Axios Pro: Health Care Policy

January 10, 2023

Axios Pro Exclusive Content

Good morning! The new Ways and Means chair is still a pretty big mystery on health care, but here's what Victoria has been able to find out.

  • And if you missed her interview with him when we launched last fall, you really should read it, because it holds up well as a guide to his thinking.

1 big thing: What to expect from Jason Smith

Congressman Jason Smith speaks at a press conference

Smith speaks at a news conference in December. Photo: Anna Moneymaker/Getty Images

The choice of Jason Smith as the new Ways and Means chair is likely to mean less health care legislation and more oversight hearings and continued messaging on health policy, lobbyists, health analysts and former Hill staffers tell Victoria.

The big picture: Smith isn't a known quantity on a lot of health care issues — but he is close to Speaker Kevin McCarthy and will likely follow his lead on health care issues.

What he's saying: His statement after winning the chairmanship yesterday was light on health care, except for a couple of passing references to strengthening the medical supply chain and using the tax code to "build financial and health care security for families."

  • But in an interview last fall, Smith told Victoria that as chair he wanted to focus on access to health care in rural America, telehealth, price transparency, health care security, innovation and “aggressive oversight.” That includes holding hearings about health care costs across the country.
  • He hasn't said whether he'd support raising the Medicare retirement age or repealing the IRA's drug pricing provisions.
  • Since Smith isn't as much of a health guy, his staffers will likely have greater importance, said one health care analyst and former GOP staffer.

Between the lines: Smith has served as the GOP ranking member of the House Budget Committee for the last two years, where he argued that the IRA is contributing to inflation and that the American Rescue Plan’s COVID spending has resulted in “waste and fraud.”

  • He beat out the more senior Reps. Vern Buchanan and Adrian Smith for the top Ways and Means job.
  • Buchanan, who is a businessman himself, had made more connections on K Street because of his background and was seen as more industry friendly. The health industry — especially hospitals — would have preferred him to Smith, said the health care analyst and former GOP staffer.
  • The consequences of fewer connections on K Street means that businesses may be more likely to be targeted in committee hearings or that business interests could be more likely to be sacrificed in negotiations, the former staffer added.
  • "While we do not expect much HC [health care] legislation to pass there are a few areas that may find common ground with the Dem controlled Senate such as avoiding the Hospital Medicaid DSH cuts set for later this year" as well as dealing with other expiring health care extenders, Rick Weissenstein, a health care analyst with the Cowen Washington Research Group, wrote in a report yesterday.
  • Extending pandemic-era telehealth flexibilities, mental health reform, boosting medical innovation, and revisiting pandemic preparedness are other potential areas of bipartisan action, noted Weissenstein.

Even though Smith doesn't have a detailed track record on health financing issues, that may not end up mattering, said Larry Levitt, executive vice president of health policy at the Kaiser Family Foundation.

  • "As chair of the Ways and Means Committee, health care issues tend to find you even if you don't go looking for them," said Levitt. "That will especially be true if Republicans try to push for entitlement cuts tied to an increase in the debt limit."

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