Jan 3, 2018

It's unclear what gets done this month on health care

Immigration is likely to overshadow health care this month. Photo: Andrew Harnik/AP

Congress still has the same long list of health care problems to solve as it has had since the fall. The Children's Health Insurance Program needs to be reauthorized, the individual insurance market likely needs to be stabilized, and the health care industry really wants some Affordable Care Act taxes to be delayed. But it's unclear how much of that will be addressed this month.

Be smart: The big political fight this month is much more likely to be around immigration than health care, although Democrats — or even key Republicans — could use their leverage to get CHIP funding reauthorized, as well.

What to watch: The GOP will need Democrats' support to pass a spending bill. But you can only win so many battles at once, and Democrats are fighting this month to raise domestic spending caps, pass an immigration measure and pass a CHIP bill — or at least to find an agreement in all these areas.

  • Every staffer and lobbyist I asked says immigration will be a bigger fight than health care.
  • The Alexander-Murray ACA stabilization bill is losing steam. Democrats don't want it any more, saying it won't do much good now that Congress has repealed the law's individual mandate. Conservatives have always been skeptical of the bill. Sen. Susan Collins was promised a vote on Alexander-Murray in return for her vote on the GOP tax bill — but she has already voted for the tax bill. Alexander-Murray "needs to be massively rewritten to deal with the lack of an individual mandate," a Democratic leadership aide told me. Sen. Patty Murray, one of the bill's authors, said a very similar thing last month. Health policy experts have also soured on the measure.
  • Congress passed a short-term CHIP bill before leaving for the holidays, so there's less of a time crunch now. But Democrats could easily make it into a big deal, potentially creating public pressure to get it done.
  • The medical device industry and health insurers really want their respective ACA taxes delayed. Yet Congress is only quietly dealing with these in the committees of jurisdiction; they don't seem to be a priority for anyone at the moment.
  • Several other health care issues are buried even further down, like retrospectively ending cuts to disproportionate share hospital payments and potential Medicare cuts to the home health and nursing home industries.

Yes, but: Republicans have been laser-focused on taxes for the past few months, and now that's over with. It's also not just Democrats who are annoyed CHIP hasn't been dealt with yet.

  • Finance Committee chairman Orrin Hatch slid into his retirement announcement yesterday an assurance that CHIP is "to be reauthorized this month."
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