Smith, left, speaks as ranking member Richard Neal listens during a hearing March 9. Photo: Bill Clark/CQ-Roll Call Inc. via Getty Images
When Rep. Jason Smith became the Ways and Means chair in January, health analysts and lobbyists felt that he wasn't exactly a known quantity on health care.
The big picture: They now understand his style a little better — that his agenda is going to be set by what he hears from people around the country rather than D.C. insiders. But they're still looking for signs of what that means for them.
- Health industry groups are definitely worried about how the GOP budget could affect their bottom lines and are watching what Ways and Means does, with providers and health plans worried about potential cuts.
- "If you're not cutting beneficiaries' benefits, there's really only one way to save money, if you want to make it more solvent, and that's provider cuts," said one of the lobbyists who spoke to Axios.
Zoom in: Health care seems to have had a slow start for Ways and Means in the new Congress, where much of the discussion has centered on the debt ceiling and Medicaid (an Energy and Commerce issue), while the committee has focused more on the IRS and trade.
- Part of that slow start can be attributed to the committee still hiring staff, plus the fact that the chairman's vote was pushed to January.
- Still, in Smith's first few months, there's already been a tamping down of talks about cutting Medicare in the budget and a battle around Medicare Advantage, which have resulted in some outlines of what the new chairman's leadership might look like.
What they're saying: Smith has made it clear he wants to hear from people outside of the D.C. bubble, as he did by holding the committee's first two hearings of the new Congress in the field in West Virginia and Oklahoma.
- That pattern continued in Thursday's health hearing (held in D.C.), where the chairman called a small-business owner up to talk about how difficult it is to offer health insurance for employees and a nurse practitioner to discuss how inflation has made running his practice more difficult.
- Having average citizens and small-business owners — not typically traditional witnesses — helping to dictate the hearing discussion has added "a little bit of element of surprise to the downtown community," one GOP health lobbyist told Axios.
- That's in part because trade associations are often heavily relied upon by chairs when trying to figure out topics of hearings, the lobbyist added.
Between the lines: Kevin Brady, who was the top Republican on the committee for the last seven years, had good relationships with the CEOs of big health industry groups and trade associations.
- That meant K Street was accustomed to Brady's leadership style and good communication with downtown, whereas Smith seems to care more about his constituents and colleagues than K Street, another GOP health lobbyist said.
- "Kevin Brady is not Jason Smith and Jason Smith is not Kevin Brady. Jason isn't going to be quite as focused on downtown, and people will get used to it and adapt," the lobbyist said.
- But lobbyists say Smith and his team at Ways and Means were very active in talking to K Street about the controversy over the Medicare Advantage payment rate changes. And in general, as a team they win good marks for openness about communicating with downtown.
- Downtown was also happy that Rep. Vern Buchanan stayed on as the chair for the health subcommittee, since he has good relationships with K Street and can fill in with the areas or industries where Smith may not be focusing, one GOP lobbyist said.
What we're watching: The lobbyists do expect that PAHPA reauthorization and health care extenders will get done this year — along with a lot of talk about Medicare Advantage and the budget.
- One area that Smith is passionate about which could see some movement is rural health care, which could involve perhaps changing some of the extenders, such as the low volume hospital program.
- There's also potentially room for movement on prior authorization and provider consolidation.
