Washington DC: The Week Ahead (3/27/17)

The Week Ahead

Lawmakers are turning to foreign policy and the budget after House Republican leaders’ and President Donald Trump’s stinging defeat last week over repealing and replacing Obamacare.
As Republicans regroup from being forced to pull the measure from the House floor amid prohibitive party defections, look for House appropriators to grill Health and Human Services Secretary Tom Price over what is next on the health-care front and proposed cuts in Trump’s bare-bones fiscal 2018 budget request.

Trump’s proposals to scrap funding for the Community Services Block Grant and Low Income Home Energy Assistance Program probably will face scrutiny when Price testifies Wednesday before the Labor-HHS-Education Subcommittee.

Also unpalatable to lawmakers is a proposal to cut National Institutes of Health funding to $25.9 billion from $32 billion, a $6 billion reduction that would bring the agency to its lowest level since 2002.

The request comes on the heels of bipartisan passage late last year of the 21st Century Cures Act, P.L. 114-255, which authorizes an additional $4.8 billion to the NIH over the next 10 years.
“We just passed the Cures Act just this last December to increase spending in the NIH because we really think we’re kind of getting close to some breakthrough discoveries on cancer and other diseases,” Speaker Paul Ryan said March 19 on “Fox News Sunday.”
“So that’s something that I think in Congress you’ll probably see some changes,” Ryan said. “NIH is something that’s particularly popular in Congress.”
The secretary also can expect to field questions over HHS’s suspension of social media and other outreach in the closing days of the Obamacare enrollment period. The department’s inspector general is investigating the matter.

Lawmakers step up their investigations into Moscow’s influence in the 2016 election, with more bipartisan cooperation in the Senate than in the House.

The Senate Intelligence Committee plans an open hearing Thursday on Russian disinformation and influence campaigns. Retired General Keith Alexander, a former National Security Agency director, and foreign policy and cybersecurity experts are scheduled to appear.
In the House, partisan skirmishing over the Intelligence Committee’s probe of Russian meddling in last year’s presidential campaign intensified after Chairman Devin Nunes canceled a hearing that had been planned for tomorrow.

Instead, Nunes wants follow-up questioning behind closed doors of FBI Director James Comey and NSA Director Mike Rogers. The panel’s ranking Democrat, California’s Adam Schiff, decried Nunes’s decision and is pressing for an open hearing with testimony from former Obama administration officials, including Sally Yates, the deputy attorney general that Trump fired earlier this year.

The House Armed Services Committee has scheduled a hearing tomorrow looking at Russia’s behavior in Europe. Army General Curtis Scaparrotti, head of European Command and NATO’s supreme allied commander, will testify.

Also tomorrow, the Senate Foreign Relations Committee plans a hearing on U.S. policy in Iran.

The House Foreign Affairs Committee on Wednesday plans to mark up a bill that would enhance sanctions affecting North Korea.

The Senate Judiciary Committee is scheduled to hold a markup today on Neil Gorsuch’s Supreme Court nomination, although the panel’s chairman Chuck Grassley said he anticipated the vote will be delayed a week. Senate Democratic Leader Charles Schumer has opposed the nomination and served notice that Gorsuch will face a filibuster. “He will have to earn 60 votes for confirmation,” Schumer said last week. Republicans have expressed confidence Gorsuch will be confirmed.

The Senate plans a cloture vote today on a treaty allowing Montenegro into the North Atlantic Treaty Organization. Senate Armed Services Committee Chairman John McCain of Arizona has championed the small Balkan nation’s entry into the military alliance, and has been stymied by Kentucky Republican Rand Paul, who has objected to quickly passing the measure by unanimous consent.

In the House, look for another vote to scrap Obama administration regulations, in this case Federal Communications Commission rules on broadband privacy.
House Leaders Pull Health Bill, Likely Ending Obamacare Repeal Effort

House Republicans have largely abandoned their plan to repeal the Affordable Care Act after failing to garner enough support among their own ranks for a bill to overhaul the health law.
After consulting with President Donald Trump, House Speaker Paul Ryan (R-Wis.) March 24 removed the repeal bill he endorsed from consideration. He told reporters the House would not again consider the legislation, titled the American Health Care Act, after weeks of trying to build support for it among Republicans.

Republican lawmakers will largely leave the ACA alone in coming months, Rep. Joe Barton (R-Texas), a member of the House Energy and Commerce Committee, told reporters March 24. He said there was not enough support for it, particularly among hard-line conservatives.

Those who designed the legislation said they were disappointed with the decision not to act on it and blamed conservative lawmakers who refused to back the bill.

“We tried. We tried our hardest,” Rep. Michael Burgess (R-Texas), head of the Energy and Commerce health subcommittee, told reporters. “There were people who were not interested in solving the problem. They win today.”

Support for the legislation among House Republicans eroded over the week, as hard-line conservatives demanded changes and moderates warned the bill could leave millions of Americans uninsured. Some of those who opposed the legislation told reporters they expect this failure will force House leaders to reconsider a more conservative approach to repealing the ACA.

Democrats said they were cautiously optimistic that the ACA, President Barack Obama’s signature legislative achievement, will remain law at least for the time being. House Minority Leader Nancy Pelosi (D-Calif.) said she hopes the failure of the AHCA will make Republicans more willing to fix the health law rather than bring it down.

Next Steps in Health Policy

The House Energy and Commerce Committee, tasked with overseeing many aspects of the ACA, including its Medicaid expansion provisions and insurance regulations, will not write another ACA repeal in the near future, Burgess said.

Rep. Tim Murphy (R-Pa.), a member of the GOP Doctors’ Caucus and the Energy and Commerce Committee, told reporters the panel would not revisit the ACA until after the summer. The committee will continue trying to reform Medicaid and will lean on the Trump administration to grant states more flexibility to experiment with their public health insurance programs for the poor.

Burgess said the committee will continue with its health agenda otherwise, authorizing the user fees that drug and medical device companies pay to the FDA for reviewing their products.

All of the Food and Drug Administration’s user fee programs expire Sept. 30 and Congress is preparing to consider legislation to reauthorize the programs for fiscal years 2018 through 2022.

President Trump challenged Democrats to work with Republicans on a future health bill. However, Democrats said they would not help Republicans dismantle the ACA and its consumer protections.

Liberals in the House are concerned Republicans will now repeal major parts of the ACA, including its prohibition on insurers raising insurance premiums for people with health conditions, Rep. Frank Pallone Jr. (D-N.J.), ranking member of the House Energy and Commerce Committee, said.

Push for Better

Many of the members of the House Freedom Caucus, a coalition of hard-line conservatives who delayed passage of the bill seeking further changes to the ACA, said they expect the defeat of the repeal bill to result in a “true repeal” of the health law.

Members of the group wanted to repeal aspects of Title 1 of the ACA, which includes the individual mandate, rules for the kind of coverage insurers must include in plans and community rating regulations.

Rep. Mo Brooks (R-Ala.) told reporters that repeal efforts will “have to start over looking for a real repeal.”
Republicans need to “get back to the drawing board and bring forward a bolder effort to replace the failing Obamacare with a plan to reduce costs by increasing choice and competition,” Rep. Jim Jordan (R-Ohio) said in a statement.

However, Republican moderates have made clear they will not support such dramatic changes to the health insurance industry. Rep. Charlie Dent (R-Pa.), head of the moderate Tuesday Group, told reporters market reforms must be “do-able and sustainable.” “There are parts [of the ACA] that need to be repealed, parts that need to be replaced. This needs to be reformed, repaired and overhauled, and some parts will be retained—we all know that,” he said.

Medicaid Managed Care in the Balance amid Failed Health Proposal

The debate over Medicaid’s financing may still have long-term effects on the future of managed care and delivery systems, despite the demise March 24 of an Obamacare repeal bill that would have overhauled how the federal health program is funded.

The GOP’s proposal would have ended the federal match for the $550 billion safety-net program and instead implemented per-enrollee spending limits, with the option of lump-sum grants to states that would have been locked in for 10 years. The Congressional Budget Office had estimated the original bill would strip $880 billion from Medicaid over the next decade. Medicaid experts, as well as industry officials and investors, had been closely watching how an overhaul would have slowed efforts already in progress to move health care from a fee-for-service system to one that’s more value-based, integrated and efficient.

With conservative leadership in HHS Secretary Tom Price and CMS Administrator Seema Verma at the helm promising increased freedoms for states to handle their own programs, the conversation will likely push forward despite the bill’s demise.
Delivery Innovation

Medicaid, the federal health insurance program for the poor and disabled, has seen drastic shifts in how it is run since its 1965 inception.

More than 76 percent of Medicaid beneficiaries are covered today under managed care plans, according to the Medicaid and CHIP Payment and Access Commission, allowing private firms to keep better track of their enrollees’ health outcomes and data. They often contract for specific services such as mental health care or case management. Rates are risk-based but must be “actuarially sound” and can include competitive bidding.

The current system can take into account funding changes for things like a Zika outbreak, opioid abuse epidemic or a recession.

John Zang Contributed to This Report

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