Federal Health Policy Updates for the Week of January 2, 2023

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You can’t rush progress
Some things take the time they do

Others? Need a shove


The Rundown

  • The 118th Congress is off to a bumpy start with no Speaker yet chosen in the House
  • A snapshot of policy issues likely on House and Senate dockets for the first session of the 118th Congress
  • Join Duke Health Advocacy Network

Federal Updates

Welcome to the (almost) 118th Congress
And they say that there is never anything interesting or new on television or streaming at the start of a new year. The 118th Congress has not quite gotten off to the start many would have hoped, particularly a majority of the incoming House Republican conference. The Senate has sworn in its new and returning members and confirmed leadership positions. The House, as of the time of this publication, is still trying to get there.

As a team, we have been as transfixed as the rest of the country on how this usually routine process is playing out. We wonder about agendas and potential committee line-ups as trade-offs are floated to secure votes. We’ve also been thinking about our colleagues on staff in the NC congressional delegation – who are in their own state of temporary limbo. As disorienting as it has felt at times, the prolonged floor battle to select a Speaker and move House business forward has also been a great reminder, as well as instructive of what might lie ahead in the 118th.

People are inherently messy. Life is messy. So, it follows that even with the best intentions in mind, the institutions and procedures created by people to help foster some sense of order can sometimes also get messy. Those not involved in day-to-day Congressional activities often don’t get to see that side of Congress, though. Sure, there are soundbites, hearings, and floor speeches – but most of the time those are carefully and cleverly choreographed. No Speaker means no formal majority rules agreement telling cameras where to point and when. When the chamber comes to order, we’re seeing it all – or at least more than is normally shown to those outside of the building.

What it tells us is that navigating a narrow majority containing its own entrenched minority will be a delicate balancing act for whomever finally wins enough votes to be named Speaker of the House. Remember, the Speaker not only has to negotiate with their own party, but with House Democrats, the Senate, and the President. This will have massive implications for the types and frequency of legislation that can pass the lower chamber, and for the “big” things, bipartisanship, even nominally, will be a virtual requirement.

It’s messy – but that’s life.

Republicans have a 222-212 majority, with one vacancy, in the House of Representatives. In order to move forward with formally swearing in members and other essential opening business – assuming all members are present for the vote – 218 votes are needed to elect a Speaker. Rep.-elect Kevin McCarthy (R-CA), designated Speaker-elect by a majority of the Republican conference, remains the frontrunner to eventually claim the number of votes necessary to claim the Speaker’s gavel. That could change, but so far, McCarthy and his allies are prepared to wait out any detractors. Rep.-elect Hakeem Jeffries (D-NY) is on track to become the next House Minority Leader.

Until the Speaker’s race is decided, we won’t have any further clarification on committee leadership, assignments, or the  agenda. We also don’t technically have any House members.

This could be resolved today – or it could drag into next week. We’re monitoring negotiations and new developments closely.

One hundred members of the Senate were sworn in this week, including the new junior member from North Carolina, Senator Ted Budd (R). Democrats hold a 51-49 majority, picking up a seat in the 2022 elections. Senate Majority Leader Chuck Schumer (D-NY) was selected to his post for another term while Senate Minority Leader Mitch McConnell (R-KY) became the longest serving party leader in Senate history.

The Senate has adjourned until the week of January 23rd.

What’s Next?
The dust is going to eventually settle on a divided 118th Congress, and the Senate Democratic and House Republican majorities will get to work on their broad, and maybe sometimes competing, agendas. Below is a quick snapshot of health and other major policy issues we anticipate will be priorities in the opening session:

  • Prescription drug access and drug pricing
  • COVID-19 funding and resources oversight;
  • Length of the COVID-19 Public Health Emergency (PHE)
  • Federal debt limit
  • FY 2024 federal funding
  • Permanent telehealth and digital medicine policy and expansion
  • Data privacy and cybersecurity
  • Animal Drug User Fee Act (ADUFA) and Animal Generic Drug User Fee Act (AGDUFA)
  • Mental and behavioral health program reauthorization (includes NCTSN)
  • Pandemic and All Hazards Preparedness Act reauthorization
  • Medicare solvency
  • Medicaid access
  • Maternal health
  • Palliative care

Our team looks forward to renewed opportunities to work with Duke Health leadership and experts on these and many other federal policy issues in the coming year. We will continue to advocate strongly for Duke Health priorities as we strengthen current and establish new relationships in the 118th Congress.

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