Haiku writer’s block
When the syllables don’t fit
Thoughts, you rearrange
The Rundown
- Guest column! Update on the NC redistricting process
- Infrastructure week arrived but the reconciliation process isn’t quite done
- It’s beginning to look like another continuing resolution
- Rep. David Price meets with the Duke Military Association
- The latest from our desks
Federal Updates
Better know your district – because it may be about to change
This week, we are once again joined by our colleague in the Duke State Relations office for a part II update on the redistricting process. The maps are drawn, and candidates are preparing to file. Is it over? Maybe not.
By: Katie Lipe, Communications and Outreach Coordinator, Duke State Relations
The North Carolina House and Senate finalized the redistricting process last week and approved new state and congressional district maps - a process that will likely result in future legal battles over the redrawn districts. The state legislature is statutorily required to redraw legislative district maps every ten years following the release of updated census data in order to account for population changes and to maintain equal representation in districts. Watchful eyes both inside and outside the state paid close attention to the process this year given North Carolina lawmakers’ infamous history of gerrymandering over the last several decades.
To avoid the perception of overly partisan decision making this redistricting cycle, the Republican-controlled majority opened more opportunities for public comment, citing an interest in transparency and fairness. The House and Senate Redistricting Committees also adopted a set of criteria to draw legislative districts with compactness, equal population, and contiguous boundaries, and without consideration of data related to race, partisanship, or election results. Since Democratic Governor Roy Cooper lacks veto authority over redistricting matters, Republican leaders were ultimately in charge of redrawing and approving new legislative districts. Even with the presence of procedural guardrails and concerns about the redistricting criteria raised by some policymakers and members of the public, the current final maps approved by the legislature are expected to give Republicans a significant advantage in the U.S. House of Representatives, the NC House of Representatives, and the NC Senate.
The approved NC Congressional map includes a new 14th seat in the U.S. House of Representatives due to population growth over the last decade. It’s predicted that the new congressional map will result in 8 safe Republican seats, 3 safe Democratic seats, and 3 competitive seats, of which 2 lean Republican and 1 leans Democratic. This would result in at least a 10-4 advantage for Republicans in NC, who currently have an 8-5 advantage of Republican to Democratic members in the NC delegation. The new NC House of Representatives map is estimated to produce 55 safe Republican seats, 41 safe Democratic seats, and 24 competitive seats, of which 13 lean Republican and 11 lean Democratic. Predictions indicate the NC Senate map will produce 24 safe Republican seats, 17 safe Democratic seats, and 9 competitive seats, of which 5 lean Republican and 4 lean Democratic.
In recent years, North Carolina’s political leanings have been trending decidedly “purple” rather than strongly moving in either a red or blue direction, and the decided Republican advantage in terms of district geographical boundaries has raised criticism. Although political gerrymandering isn’t illegal and has become a tool used by both parties holding majorities in many states across the country, courts have struck down maps in the past that were considered to be extremely partisan. Two civil rights groups have already filed lawsuits against the U.S. House of Representatives map and others are expected to follow.
With new legislative districts finalized for now, candidates are beginning to express their intent to run for office and have until December 6th to file for candidacy. This will mean some shuffling for both current federal and state legislators, as well as those newly aspiring to run. What does it mean for Duke? For the moment at least, the person who replaces the retiring Rep. David Price (D-NC-04) to represent Duke and the Durham area will not do so from the 4th congressional district, but now in the redrawn 6th district.
Only time – and the courts – will tell if these newly redrawn maps hold for the 2022 elections.
Infrastructure week happened? – now, what happens next
After many fits and starts, jokes that could write themselves, and numerous moments where it all felt a little too ambitious – it was finally infrastructure week. Well, at least for the bipartisan “traditional” infrastructure package.
House Democratic leaders and the progressive and moderate wings of the Democratic caucus finally reached a deal that allowed the House to pass the bipartisan infrastructure legislation cleared by the Senate over the summer. The $1.2 trillion legislation, $550 billion of which is new investments including $65 billion for broadband infrastructure, will be formally signed into law by President Biden on November 15.
Where does that leave the $1.75 trillion Build Back Better Act (BBBA) “human” infrastructure framework and reconciliation strategy? Believe it or not, it’s complicated. House Democratic leadership plans to hold a vote on the BBBA next week, which was part of the deal struck with progressives to vote on the separate bipartisan infrastructure legislation. The caveat? Democratic moderates agreed to the BBBA vote provided that Congressional Budget Office (CBO) evaluation of the BBBA closely matched the costs and investment estimates provided by the Biden administration. Full cost evaluations by CBO are expected to take weeks, but some reporting on individual provisions and sections is beginning to be released. Will it be enough to allow the vote to proceed? We likely won’t know until next week.
What does seem abundantly clear at the moment is that whatever version of the BBBA eventually passes the House will be subject to changes in the Senate, whether through amendments, rulings by the parliamentarian (she’s back!), or policy changes necessary to secure 50 Democratic votes. We’ve come a long way from September, but the second track of the administration’s infrastructure plans likely still has miles ahead of it before a final stop.
We continue to monitor the situation closely and advocate for priorities important to Duke Health and the communities served by our institution.
From one CR to another - Congress faces year-end crunch
The current continuing resolution (CR) passed by Congress in late September to kick off FY 2022 is set to expire in three weeks. In terms of scheduled legislative calendar days for Congress, it’s far less.
House and Senate appropriations leadership have reportedly begun negotiations on a final FY 2022 spending agreement that would encompass funding for all twelve of the annual appropriations bills, but they will almost certainly not reach an agreement before the December 3rd deadline. Another CR is practically inevitable; the only outstanding question at the moment is its scope and duration.
Some are floating the prospect of a few weeks extension, hoping the pressure of the year-end holidays will incentivize policymakers to negotiate more quickly. Others have suggested a slightly longer CR into early February in recognition of a number of other major priorities Congress intends to address by the end of the year. There is also the less likely, dreaded year-long CR that would carry Congress through the midterms but not allow the new Democratic majorities to put their stamp on federal funding priorities.
Congress also faces deadlines to pass the FY 2022 National Defense Authorization Act (NDAA), a major defense policy bill that would, among other provisions, authorize medical research programs at the Department of Defense; fix looming Medicare sequestration cuts; and to further extend the federal debt limit, which absent “extraordinary measures” by the Treasury will be exceeded in early December.
There is not a lot of time – and even more to do within a legislative calendar that offers little certainty and no favors.
Our office continues to advocate for Duke Health federal funding priorities and will be closely engaged with the NC congressional delegation and our partners in regional and national coalitions as the year-end process unfolds.
Rep. David Price visits (virtually) with the Duke Military Association
This week, our team is especially grateful for our Veterans and truly honored to have partnered with the Duke Military Association to have Rep. David Price (D-NC-04) speak at the DMA’s November meeting.
The DMA is an employee-led, voluntary group that offers the opportunity to network internally, attract and retain Veteran talent, provide military-based educational opportunities, and create opportunities to support community outreach activities. The conversation with the congressman was led by DMA founder Dan Bruno (Army), Chief Operating Officer for Duke Health Technology Solutions, and current DMA president Valerie Eatmon (Navy), Director for Duke Health Technology Solutions. Rep. Price spoke to the group about current congressional priorities, including defense spending and investments in the Triangle area, as well as answered questions from attendees about his time in Congress, getting involved in public service, and his goals before his announced retirement in 2022.
To all of our Duke Health Veterans, thank you for your service!
From our desk(s): Duke Health GR this week
On Wednesday, our team took advantage of a brief recess in D.C. to join our government relations colleagues from health systems across the state to meet virtually with North Carolina congressional delegation staff as part of an event organized by the North Carolina Hospital Association. We discussed support and concerns with the evolving reconciliation process, scheduled cuts to Medicare reimbursement, telehealth expansion, surprise medical billing rule implementation, the 340B program, and workforce issues.
Later today, a member of our team will join a listening session of the Center for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare and Medicaid Services (CMS) to discuss concerns with the Interim Final Rule part II of the No Surprises Act, which creates the federal independent dispute resolution process for out-of-network billing disputes. Earlier this week, a final House letter with over 150 bipartisan signatures, including Reps. Alma Adams (D-NC-12), Richard Hudson (R-NC-08), Greg Murphy, MD (R-NC-03), and David Rouzer (R-NC-07), was sent to the Biden administration urging it to revisit the rule and make changes to the federal independent dispute resolution process to more closely align with the legislative intent of the No Surprises Act.
We also monitored a meeting of the Medicare Payment Advisory Commission (MedPAC), which featured discussions on a number of topics of interest to Duke Health, including benchmark incentives for accountable care organizations (ACOs), Medicare payment polices for safety-net providers, and telehealth. These are ongoing conversations that our office will continue to monitor and share updates as appropriate. All presentations can be viewed here: http://www.medpac.gov/-public-meetings-/meeting-details/november-2021-public-meeting. |
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