The Week Ahead

Yep, we are using the title of the great Charles Dickens’ novel to describe the Senate and House this week.  Their visions for a budget are vastly different and they need to come together to make “one big, beautiful bill.”  Will they choose “the age of wisdom” or “the age of foolishness?” It’s all in the eyes of the beholder, isn’t it?  With that, let’s get into it.  Welcome to the Week Ahead!  

The Administration 

SOTU? Nope…it’s actually called a joint address to Congress.  President Trump will address a joint session of Congress on March 4, marking his first major speech since beginning his second term. (While often referred to as a State of the Union (SOTU), a president never delivers an official SOTU address in the first year of a new term.)  President Trump is expected to outline his administration’s policy priorities, including recent plans to impose new tariffs on imports from China, Mexico, and Canada, as well as his approach to foreign relations, particularly concerning Ukraine. 

We are wondering about what scooby-snacks the President will hand out this year.  Recall previous made-for-television addresses where he would announce special awards to gallery attendees…. 

Democrat response… who’s the party’s next rising star?  Senator Elissa Slotkin of Michigan, who previously served in the House and flipped a red district in 2018 before narrowly winning her Senate seat in a state that Trump also carried, will deliver the party’s response.  She will highlight alternative policy perspectives with a focus on kitchen-table issues and protecting Medicaid and Medicare.  The speech is often a launching pad for a rising star to spotlight party priorities and establish a national presence. 

Overturning 50 years of precedent, HHS posted a policy that exempts from public comment matters related to “agency management or to public property, loans, grants, benefits, or contracts,” calling the process inefficient to the operation of the Department.  Notice and public comment will continue for all matters required by statute. 

Connect the dots with a DOGE executive order for a 30-day sprint to review and reduce Federal contracts, grants, and loans related to immigration, law enforcement, the military, public safety, and the intelligence community.  

DOGE is coming for you, HHS.  Think CMMI contracts, HRSA grants and loans, NIH. 

The Senate  

Order up, it’s health care nominations in the Senate.  We will hear from Jayanta Bhattacharya, nominee to head the National Institutes of Health on March 5, and Dr. Marty Makary to lead the Food and Drug Administration on March 6.  

What should we expect?  For NIH, hot topics will include the slashing of indirect costs for researchers, job eliminations in the federal government, and what the research agenda will be for the administration.  For FDA, well yes, vaccine safety and efficacy, but don’t forget about the drug and device approval process, supply chain and US manufacturing of drugs, and the controversial lab-developed test rule. 

And don’t forget (how could we) that the government funding runs out March 14, and the health care extenders at the end of March.  While Republicans and Democrats were working to complete their FY 2025 bills, it’s looking increasingly likely another continuing resolution is in the offing.  This time, the extension would run through September 30 with another extension.  Riding along would be the health care extenders through September 30 and December 31. 

Senate hearings this week 

• March 5:  Senate HELP confirmation hearing of Jayanta Bhattacharya for NIH 
• March 6:  Senate HELP confirmation hearing of Jayanta Bhattacharya for NIH  
• (and don’t forget March 6-7 is MedPAC) 

The House 

The hard work of hammering out a budget bill begins. While the Speaker delivered “one big, beautiful bill,” he signaled his support for the Senate Republican leadership’s approach to taxes.  Can Speaker Johnson get his fiscal hardliners on board?  Senate and House Republican leaders will be meeting this week (and beyond) to determine how best to craft a budget resolution that achieves the President’s domestic agenda AND pass both chambers.   

Don’t forget, they must pass the same budget, then the committees have to figure out which policies to fit the budget, then both chambers have to pass that whole budget reconciliation package.  The Speaker has stated his goal of delivering a final reconciliation package to the President in May.   

One person to keep an eye on is Rep. Elise Stefanik (R-NY) as Senate Republicans have yet to confirm her for the U.S. Ambassador to the United Nations. Her vote has been an important one for Speaker Johnson as Republicans have 2 vacancies in Florida that will not be filled until early April. But with the world scene heating up, how much longer the White House is willing to wait for her nomination is unclear.  

In an effort of bipartisanship, the House will take up the Chronic Disease Flexible Coverage Act . Sponsored by Reps. Vern Buchanan (R-FL) and Jimmy Panetta (D-CA), the bill would codify an IRS policy stating that employers who offer high-deductible health plan coverage for their employees the option of including pre-deductible coverage for chronic illnesses.  

There You Have It 

Did you know that A Tale of Two Cities is considered historical fiction?  We in DC feel sometimes we are both working on history and fiction at the same time!  What’s your favorite genre?  Let us know! Make it a great week!  

For those who had Presidents’ Day off, we hope you enjoyed the holiday weekend. Even with the holiday, things continue to move quickly here in Washington. So, let’s get into it, Welcome to the Week Ahead!  

The Administration 

Something is cooking at the Department of Health and Human Services (HHS), and given the swearing-in of RFK Jr. as Secretary, we assume the food is not processed. His first full week on the job coincides with the first full week for the Make America Healthy Again (MAHA) Commission.  The Secretary and his assistant chefs will have their hands full as the Executive Order creating the Commission calls for an assessment of how to address the childhood chronic disease crisis within 100 days.  

Even with all the excitement of a new cook in the kitchen, it’s important to remember that the President remains the top chef and hasn’t been waiting for his staff to arrive. In just 4 weeks, President Trump has issued over 60 Executive Orders since January 20, more than he signed in the first year of his first term! These orders are on top of dozens of other Administration actions that include limiting National Institutes of Health grant funding for “indirect costs” to cutting funding for the Affordable Care Act (ACA) Navigator Program—and we can assume there will be more to come. So, what will he be cooking up this week?  We don’t expect Trump to take off his apron any time soon.  

The Senate  

Senate Budget Committee Chair Lindsey Graham (R-SC) is also eager to serve up his own special dish after the passage of a Senate budget resolution out of committee on February 12.  Look for the full Senate to debate the measure soon— possibly as early as this week.  

Regarding the ingredients list, several Senate Republicans have said they want to ensure a permanent extension of the 2017 Trump tax cuts makes it into the final recipe. To make that easier, Republicans would have to use the Congressional Budget Office’s “current policy” baseline instead of using “current law” as the baseline. Using “current policy” means making the tax cuts permanent would cost significantly less dough. 

Why does that matter?  For health care, that means 2 big things.  One, Republicans may be less inclined to take a big chunk out of Medicaid spending to offset the cost of extending the tax cuts if the tax cuts cost less.  Two, other policies like the enhanced ACA premium tax credits, due to expire at the end of 2025, would also cost less.  What Republicans want to do with the ACA tax credits is far from being baked at this point.    

In non-budget news, the Senate Health, Education, Labor, and Pensions (HELP) Committee will hold a hearing to consider the nomination of Lori Chavez-DeRemer to be the Secretary of Labor. In that role, she will be in a position to impact health care policy in several ways, including through the administration of the Employee Retirement Income Security Act which sets minimum standards for private, employer-based health plans.  While some of her positions have garnered praise from Democrats, we will see if her confirmation will be more like Secretary of Agriculture Rollins, who garnered 19 Democratic votes, or if she will face united Democratic opposition like HHS Secretary Kennedy.  

The House 

After the House Budget Committee came together to pass its own version of a budget resolution, the House of Representatives adjourned on February 13. This gives the cooks in the House a chance to take their menu on the road and hear from the diners directly while allowing critics to organize their messaging about why the menu should be rejected.  

Don’t forget that the expiration of the continuing resolution is less than a month away.  Appropriators are rumored to release topline numbers to come out for fiscal year 2025 any day now.  

There You Have It 

In honor of Presidents’ Day, we wanted to share some presidential trivia with you all, courtesy of the Library of Congress. How many did you get right? Let us know! Make it a great week!  

Lawmakers return to D.C. following tragic plane crashes in Arlington, VA and Philadelphia, PA,  amid a number of questions regarding airline safety. Congress continues consideration of President Trump’s cabinet nominees as well as discussions on budget reconciliation and government funding. So, with that, let’s get into it. Welcome to the Week Ahead!  

The Administration 

The Centers for Medicare and Medicaid Services (CMS) issued a presser on January 29 commenting on the Biden administration’s recent release of the next 15 drugs to be included in the second cycle of Medicare prescription drug price negotiations. CMS intends to “provide opportunities for stakeholders to offer specific ideas to improve the Negotiation Program consistent with the goals of achieving greater value for beneficiaries and taxpayers and continuing to foster innovation.” 

Allowing the government direct negotiating power in the Medicare prescription drug program (Part D) was a signature achievement of the Inflation Reduction Act and has been a policy goal for Democrats going back to the creation of the Part D program.  President Trump’s position on Medicare drug price negotiations is murky at best.  While he hasn’t always held to traditional conservative positions on drug policy, Democratic Members of Congress aren’t taking any chances and are asking for Trump to reject any effort to undo the Medicare negotiation policy. 

The Senate  

The name of the game for the Senate continues to be confirming President Trump’s nominees. On February 4, the Senate Finance Committee will hold an Executive Session to vote on the nomination of RFK Jr. to be the Secretary of the Department of Health and Human Services (HHS). This vote follows hearings at both the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP Committee) where RFK Jr. received widespread support from Republicans (although there were some grumblings from a few HELP GOP Members about Kennedy’s position on vaccine safety and efficacy). Since the Senate Finance Committee is the only committee that will vote on Kennedy’s nomination, the next step after the February 4 vote (assuming the committee advances the nomination) will be a vote on the Senate floor for confirmation.   

The Senate Finance Committee will also consider Jamieson Greer for U.S. Trade Representative on February 6. The U.S. Trade Representative can have a significant impact on health care policy as they work to implement the President’s trade agenda.  

In Trump’s case, that agenda includes the use of tariffs. Even though the Constitution gives Congress the authority to lay and collect duties on imported goods, Congress has given the President authority to change tariff rates if the administration can make the case that doing so is in response to specific national security or foreign policy interests.  

President Trump made use of these authorities during his first administration and has promised to impose tariffs on imported products including medical supplies and prescription drugs. The Trump Administration and other Republicans argue that these tariffs are necessary to protect American industry and reduce the nation’s dependence on foreign countries for critical supplies such as medicines. Opponents raise concerns that tariffs may lead to increased prices and more shortages of generic drugs. We expect tariffs to be a major topic of conversation at Greer’s hearing.  

The House  

Rep. Greg Murphy (R-NC) and a bipartisan group of lawmakers introduced the Medicare Patient Access and Practice Stabilization Act of 2025 on January 31. This bill would provide physicians with a 6.62% increase in Medicare reimbursement rates that would be retroactive to the start of 2025 when a 2.8% reimbursement rate reduction went into effect. Addressing concerns about the Medicare reimbursement rates for physicians has long been a priority for doctors. When Congress didn’t step in to mitigate the impact of the reimbursement rate reduction at the beginning of the year, physician groups were disappointed. But the introduction of this bill gives some hope that some relief from the payment cut that took effect on January could happen. That said, introducing the bill is just the first step in a year packed with government funding decisions and budget reconciliation.  

Speaking of budget reconciliation, it is unlikely that House Speaker Mike Johnson (R-LA) will be able to meet his optimistic goal of passing a budget resolution by February 27. This is especially true given reports of a phone call between members of the House Budget Committee that apparently failed to produce a date for marking up the resolution. Speaker Johnson is now reportedly pushing expectations back to May 2025, a timeline more in line with recent Congresses.  A later date is also an acknowledgment of the difficulty of passing a partisan resolution where just one or a few GOP defectors could be spoilers.  

Also Happening This Week 

• 2/5: House Natural Resources Subcommittee on Indian and Insular Affairs legislative hearing on bills including H.R. 741, to elevate the Director of the Indian Health Service (IHS) to an Assistant Secretary position (Note: RFK Jr. has said he will elevate the IHS Director to an Assistant Secretary position if confirmed as HHS Secretary). 

• 2/6: House Energy and Commerce Health Subcommittee hearing on the threat of illicit drugs.  

There You Have It 

The 2025 GRAMMYs were awarded on February 2, with a special effort to raise funds for those impacted by the L.A. wildfires. Did your favorites win? Let us know! Make it a great week!