year.

The House

Retirement season has officially kicked off on Capitol Hill. Former Speaker McCarthy is leaving at the end of the year, Chairman Patrick Mc Henry (R-NC) is in his final term, and we expect several more are going to leave before they must file to run for another term. Many members are citing (shocker) dysfunction and just want to go back to their private lives.  With one week remaining, major fireworks remain on emergency packages for Ukraine, Israel, Taiwan, and the border wall. The Senate continues to negotiate, but the Senate package still must pass the House and must include border security.

In the area of artificial intelligence, the House Energy and Commerce Committee will hold a hearing on Wednesday leveraging agency expertise across the economy to position America as a leader in AI.

Health Care

As Congress looks to close its work for 2023, the House will be taking steps to move health legislation forward with an eye to positioning themselves going into 2024.

• The House will consider 14 bills, including:
  • Lower Costs, More Transparency Act (H.R. 5378), which would establish increased transparency for insurers hospitals and PBMs.
  • Support for Patients and Communities Reauthorization Act (H.R. 4531)
  • PREEMIE Reauthorization Act of 2023 (H.R. 3226).

Each of the bills will be considered under the suspension of the rules signaling House leadership’s belief that the bipartisan bills will garner enough support to pass with the required two-thirds majority needed under the procedure. By moving the legislation with strong bipartisan support, the House leadership will be asserting a strong position on several health issues, including pharmacy benefit manager reforms and provider payments, as House and Senate are expected to work to reach an agreement on health legislation in 2024.

Beyond this public work on health care, we also expect work and conversations to continue behind the scenes, as leadership and committee staff on both sides of the Capitol work with an eye toward drafting legislation to address several expiring health care provisions and programs in January. As readers are likely aware, the House Energy & Commerce Committee moved 19 pieces of health-related legislation last week, including measures to extend the work Geographic Practice Cost Index floor, to revise the phase in of certain payment changes for lab services, an extension of expiring incentive payments for alternative payment models, and additional relief to help mitigate the 3.4% cuts in Medicare physician payments scheduled for January 1, 2024. At this time, we do not anticipate seeing a final agreement on these provisions before Congress adjourns in 2023, but it is expected that these other health provisions could be included in a legislative package in January.

Your insights are valuable, so please reach out with any questions or information.  Please create a great week!