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!