The Week Ahead

Congress is back in town, and the race is on to meet House Speaker Mike Johnson’s ambitious goal of passing a budget reconciliation bill by Memorial Day. Meanwhile, the Trump administration is busy with plans to change civil service classification and restructure the Department of Health and Human Services. So, with that, let’s get into it. Welcome to the Week Ahead!

The Administration 

The Treasury Department is expected this week to provide an estimate of when the X Day will occur – the day on which the federal government will have exhausted its ability to pay its bills. This date is expected to be sometime in the summer or early fall of 2025.

Remember, Republican leaders in Congress included raising the debt ceiling in the reconciliation bill they are trying to pass. An earlier X Day means an earlier deadline for when Congress would need to raise the debt ceiling.

The Trump administration is also dealing with the fallout of a leaked copy of the proposed fiscal year 2026 (FY 26) budget for HHS to the Washington Post. Health care advocacy groups are concerned about the proposed $80B in cuts to discretionary spending, plans to eliminate funding for several agencies and programs, and the restructuring of several parts of the department into a new “Administration for a Healthy America.” The official budget is expected in May, and the president’s proposed budget is just that, a proposal that Congress can change or even ignore.

Proposed cuts to spending and reorganizing federal agencies are nothing new for an administration’s budget proposals. However, these proposals hit differently coming from an administration that has not been shy about exerting executive branch authority to move forward with its agenda. Case in point: the Trump administration plans to move forward with a plan to reclassify civil servants to make it easier for them to be removed.

The Senate 

We don’t have dates yet for the Senate committee markups for their budget reconciliation legislation, but they are under pressure to get a reconciliation bill passed by Memorial Day. We are paying particular attention to the Senate Committee on Health, Education, Labor, and Pensions (HELP), as this committee has been instructed to find at least $1 billion in savings over ten years.

Senate Hearings 

• April 29: Senate Veterans’ Affairs Committee hearing on veterans’ mental health
• April 30: Senate Appropriations Committee hearing on biomedical research

The House 

The House Committees on Armed Services, Education and Workforce, and Homeland Security will kick off the reconciliation markup process on April 29. House Energy and Commerce Committee is still working to find $880B in savings including what and how much Medicaid spending will be cut.

Based on conversations with the Hill, Republican leadership thinks it can get to $500B over ten years by addressing “waste, fraud, and abuse” within the Medicaid program, according to previous work from the Government Accountability Office.

Other potential sources of savings within the Medicaid program that have been mentioned include work requirements, changes to provider taxes, and penalties on states that provide care for undocumented immigrants. Republicans are saying other non-Medicaid policies, such as cuts to Medicare Advantage plans and policies to address Medicare reimbursement for physicians, are unlikely for reconciliation but could come later in the year.

House Hearings 

• April 29: House Education & Workforce Committee markup of reconciliation directives and H. Res. 344, a resolution directing President Trump and HHS Sec. Kennedy to provide documents related to the elimination of the Administration for Community Living
• April 29: House Energy and Commerce Committee markup of 6 health care bills (not reconciliation)
• April 29: House Veterans’ Affairs Health Subcommittee hearing on reforming state veterans homes
• April 30: House Veterans’ Affairs Oversight and Investigations Subcommittee hearing on the VA’s mental health policies
• April 30: House Education & Workforce HELP Subcommittee hearing on ERISA

There You Have It 

If you need a break from betting on the likelihood that Congress will pass a reconciliation bill by Memorial Day, the 151st Kentucky Derby takes place on May 3. Do you have plans to watch? Make it a great week!

While the men’s and women’s Final Four brackets are set, the Congressional budget is not at all locked up.  Senate Majority Leader Thune (R-SD) is preparing to vote this week on a budget they’ve been negotiating with the House, while Speaker Johnson (R-LA) is hoping to add two members to his razor-thin majority by winning special elections in Florida.  Will March Madness yield a “beautiful” budget in April??  Let’s see!  Welcome to the Week Ahead!  

The Administration 

We are eagerly awaiting the final Medicare Advantage (MA) and Part D technical changes and rate announcement rules, as well as the proposed rules for the fiscal year payment systems.  CMS Administrator-nominee Oz is waiting for his Senate floor vote, and he was not especially warm on MA during his confirmation hearing.  We know the final MA rule will look different than the proposed rule released during the previous administration, but how much different?  Will the rule come out on time – around April 7?   

And how will the continued DOGE-ing complicate rule-making and public input?  In case you were under a rock, you might have missed that the Department of Health and Human Services (HHS) announced plans to reduce its full-time workforce by 10,000 employees and consolidate the number of divisions from 28 to 15. The Department says this decision is about improving efficiency, saving taxpayer dollars, and better implementing the Trump administration’s focus on addressing chronic disease rates.  

The Senate  

The Senate aims to vote on the budget resolution this week they’ve been negotiating for the past few weeks with the House. While an agreement has yet to be shared publicly, rumors are the budget would set up a reconciliation bill that would require smaller cuts from Senate Committees (at least $3B) than from those in the House (at least $1.5T).  Notably, the resolution may call for at least $1 billion in cuts from the Senate Health, Education, Labor, and Pensions Committee, which has jurisdiction over many HHS agencies. 

Wait, what?  How can they do that?  Doesn’t the Senate and the House have to vote on the SAME budget?   

Yes, they do, but the House and Senate do not have mirrored committees, so the Senate is really only voting on policies within the Senate’s committee structure, and the House is only voting on policies in the House’s structure.   

The move here is essentially a way for Senators to delay making the tough decisions on policies like Medicaid, Medicare, and taxes later on in the process of budget reconciliation.  Senators can vote for the budget this week and still vote against the final reconciliation bill if it doesn’t pass muster (ala the Sen. John McCain-style moment in 2017). 

Senate Hearings This Week 

• April 3:  Senate Judiciary Committee meeting on April 3 on bills increasing transparency and promoting competition within the prescription drug industry  

The House 

The votes are tight – for everything in the House including the budget.  Even with Democratic vacancies following the deaths of Reps. Sylvester Turner (D-TX) and Raul Grijalva (D-AZ), President Trump still felt the need to withdraw Rep. Elise Stefanik’s (R-NY) nomination to be UN Ambassador to boost his chances for a budget win.  All eyes now turn to Florida, where Republicans hope to pick up two seats in special elections to replace former GOP Reps. Matt Gaetz and Michael Waltz on April 1. 

These should be easy pickups for the GOP, but special elections should never be taken for granted. Republicans are growing anxious that Josh Weil, the Democratic candidate in the race to replace Rep. Waltz in Florida’s 6th congressional district, could pull off an upset against Republican Randy Fine. These races could either give Republicans more breathing room on forthcoming budget votes or make their lives even more difficult. Even if Republicans win both seats, they can still afford only 3 defections to reach the required 217 votes to pass a budget resolution and ultimately reconciliation. 

House Hearings This Week  

• April 1: House Energy and Commerce Health Subcommittee hearing on the regulation of over-the-counter monograph drugs 

• April 1: House Energy and Commerce Oversight Subcommittee hearing on cybersecurity vulnerabilities in legacy medical devices 

• April 1: House Veterans’ Affairs Committee oversight hearing on modernizing VA health care 

• April 2: House Veterans’ Affairs Oversight Subcommittee hearing on the VA’s mental health policies  

• April 2: House Education and Workforce Health, Employment, Labor, and Pensions Subcommittee hearing on employer-based health insurance  

There You Have It 

Speaking of March Madness, how are everyone’s brackets looking? Is your team still in it?  Mixing hoops and vote-a-rama is a great way to watch the Senate floor.  Let’s make it a great week!  

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!