Expediency
The cost of now or waiting
Must be reconciled
Federal Updates
An Ode to 80s Hair Metal: Reconciling “Reconciliation”
Here [they] go again on [their] own? After the “November Rain” of the 2020 elections comes an opportunity for Democratic leadership in control of both chambers of Congress and the White House to employ the mechanism of budget reconciliation to make it much easier to pass their preferred version of the next round of COVID-19 relief. It’s a bold move with little room for error and plenty of traps. In short, it’s meant to be a tool, not a lifestyle.
How does it work? Both House and Senate Budget Committees prepare budget resolutions with “reconciliation instructions,” which are essentially guideposts to instruct various committees to meet certain spending or revenue targets. For a COVID package, these targets become the funding parameters for various policy provisions. The House and Senate must then vote on their respective resolutions.
This is a fairly straightforward process in the House. In the Senate? It’s [anything] but a good time. While only a simple majority is required to pass the resolution, the tradeoff is that Senate rules allow a process called “vote-a-rama” for budget resolutions, meaning that it’s possible for hundreds, even thousands of amendments to be offered. While only a smaller fraction will actually receive a vote, the process takes a lot of time.
Once both resolutions make it across the finish line, they must then be “reconciled” into one resolution if text isn't identical - which is usually the case thanks to the Senate amendment process. Then, the various committees are off to the races to begin putting together what will become a COVID-19 relief bill. Will this strategic move turn out to be “Bad Medicine” or “Heaven Sent”? We’ll know soon. The benefit for Democratic leadership is expediency and avoiding procedural hurdles that might otherwise hold up their favored $1.9 trillion COVID plan in the Senate, but “Every Rose Has It’s Thorn.”
Reconciliation does place some limitation on which priorities can move forward and will require expending valuable political capital needed to court congressional Republicans on other priorities.
Biden meets with Republicans, but the aforementioned reconciliation is likely the way forward
This week, President Biden met with a group of 10 Senate Republicans at the White House, including Senator Thom Tillis (R-NC), to discuss their proposed $600 billion COVID relief plan as an alternative to Biden’s $1.9 trillion American Rescue Plan. The number 10 is significant in this case because it is the number of Republicans that Senate Democrats need under regular rules to move forward on most legislation. While President Biden signaled openness to considering some of the group’s suggestions, including modifying the eligibility thresholds for individual direct checks, he also indicated that their package’s price tag was far too low.
With any form of negotiations at an impasse and the White House wanting to move quickly on the next round of relief, budget reconciliation seems to be the likely pathway forward. The House has passed its budget resolution for reconciliation and the Senate has voted to proceed with its own reconciliation process, finishing up its "vote-a-rama" early this morning. The House will now vote on the Senate's amended resolution to reconcile the two versions. House Democratic leadership and key committee chairs are expected to visit the White House today to begin charting out the legislative framework for the American Rescue Plan.
President Biden has not abandoned hope that a bipartisan deal is still possible, but congressional Democrats are preparing to proceed without Republican support.
Delayed immigration policy day highlighted by Mayorkas confirmation and new executive orders
The Biden administration delayed its immigration policy day from last Friday to Tuesday this week to coincide with the rescheduled confirmation vote of new Department of Homeland Security Secretary Alejandro Mayorkas. Mayorkas is expected to get to work quickly to review outstanding Trump administration immigration policies and begin implementing as much of President Biden’s immigration reform plans as he can under executive authority. As part of immigration policy day, Biden signed executive orders to set up a task force to help reunite families separated at the borders, review asylum policies, and to review changes made to the public charge rule. Additional actions are anticipated that may roll back other immigration orders extended by President Trump before leaving office last month.
Our office is aware of the ongoing challenges facing students, faculty, and staff with respect to new visa applications and renewals. We are working with our Duke University government relations colleagues, professional associations, partners, and others to advocate and seek solutions on behalf of our international students and workforce while recognizing their substantial contributions to the medical workforce and research enterprise.
Senate reorganization is (finally) complete; Burr takes over top Republican HELP slot
It’s officially official. Finally. Senate Majority Leader Chuck Schumer (D-NY) and Minority Leader Mitch McConnell (R-KY) have both signed onto a long sought after power sharing agreement. The deal preserves the ability of Democrats to set the agenda while ensuring more equal representation for Republicans on committees. The agreement also means that Senate Republicans have also announced their committee assignments for the 117th Congress.
Of note, Senator Richard Burr (R-NC) takes over the top Republican spot on the Senate Health, Education, Labor, and Pensions (HELP) Committee as ranking member. Burr will also remain on the Senate Finance Committee, which has jurisdiction over Medicare, as well as the Select Committees on Intelligence and Aging, respectively. Senator Thom Tillis (R-NC) will remain on the Senate Armed Services Committee, the Judiciary Committee, the Veterans’ Affairs Committee, and the Banking Committee.
The delay in the power sharing agreement has been among the reasons that hearings have not taken place for some Biden administration nominees, including those for the Department of Health and Human Services.
E&C Health Subcommittee Holds First COVID-19 Hearing of the 117th Congress
This week, the House Energy and Commerce Health Subcommittee held its first COVID-19 hearing of the 117th Congress entitled, “Road to Recovery: Ramping Up COVID-19 Vaccines, Testing, and Medical Supply Chain.” This was also the first hearing for new Subcommittee Ranking Member Brett Guthrie (R-KY-02). In her opening statement, Subcommittee Chair Rep. Anna Eshoo (D-CA-18) noted the changes the U.S. has undergone due to COVID-19, commenting that veil has been torn off of every system and laid bare the country’s many pre-existing conditions including inequities of care in communities of color.
To inform the hearing, Tom Owens, MD, President of Duke University Hospital and Senior Vice President for Duke University Health System, met with staff in the office of Rep. G.K. Butterfield (D-NC-01), who serves as vice chair of the Subcommittee. At the hearing, Rep. Butterfield stressed that health equity needs to be at the center of any plan for distributing vaccines, but noted this has not been the trend. He also noted the previous lack of plans regarding vaccine distribution, which led to lack of reporting and incomplete data. His questions focused on how to improve data collection and utilize retail community pharmacies for vaccine distributions.
A “sweet” spot for telehealth: TREAT Act reintroduced
It’s back. The Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act (H.R. 708/S. 168) was officially reintroduced in the House and Senate this week. The legislation, slightly modified from the version introduced last Congress, would temporarily allow, subject to scope of practice and other requirements, a health care professional to provide in-person and telehealth services in any U.S. jurisdiction based on that individual's authorization to practice in any one state or territory during the COVID-19 public health emergency (PHE) - and for a 180 day normalization period after the end of the PHE.
Duke Health and Duke University endorsed the bill along with over 200 other health systems, academic medical centers, and other stakeholders.
In support of this legislation and other proposals to expand telehealth services, Duke Health Government Relations is working in partnership with Duke leadership and the Duke Telehealth Office to ensure that beneficial telehealth policies are strengthened and maintained during the COVID-19 PHE and beyond.
Shine on: RISE Act reintroduced
Today a bipartisan group of House Members are reintroducing the Research Investment to Spark the Economy (RISE) Act. This bill would authorize $25 billion in emergency relief funding for federal science agencies – including the National Institutions of Health – to support the U.S. research enterprise that has been significantly impacted by COVID-19. As of this writing, original cosponsors include Reps. Butterfield (D-NC-01) and David Rouzer (R-NC-07). Duke Health supports these efforts and investments that help strengthen our scientific enterprise and its recovery.
From our desk(s): Duke Health GR this week
The Duke Health Government Relations team met this week with the offices of freshman congresswomen Rep. Deborah Ross (D-NC-02) and Rep. Kathy Manning (D-NC-06) to discuss a number of Duke Health priorities as well as highlight the health system’s research efforts, vaccination rollout, and continued response to COVID-19 in our communities.
Staff also connected Duke experts with the office of Rep. G.K. Butterfield (D-NC-01) to highlight the ABC Science Collaborative, which pairs scientists and physicians with school and community leaders to help them understand the most current and relevant data about COVID-19 in support of safely returning the classroom. Learn more at https://abcsciencecollaborative.org/.
We continue to engage with the North Carolina congressional delegation and other key members of Congress and congressional committees on a wide range of public health issues, including telehealth, maternal health, health equity, and strengthening medical research.
(Virtual) Hill days are coming - and we can help
With the calendar turning to February, we are getting closer to the kickoff of professional association Hill days. While these activities will be virtual this year, they are still wonderful opportunities to connect with your elected officials, showcase your work, and make connections on key federal policy issues for your field.
If you’re planning to join or even considering joining an association lobby day this year, we’d love to hear from you!
We know your associations provide great training opportunities and materials to prepare you for the big day, but please know that we’re your in-house resource every day of the year for consultation and to help you continue to build those relationships with staff and Members of Congress.
Contact Brian Lee in our office at brian.lee887@duke.edu to share your information
It’s not just our jobs - it’s also a lot of fun - and we look forward to connecting with you.