In the Aftermath of the 2014 Mid-Term Elections

The 2014 mid-term elections are over and the Republicans have won control of the Senate and increased their majority in the House of Representatives.  As of now, the Republicans have a 53 -46 advantage over the Democrats in the Senate, which is likely to increase to 54 seats when all the contests are over (Louisiana has yet to be decided).  In the House, the Republicans will enter the 114th Congress with at least a 244 – 184 margin (there are also a few House seats not resolved). 

By gaining control of both chambers, the Republicans will be able to set the congressional agenda, determine the Chairs of all of the committees and subcommittees, which is where most legislative work is done, and decide the issues that are brought up for votes.  Within the next two weeks, the two parties will pick their party leaders for next year.  It’s expected that Senator Mitch McConnell (R-KY) will become the new Senator Majority Leader and Rep. John Boehner (R-OH) will retain his position as Speaker of the House.  Senator Harry Reid (D-NV) and Rep. Nancy Pelosi (D-CA) are expected to return as the Democratic leaders. 

In the short term, the status quo will remain through early December when Congress adjourns until the new Congress reconvenes in January.  During the interim, the two sides need to address a number of issues, most importantly passing legislation to keep the government open past December 11, when the current continuing resolution expires. Legislators are working on an omnibus appropriations bill to fund federal activities through the end of the 2015 fiscal year. 

Before leaving, the two parties are also expected to take up legislation to provide additional money for government efforts to address the Ebola crisis and ensure the military has sufficient funds to carry out its operations against ISIS. One issue that AACC is urging Congress to take up before it leaves is newborn screening legislation. The measure passed the House and Senate unanimously this year, but because the House version is slightly different, the Senate needs to pass the amended version…and time is running out.   

Changes in the Senate

With the Republicans winning the Senate, there will be new chairs of the committees affecting health care. The three major committees important to AACC are: Appropriations, which funds government programs; Finance, which is responsible for Medicare and Medicaid spending; and the Health, Education, Labor and Pensions (HELP) panel, which address general health policy issues. 

The new Appropriations Chair will be Senator Thad Cochran (R-MS). He is a moderate to conservative Republican, who held the same position from 2005-2007 when the Republicans were in control of the upper chamber.  Senator Cochran will replace Senator Barbara Mikulski (D-MD), who has been a long-time ally of AACC and the laboratory community.  She was instrumental in passing and protecting CLIA’88, and most recently included in the draft Senate 2015 Appropriations bill AACC-backed report language ins support of harmonizing clinical laboratory test results. 

The new Finance Chair will be Senator Orrin Hatch (R-UT), who is a strong supporter of the medical device industry.  For years he worked with the late Senator Edward Kennedy (D-MA) on health care legislation, including passage of the Safe Medical Device Act of 1990 that refined the medical device approval and clearance processes.  Senator Hatch is a leading sponsor of legislation to repeal the Medical Device Excise Tax.  AACC supports the repeal of the device tax.  Senator Hatch is also one of the sponsors of the Newborn Screening Saves Lives Reauthorization Act, which the Association also endorses.

The new Chair of the HELP panel will be Senator Lamar Alexander (R-TN), who has keen interest in health and education issues.  He is likely to hold hearings on the Affordable Care Act and identify elements of the law that can be refined or repealed.   Look for Senator Alexander to work with Senator Hatch to craft legislation that modifies areas of ACA where there may be bipartisan interest.  Senator Alexander also has a strong interest in pediatrics, sponsoring legislation that was signed into law that strengthened ongoing efforts to track, prevent, and treat premature births.

Status Quo in the House

Since the Republicans retained the House, there will be fewer changes in its leadership. Rep. Boehner will remain as speaker and it’s likely that Rep. Kevin McCarthy (R-CA) will retain his position as House Majority Leader (he assumed the job when the previous Majority Leader, Rep. Eric Cantor (VA), lost in the Republican primary in June). Rep. Hal Rogers will remain as the Chair of the Appropriations Committee.  He has not been an active leader in the health care arena. 

The Energy and Commerce panel remains under the tutelage of moderate Republican Fred Upton (MI).  One of his priority initiatives, “A Path to 21st Century Cures,” seeks to identify new innovative ways of improving patient care and saving lives.  Among the laboratory-related issues he examined in 2014 were personalized medicine and laboratory developed tests (LDTs).  Look for LDTs to continue to get committee attention in 2015 given the increasing opposition to the guidance among key stakeholders and the active interest of key Republicans on the panel, such as Rep. Joe Pitts (PA) and Rep. Michael Burgess (TX), who happens to be a physician.

The one health-related committee where there is uncertainty is the Ways and Means panel.  The current Chair, Rep. Dave Camp (R-MI), is retiring. The expectation is that the Budget Committee Chair, and rising GOP star, Rep. Paul Ryan (R-WI), who was also Mitt Romney’s running mate in the 2012 presidential race, will get the position given his budgetary acumen and desire and ability to develop and advance innovative approaches to government.  If Rep. Ryan gets the position, look for him to take an active interest in improving the delivery of care provided by Medicare and Medicaid and how services are reimbursed by the programs. . 

Short-term Expectations from the New Congress

Revisions to health care reform will clearly be a high priority for the Republicans.  Although there will be some discussion of repealing the Affordable Care Act, the chances of that occurring are unlikely given that the Republicans don’t have 60 votes to end a filibuster nor the two-thirds majority needed to override a presidential veto.  After the initial gamesmanship, look for a package of reforms to the Affordable Care Act.  Such a package is likely to include repeal of the medical device tax, elimination of the Independent Payment Advisory Board, and the redefinition of what constitutes full-time employment, since many employers are complaining about having to provide insurance to employees working 30 hours.

Also, in the near term, Congress will have to take up the issue of reforming the Sustainable Growth Rate (SGR) for physicians.  The current ‘extension’ expires April 1, 2015.  Given past history, the formula to restrain physician payments often projects cuts in the range of 20 to 30 percent. Congress has never let those cuts go into effect and is unlikely to do so next year. The question will be whether they continue to postpone the cuts or develop and enact a permanent fix. The price tag to replace the SGR formula is in the range of $100 billion to $200 billion.  The question remains how Congress would pay for it. 

Another issue that may emerge early in the new Congress is newborn screening.  If the Senate is unable to pass the amended House version before the end of the lame duck session in December, the bill would have to be re-introduced next year and go through the legislative drafting, negotiations and committee and floor votes once more.  In addition, supporters would need to identify a new Democratic sponsor in the Senate given that Senator Kay Hagan (D-NC), who was the lead sponsor of the newborn screening legislation in the upper chamber, was just defeated.

AACC will continue to remain actively engaged in the legislative process as Congress wraps up the 113th Congress and gets ready for the 114th. Look for more updates on Association activities and information policy issues important the membership in forthcoming editions of CLN Stat and other AACC publications.