Federal Health Policy Updates for the Week of January 9, 2023

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The Rundown

  • The 118th Congress is official – and the new House majority has begun its work
  • The latest from our desks
  • Join the Duke Health Advocacy Network!

Federal Updates

And we’re off… and lightly jogging 
Following a very late Friday night and early Saturday morning that saw House Speaker Kevin McCarthy (R-CA) officially win his leadership post on the 15th ballot and members-elect of the House of Representatives officially sworn into the 118th Congress, the House returned this week to finish up some housekeeping and for the new Republican majority to begin laying down markers for its priorities. The House was the only game in town this week as the Senate is recessed through January 23rd. The House is scheduled to join the upper chamber in recess next week before also returning the week of January 23rd.

House Rule Package
At the start of every new Congress, the majority party in the House adopts a rules package that governs how the chamber will operate for the next two years. Consider it an operations manual for what gets done, how, and under what circumstances. It’s usually routine, but all eyes were on the development and adoption of this particular rules package because it was fine-tuned and re-negotiated in part to help Speaker McCarthy win enough votes from the ultra-conservative bloc of his conference to actually become Speaker. Why does it matter? This particular rules package could have serious implications for Duke Health policy, its priorities, and academic medicine overall in the 118th Congress –both for what’s in it and the implications of what’s not. Here are a few highlights:

  • Any member may make a motion to “vacate the chair” to hold a vote to remove the Speaker.
  • PAYGO, or “pay-as-you-go,” which requires that new legislation not increase the federal budget deficit or reduce the surplus, has been replaced by CUTGO, which requires increases in mandatory spending, such as Medicare and Social Security, to be offset only with equal or greater decreases in mandatory spending, with no new taxes allowed. CUTGO was previously used in the 112th Congress. 
  • Any tax increases require a three-fifths supermajority for passage.
  • The House can no longer use an expedited procedure through a budget resolution to automatically send support for a debt limit increase to the Senate.
  • Spending bills can be amended to reduce specific administrative salaries and/or zero out funding for programs.
  • Every committee, with the exception of Appropriations, Ethics, and Rules, is required to submit a plan for authorization and oversight to the House Oversight and Administration Committees by March 1. 
    • Committees must also weigh in on which programs should be moved from mandatory spending to discretionary spending, which would place them under direct control of lawmakers each funding cycle.

There are also reported – but unwritten – side agreements, including allowing more amendments on floor votes, more widely distributing committee assignments, tighter controls on discretionary spending, and other efforts to decentralize power in Republican leadership.

Granted, passing legislation takes the will of two chambers, but the rules package is yet another signal that legislative victories won’t come easy in the House.

House Committee Updates
Electing a Speaker, swearing in Members, and adopting rules also means that the House is proceeding with finalizing committee leadership assignments. Of particular interest to healthcare policy and academic medicine, Rep. Cathy McMorris Rodgers (R-WA) will officially serve as chair of the House Energy and Commerce Committee, which is one of two authorizing committees in the House with jurisdiction over healthcare issues. Rep. Jason Smith (R-MO) will take over as chair for the House Ways and Means Committee, which has jurisdiction over Medicare.

NC Congressional Delegation – House
As a quick reminder, this is our (official) NC congressional (House) delegation for the 118th Congress, with new members in italics:

NC-01: Don Davis (D)
NC-02: Deborah Ross (D)
NC-03: Greg Murphy, MD (R)
NC-04: Valerie Foushee (D)
NC-05: Virginia Foxx (R)
NC-06: Kathy Manning (D)
NC-07: David Rouzer (R)
NC-08: Dan Bishop (R)
NC-09: Richard Hudson (R)
NC-10: Patrick McHenry (R)
NC-11: Chuck Edwards (R)
NC-12: Alma Adams (D)
NC-13: Wiley Nickel (D)
NC-14: Jeff Jackson (D)

Our team has already begun evaluating and adapting Duke Health’s federal agenda to strategically match the institution’s priorities with new champions and strengthening relationships with returning members of Congress. We look forward to identifying new opportunities for Duke Health experts to inform policymakers about care delivery, research, education, and community health.

From Our Desks
This week a member of our team participated in the Trauma Centers Association of America (TCAA) Policy and Advocacy Committee 2023 kickoff meeting to discuss priorities and strategy for the 118th Congress. We also participated in the first government relations discussions for the year with the American Hospital Association, the Association of American Medical Colleges, and Association of American Cancer Institutes. 

We connected with congressional staff for the House Telehealth Caucus and Senate Telehealth Working Group to discuss the reintroduction of legislation in the 118th Congress to make permanent expanded telehealth flexibilities under Medicare.

Our team informed reproductive health experts at Duke Health about the House’s approval of two of its first policy votes mostly along party lines. The House approved a resolution by a vote of 222-209 to condemn violence against anti-abortion organizations. It passed a bill by a vote of 220-210 to reaffirm the rights of infants born after rare botched abortions. It is unlikely the Democratic-controlled Senate will consider either measure.

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