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Note: The newsletter will take a brief hiatus for two weeks and return the week of April 5th. For the latest federal policy updates until then, check in with us on Twitter @DukeGovRel.
Federal Updates
A Stimmy and a Shake (Up)
Not without a few hiccups, congressional Democrats successfully utilized the budget reconciliation process to pass the American Rescue Plan (ARP) to provide additional economic stimulus and COVID-19 relief. While the implementation of the ARP is already underway, both Congress and the administration are quickly pivoting to other major policy priorities on their agenda from infrastructure and immigration, to climate change. We’re also on the cusp of federal appropriations season, and Xavier Becerra has been confirmed as the next Secretary of Health and Human Services. There is a lot to do, and Democrats won’t be able to get by without Republican support and possible compromise on any number of key issues. Is this a recipe for gridlock? Maybe – but some change may be on the horizon.
Feeling out the filibuster
How do you really define majority and minority roles in the Senate when influence is split equally by the numbers? The Constitution speaks on the matter by allowing the Vice President to break ties, so in the case of a 50-50 split in the Senate as we have now, the answer seems pretty clear. Democratic leadership and Republican leadership in the Senate even have a formal agreement stipulating guidelines for how the new Democratic majority will operate – but operationally, the situation is far more complex. Democrats want to do things, but the very tight and technical majority makes that difficult. Republicans want to do things and have a seat at the table, which is even harder sometimes when you don’t set the agenda. The budget reconciliation process, which gets around procedural obstacles, can’t be used for everything. Why does it feel like a mess? Let’s briefly talk about the filibuster.
The legislative filibuster has a dubious history, but its basic function is to ensure that those in the minority party have some say in what ultimately comes before a final vote in the Senate. The filibuster has evolved over time and right now is largely used as a procedural tool requiring 60 votes to end debate on most items (there are exceptions, of course). Among the arguments for keeping the filibuster as it is now is the idea of encouraging bipartisanship. While this may be a factor for any number of bipartisan bills and agreements, the filibuster has been too often used as a blunt instrument by both parties on bigger ticket issues. All a Senator has to do now is threaten to withhold support, and if that threatened “no” brings the magic number to below 60, everything stops.
Expect to hear increased chatter among elected officials about either eliminating or reforming the filibuster. Outright elimination would require the support of all 50 Democrats (they don’t have it). Even some kind of reform, which President Biden suggested he could support, such as returning to the “talking” filibuster, has skeptics. Calls for bipartisanship among a growing number of more self-described “centrist” Senators must also not be discounted. Why does it matter? Nearly all of the legislative issues you read about today and in future newsletters will be impacted by this ongoing debate – and not only that, but what does or what doesn’t happen will shape the strategies for future majorities and Congresses beyond the 117th.
The filibuster, like many of the rules in Congress, is a completely made up concept – and the majority – whatever that looks like – will set the course for what happens next.
Congress working to address looming Medicare sequester
Legislation has been introduced in the House and Senate to address a looming 2% Medicare payment cut for health care providers, which will take effect on April 1 if Congress does not act. The recently passed American Rescue Plan, over procedural concerns with the reconciliation process, did not include an extension of the current moratorium on cuts set to expire March 31.
The House legislation would extend the moratorium to December 3, 2021 and also prevent another 4% Medicare payment cut scheduled to begin in 2022 as a result of congressional pay-as-you-go (“PAYGO”) rules triggered by the passage of the COVID-19 relief bill.
The Senate bill would also extend the moratorium but does not include a waiver for the PAYGO rule sequester cut.
It is possible this legislation may pass after the April 1 deadline, leaving cuts to be dealt with retroactively. Duke Health Government Relations is working with our partners and other stakeholders in support of both an extension of the sequester moratorium and waiver to prevent further Medicare cuts under PAYGO.
House advances key immigration priorities
The Biden administration’s proposal to overhaul the nation’s immigration plan, introduced in Congress in February as the U.S. Citizenship Act (H.R. 1177/S.348), may be stalled at the moment, but the House has now separately passed two of its featured provisions.
The American Dream and Promise Act (H.R. 6) would provide a pathway to citizenship for undocumented children who were brought into the United States and have remained, as well as for immigrants who have Temporary Protected Status. The Farm Workforce Modernization Act (H.R. 1603) would expand visa and citizenship opportunities for migrant farm workers. Both measures passed in the last Congress but were not taken up in the Senate. Senate Judiciary Committee Chairman Dick Durbin (D-IL) said the Committee would be unlikely to take up any immigration-related legislation until April at the earliest. Senate Democrats will almost certainly need Republican support for either measure to advance.
The somewhat tepid response to the broader U.S. Citizenship Act among some Democrats and caution from Republicans has left the bill’s immediate future unclear, but House leadership has not ruled out beginning hearings and other committee activity this spring.
Meanwhile, Rep. Maria Salazar (R-FL) and nine of her Republican colleagues have unveiled a counterproposal to the Biden immigration plan this week that calls for increased border security while also creating a pathway to citizenship for undocumented children, expanding visas for agricultural workers, and establishing a renewable residency system for undocumented individuals without criminal records. Salazar encouraged Democrats to negotiate a compromise on immigration reform, noting that many of the administration’s proposals would unlikely find much Republican support.
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, 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.
A prelude to infrastructure week (month, several months?)
While the Biden administration prepares the final details of its own Build Back Better broad national infrastructure plan, House Democrats have put forth their own marker by reintroducing the LIFT America Act (H.R. 1848).
The beefed up legislation, cosponsored by all 32 House Energy and Commerce Committee Democrats, including Rep. G.K. Butterfield (D-NC-01), seeks to invest $312 billion in clean energy, energy efficiency, drinking water, broadband, and health care infrastructure. Among the highlights include:
- $1.3 billion for digital equity and inclusion activities
- $6 billion for the Emergency Broadband Benefit Program
- $80 billion for high-speed internet broadband build out
- $4.5 billion to replace lead-based water service lines
- $3.87 billion for electric-grid infrastructure
- $850 million for Smart Communities infrastructure
- $10 billion for the Hill-Burton program for hospital infrastructure improvements
- $4.5 billion to modernize clinical laboratory infrastructure
- $10 billion for a pilot program to award grants to qualified teaching health centers and behavioral health care centers to support the improvement, renovation, or modernization of infrastructure
House Democrats will likely work to position these priorities for inclusion as part of any broader infrastructure legislation, and the Committee will hold a hearing on its proposal next week. Democrats have not ruled out using the budget reconciliation process again for at least parts of an infrastructure package, but several moderates have made clear that they will not support reconciliation unless Republican colleagues have first been brought to the table for negotiations.
Work on any final infrastructure measure may carry into the fall.
Read a section-by-section of the LIFT America Act here.
GME legislation reintroduced in the Senate
This week, Senators Bob Menendez (D-NJ), John Boozman (R-AR), and Senate Majority Leader Chuck Schumer (D-NY) introduced the Resident Physician Shortage Reduction Act to increase the number of Medicare Graduate Medical Education (GME) slots. The legislation, which was introduced ahead of Match Day, would provide 14,000 new GME slots over 7 years. Duke Health Government Relations continues to advocate for support of our healthcare workforce, including increasing the cap on Medicare GME slots to help address vital healthcare needs and physician shortages across the country.
From our desk(s): Duke Health GR this week
The Duke Health Government Relations team is continuing our follow up with leadership and staff of the Senate, Health, Education, Labor and Pensions (HELP) Committee following the testimony of Duke University Health System Vice President of Patient Care & System Chief Nurse Executive Mary Ann Fuchs at the HELP Committee’s March 9 hearing entitled, “Examining Our COVID-19 Response: An Update from the Frontlines.”
We held meetings with Duke Health experts and congressional staff to discuss the impact of federal funding on their clinical work and fields of research, continued to share the work of the ABC Science Collaborative with staff of the NC congressional delegation, and reached out to congressional offices developing legislation to permanently expand telehealth coverage for Medicare beyond the COVID-19 public health emergency.
Our office coordinated Duke Health joining two letters to advance FY 2022 funding priorities impacting the Duke University School of Nursing (DUSON) and the Duke University School of Medicine (DUSOM). The first letter, led by Research!America, urges the Biden administration to champion the Research Investment to Spark the Economy (RISE) Act and include full funding for the initiatives that would be created by the legislation in any future spending proposal advanced by the administration. The RISE Act, which includes among its lead sponsors Senator Thom Tillis (R-NC), would provide $25 billion to help restore our nation’s research capacity to its pre-pandemic strength, prevent setbacks against the formidable challenges our nation faces, and further the goal of a robust, diverse, and inclusive STEM workforce.
The second letter included stakeholders in the Sickle Cell Disease (SCD) community supporting funding for FY 2022 for the Sickle Cell Data Collection program at the Centers for Disease Control (CDC) and Prevention, and SCD programs within the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau, including the SCD Treatment Demonstration Program and SCD Newborn Screening Program. Both the CDC and HRSA programs support activities in the DUSON and DUSOM.
A Note from Us
Like so many around the country, our team has been horrified and saddened by the acts of violence being perpetrated against members of the Asian community across the country, including the recent tragedy in Atlanta. Unfortunately, such acts rooted in bigotry, racism, entitlement, and misinformation have also been the reality for the Black, Latinx, LGBTQ+, and many other marginalized and historically underrepresented communities.
There are slivers of light emerging from the shadows. On Thursday, the House Judiciary Committee held a hearing on Discrimination and Violence Against Asian Americans featuring both community leaders and several AAPI members of Congress. The House has passed legislation to protect voting rights and strengthen anti-discrimination laws. The Biden administration, through executive orders, has also taken steps to address systemic racism, health and economic inequities, and discrimination. These steps are important, but we also know that they are insufficient on their own. The real, hard work of implementation and true community building must come next.
To all of our colleagues and friends struggling in these moments: We see you. We hear you. We value you.
And we’re committed to the work ahead.