Contributed by District Policy Group
Congressional Calendar: ACA Repeal and Replace, User Fee Reauthorizations
This spring, the Congressional calendar has been largely dominated by Republican leaders’ efforts to repeal and replace the Affordable Care Act (ACA). Last Monday, Republicans released changes to the American Health Care Act (AHCA) in an attempt to woo conservative members of their caucus into the yes column in advance of the Thursday vote in the House. The changes included giving states the option of establishing a work requirement for Medicaid recipients, repealing all of the Affordable Care Act’s (ACA) taxes in 2017 (instead of 2018), and “freezing” Medicaid enrollment at their December 31, 2019 levels.
On Thursday afternoon, hours before the scheduled vote on the AHCA, the Congressional Budget Office (CBO) released its cost estimate of the revised bill. The CBO found that the new version of the health care bill would reduce the deficit by $150 billion over 10 years, down from the $337 billion in the original legislation. The bill would still result in 24 million more uninsured individuals in 2026. However, the revised cost estimate does not reflect the last minute changes being made to the bill.
Due to opposition from the House Freedom Caucus members and some of the more moderate House members, in the waning hours of Thursday, it was announced that the vote on the AHCA was cancelled. Subsequently, the White House announced that the House must vote on the health care bill on Friday, and if the repeal effort failed, President Trump wanted to move on to other priorities and leave the ACA in place.
On Friday morning, the House Rules Committee finished its work on the AHCA, sending the bill to the House floor for a vote. The Committee agreed to the manager’s amendments released earlier in the week, in addition to adding $15 billion to the Patient and State Stability Fund for maternity coverage and newborn care and mental health and substance use disorders as well as the elimination of the ACA’s requirement that insurers cover certain minimum benefits. States would be instructed to design their own benefit standards starting in 2018.
However, due to lack of support for the bill, on Friday afternoon, Speaker Ryan withdrew the AHCA from the House floor, cancelling the vote for the second time in less than 24 hours. Consequently, it appears the ACA will remain intact for the foreseeable future.
Also on Congress’ agenda for the spring and summer is completing the federal appropriations process for the remainder of fiscal year (FY) 2017 as well as the upcoming FY 2018, in addition to an overhaul of the tax code, which Republican leaders hope to pass before the August recess. These items make for a very crowded schedule in Washington, with little room for consideration of other legislative topics. For example, on February 28, House Ways and Means Committee Chairman Kevin Brady (R-TX-8) told reporters that Republicans will not take up any major reforms to Medicare this year, saying “We’re just devoting all the resources we have to repeal and replace the ACA.”
Another issue jockeying for attention this spring are the reauthorizations of the user fee programs for drugs and medical devices, which expire on September 30. The Senate Health, Labor, Education, and Pensions (HELP) Committee has arranged for two hearings to consider all four programs (Medical Device User Fee Amendments (MDUFA), Prescription Drug User Fee Act (PDUFA), Biosimilar User Fee Act (BsUFA), and Generic Drug User Fee Amendments (GDUFA); one with FDA officials on March 21 and one with stakeholders, tentatively scheduled for April 4.
Status of Trump Cabinet Nominees
February and March brought the confirmation of several nominees to health care-related cabinet and cabinet-level positions. Congressman Tom Price (R-GA-6), M.D., an orthopedic surgeon, was confirmed as Secretary of HHS; Seema Verma, a health care policy consultant, was confirmed as Administrator of the Centers for Medicare and Medicaid Services (CMS); and David Shulkin, M.D., former Undersecretary of Veterans’ Affairs and health system executive, was confirmed as Secretary of Veterans’ Affairs.
On March 10, President Trump announced that Scott Gottlieb, M.D. is his nominee to head the Food and Drug Administration (FDA). Gottlieb is a health policy fellow at the American Enterprise Institute and previously worked for both the FDA and CMS. As FDA Commissioner, Gottlieb will be responsible for negotiating a response to Trump’s calls for accelerating drug approval processes at the FDA, which he has often pointed to as one way to lower drug prices. At press time, the Senate HELP Committee had yet to schedule a hearing for Gottlieb.
Other Administration Happenings
The White House released a FY 2018 budget blueprint of basic expenditures on March 16, with a more comprehensive budget document to come in early May. Early reports indicate President Trump’s budget plan will focus on cuts in discretionary spending, including that for the FDA.
Federal agencies are preparing to release details on major regulatory priorities of each agency in the coming year. On March 2, the White House Office of Information and Regulatory Affairs (OIRA) sent the agencies guidance regarding their plan to follow the President’s January executive order requiring that the net costs for regulatory action be no greater than zero and that for every new major rule issued, two existing rules must be eliminated. The guidance asks each agency to submit the estimated costs or savings associated with each new significant rule it plans to issue in the next twelve months and to include its plans for complying with the executive order. The agency plans are due to OIRA by March 31, with the final agenda of regulatory priorities expected to be published in the spring.