Author: John Jonas

ACA Repeal and Replace Update

Congress returns to Washington next week, and House Republican Leadership maintains an ambitious agenda to pass the American Health Care Act (AHCA) despite an unclear path navigating its moderate and conservative factions. President Trump, who refuses to let health care reform disappear from the agenda, is especially eager for a victory, and today predicted AHCA would pass within the next few weeks.

During the in-district work period these past two weeks, the White House, House Leadership and Republican committee staff have kept conversations going with the two disagreeing factions within their caucus – the moderate Tuesday Group and the conservative Freedom Caucus. At this stage, there appears to be no agreement within the Republican Caucus, and there are varying reports on how close are discussions. The wild card is whether President Trump and his team can help force a deal. As soon as a deal materializes, the House will move the bill to the floor.

In addition to health care, the discretionary aspects of the Federal government are under a temporary continuing resolution which expires at the end of next week. An effort is underway to pass a measure that will fund the government through the remainder of the 2017 Fiscal Year, which ends September 30. This effort is not without controversy, and includes an attempt by the Trump Administration to appropriate funds to build its border wall. However, Republicans will need at least eight Senate Democrats to vote with them to pass an omnibus spending bill, so compromise will be required. There may be a series of short-term funding patches as Congress considers spending priorities.

One of the more interesting issues Congress and the Trump Administration face is what to do with Affordable Care Act (ACA) subsidies that were meant to help reduce cost sharing (deductibles, co-payments) for especially poor, non-Medicaid eligible individuals buying insurance on the exchange. House Republicans had successfully sued the Obama Administration in district court arguing that Congress must appropriate the money before the ACA’s Cost Sharing Reduction (CSR) subsidies could be paid. With an injunction from the district court in place, Congress must decide whether to appropriate the money in the upcoming spending bill. Some Democrats have stated they will not vote to pass any budget without funds for the CSR program included. If Republicans can pass a budget without funding the CSR subsidies, they aren’t out of the woods yet on the CSR program. Specifically, the President still has to decide whether to appeal the district court decision on May 22. If President Trump chooses to accept the district court decision and there is no appropriation, the President could unilaterally shut down the CSR subsidy program. The President has threatened to use this court decision to bring Democrats to the negotiating table, in the event that the program is not appropriated and AHCA is not passed.

The AAA will continue to keep members up to date on these issues.

Trump Healthcare Transition Analysis

President-elect Donald Trump is naming more members of his transition team as he prepares to form his cabinet and key White House position.  In the healthcare arena Andrew Bremberg will take the lead on transition issues related to the Department of Health and Human Services (HHS). Bremberg, who has been working on the Trump transition team since the Republican National Convention in July, worked at HHS for nearly eight years under the George W. Bush Administration. Bremberg later advised Senate Majority Leader Mitch McConnell on health policy and served on Mitt Romney’s transition team in 2012. Most recently, he worked on Scott Walker’s health care team during the Wisconsin governor’s presidential campaign.  He is viewed as a traditional inside professional with a strong working knowledge of the health care system.

The Trump transition team is currently focused on cabinet-level picks. Candidates to become HHS Secretary in the new Administration reportedly include:  Dr. Ben Carson, a retired neurosurgeon and former GOP presidential candidate; former House Speaker Newt Gingrich; former Louisiana Gov. Bobby Jindal; Rich Bagger (we previously worked with him when he was at Pfizer and we represented the company), executive director of the Trump Transition team and a pharmaceutical executive; and Florida Gov. Rick Scott,  Congressman Tom Price (GA), a Member of the House Ways & Means Committee, has also expressed interest in being Secretary.

Topping the list of health care priorities for Congressional Republicans is repealing and replacing the Affordable Care Act. The GOP will likely seek to pass a budget resolution, and then a reconciliation bill to repeal major portions of the health law, including the individual and employer mandates and various taxes. The budget reconciliation process will allow the Senate to advance a repeal bill with only a 51-vote majority.  Both a FY 17 and FY 18 reconciliation bills are possible

Rep. Kevin Brady (R-TX) is expected to remain as Ways and Means Committee Chairman, and Rep. Pat Tiberi as Chairman of the Health Subcommittee. Republicans will need to fill a few seats on the Committee; Rep. Charles Boustany (R-LA) lost his Senate race, while Rep. Todd Young (R-IN) won his. Rep. Robert Dold (R-IL) lost his re-election bid.  On the Democratic side, it is not clear whether the six seats gained by the Democrats will change the Committee ratios in any way.  Brian Higgins will likely regain his seat on the Ways & Means Committee to fill one of the seats vacated by Charlie Rangel and Jim McDermott.  A fair number of Members on both the Republican and Democratic side are lobbying for positions on the key Ways & Means Committee.

We will continue these updates as we collect additional information on the Trump transition, particularly as it looks at sub-cabinet level positions in HHS and CMS.  I have attached for folks’ review, the Ways & Means Committee document, A Better Way, which discusses their replacement for the ACA and is probably the best starting point for those looking to begin to discern what repeal and replace will look like.  We will provide more updates on this process as they begin to take shape.