Major Policy Developments
With Republicans enjoying a narrow majority in the Senate, healthcare policy priorities will begin to shift in the 114th Congress, with divergent paths for both the ceremonial and practical. Senate Minority Leader Mitch McConnell (R-KY) has indicated he would like to “clear the decks” of must-pass legislation in the lame duck session to allow the new Republican majority to focus on policy priorities and advance legislation next year. The healthcare policy agenda in the new Congress will continue to focus on implementation of the Patient Protection and Affordable Care Act (ACA), as deadlines for major elements of the law and significant rulemaking proceed at a rapid pace. The new Republican majority in the Senate, however, marks the first real opportunity for Congress to consider and approve changes to President Obama’s signature policy achievement.
First on the agenda in the new year will be a revived attempt to repeal the healthcare reform law,which the House has considered in some form over fifty times in the last four years. As in the past, a full repeal vote will be purely symbolic and would certainly face a presidential veto. Congressional Republicans also would have an opportunity to move from ACA repeal votes to consider “replace” health reform legislation.
With a repeal (and possibly replace) vote behind them, the Republican Congress can address more attainable ACA changes. A handful of reforms likely to be considered earned bipartisan support in the 113th Congress, but failed to advance with the Democratic majority in in the Senate, which feared that approving any changes to the law would undermine their prospects in the mid-term elections. Senate Republicans
are still well short of the 60 vote super-majority and will have to identify proposals that actually stand a chance of being signed into law. Their best hope to change the ACA before 2016 will be to focus on provisions that can draw Democratic support with a goal of improving the law rather than undermining it. Such proposals could include a repeal of the medical device tax, changing the “full-time-employee” definition for purposes
of employer responsibility and health insurance coverage, and changes to consumer friendly health care tools like flexible spending accounts (FSAs).Rising insurance premiums may encourage congressional Democrats to support legislation that would allow Americans to keep the coverage if they like it, without a penalty for failing to meet the law’s qualified health insurance benchmarks. Republicans could also attempt to revise the risk corridor program, which allows for additional federal payments to insurers that enroll a disproportionate number of sick (and expensive) patients, and has been criticized as a bailout for the health insurance industry.Other provisions likely to see congressional activity and debate, but without robust crossover political appeal, include repeal of the Independent Advisory Payment Board (IPAB), religious exemptions, and repeal of the individual mandate (which earlier this year scored $35 billion in savings, making it an appealing offset for other policy priorities).
Next year also marks the implementation year of a number of ACA provisions that have been delayed, including the employer mandate, large employer reporting requirements, and minimum essential coverage reporting by insurers. The administrative delay of the employer mandate drew fire from congressional Republicans, prompting a potential lawsuit that would accuse the White House of abuse of executive authority and skirting the issue in advance of the mid-term elections. Large employers have already responded to the impending mandate by cutting workers’ time or, in some cases, dropping employer-sponsored plans all together.
The new Senate majority could drive the issue with an aggressive push for repeal or another delay. Changes to impending reporting requirements, however, offer a middle ground option to address concerns of mid-size business struggling to adhere to the rules. Reconciliation offers another avenue to address ACA changes, with the added irony that the same procedural maneuver was used by congressional Democrats to move healthcare reform in 2010. Reconciliation will be an attractive option to the slim Republican majority in the Senate as the process limits debate in the Senate to 20 hours, and doesn’t require the 60 votes necessary to break a filibuster. But there are limits to this approach under Senate precedent, as embodied in the Byrd Rule, which in theory limits reconciliation to provisions with a budget impact and does not allow for inclusion of extraneous policy provisions. As with other legislative initiatives, the Senate Republican majority will have to carefully balance priorities of the conservative House majority with what the Obama Administration is willing to sign into law.
Anticipated Congressional Committee Developments
Expect Senator Orrin Hatch (R-UT) will lead the Finance Committee in the 114th Congress, with Senator Ron Wyden (D-OR) serving as Ranking Member. Senator Pat Roberts (R-KS), having narrowly defeated his challenger following a tumultuous election year, will serve as Chairman of the Subcommittee on Healthcare, with Senator Debbie Stabenow (DMI) rising to the Ranking Member position with the retirement of current
Chairman Jay Rockefeller (D-WV). The Senate Committee on Health, Education, Labor and Pensions (HELP) will see Senator Lamar Alexander (R-TN) taking over as Chairman of the full committee and Senator Patty Murray (D-WA) as Ranking Member.
Senator Susan Collins (R-ME) will assume the Chairmanship of the Special Committee on Aging, with Senator Bill Nelson (D-FL) serving as Ranking Member.
In the House, Representative Fred Upton (R-MI) will continue to chair the Energy and Commerce Committee with Representative Joe Pitts (R-PA) serving as Health Subcommittee Chair. With the retirement of Representative Henry Waxman (D-CA), two Members are vying to serve as Ranking Member: Representatives Anna Eshoo (D-CA) and
Frank Pallone (D-NJ). Selection of the Ranking Member of the Health Subcommittee will follow caucus votes on the full committee Ranking Member position.
With Representative Dave Camp’s (R-MI) retirement as Chairman of the House Ways and Means Committee, the committee will be under new leadership next year. Representatives Paul Ryan (R-WI) and Kevin Brady (R-TX) are both pursing the gavel. Both Members have been actively engaged in healthcare policy, with Representative Brady serving as the
current Health Subcommittee Chair, and Representative Ryan’s leadership on entitlement reform showcased in previous budget proposals. Representative Sandy Levin (D-MI) will continue on as Ranking Member.