Summary
Congress returns to Washington this week after a six-week recess. Following last week’s election, the Republicans are poised to have a “trifecta” and be in control of the White House, the Senate, and the House of Representatives, though the margins by which they hold control of the House and Senate are still not finalized. As Impact Health Policy Partners continues to work on our post-election analysis, below we try to explain where things currently stand.
Congressional Election Results: At this point, two Senate races have not yet been finalized. Neither Pennsylvania Senator Bob Casey (D) nor Arizona Republican candidate Kari Lake (R) have conceded their races, though they are both trailing in the vote count and many news outlets have called the races. Currently Senator Bob Casey (D-PA) lags behind Republican challenger, Dave McCormick and Kari Lake is behind Rep. Ruben Gallego in Arizona’s open seat. If Mr. McCormick and Rep. Gallego both win as expected, the Republicans will have a 53-47 majority in the Senate.
In the House, the Republicans currently have 214 seats, the Democrats have 205, and there are 16 races yet to be called. The Republicans are expected to retain the majority, though it is unclear by what margin. Ten of the uncalled races are in California, and five of those races could be decided by very small margins. Despite the Republican “trifecta,” many are forecasting that the Republican majority will be as tight, or even tighter, than the current Congress. Speaker Johnson will need to bring his entire conference along to pass any controversial legislation, something that has proven difficult in the 118th Congress.
Leadership Elections: House and Senate Republicans are scheduled to hold their leadership elections tomorrow. Speaker Mike Johnson (R-LA), Majority Leader Steve Scalise (R-LA), and Majority Whip Tom Emmer (R-MO) are all expected to keep their leadership positions, though there will be a scramble for the Chair of the Republican Conference, the number four position among the House Republicans, as Rep. Elise Stefanik (R-NY) has accepted President-elect Trump’s offer to be the U.S. Ambassador to the United Nations. In the Senate, Republican leader Mitch McConnell is stepping down from the top leadership role and Senators John Thune (R-SD), John Cornyn (R-TX), and Rick Scott (R-FL) are all running to replace him. President-elect Trump has not endorsed a candidate, though Senator Scott is trying position himself as the closest Trump-ally.
Leadership of the House and Senate Democratic caucuses will be formally elected on November 19, though no changes are expected to occur, and Hakeem Jeffries (D-NY) and Chuck Schumer (D-NY) should keep their respective positions as House and Senate Democratic leaders.
Committee Leadership: Once the leaders have been chosen, the party caucuses will move on to determining the Committee leadership positions. The biggest change to health-related Committees will be the selection of a new top Republicans on the Energy & Commerce and the Education and the Workforce Committees. The current E&C Chair, Rep. Cathy McMorris Rodgers, is retiring at the end of the Congress leaving the seat to be filled by either Rep. Bob Latta (R-OH) or Health Subcommittee Chair Brett Guthrie (R-KY). The Education and the Workforce will have a new Chair due to Republican conference term limits. Rep. Virginia Foxx (R-NC) will likely be replaced by either Rep. Tim Walberg (R-MI) or Rep. Burgess Owens (R-UT). We will cover the leadership changes and changes in Committee rosters in the weeks to come.
Lame Duck Congress: As we have been covering over the past several weeks (see our lame duck preview here), there is a lot to be done between now and the end of the year. In addition to needing to pass a fiscal year (FY) 2025 budget, or a continuing resolution (CR), before the current CR runs out on December 20, disaster funds need to be replenished, NDAA will need to be passed, and several key authorizations will expire at the end of the year. Additionally, current Senate Majority Leader Chuck Schumer has made no secret of his intention to try and confirm as many of President Biden’s pending nominations as possible in the remaining weeks of this Congress, despite President-elect Trump’s post on X stating that “no Judges should be approved during this period.”
Trump Administration Nominees: President-elect Trump, who won both the popular and electoral votes by a respectable margin, is wasting no time setting up his new Administration. Over the weekend Trump weighed into the Senate Majority leader debate by posting his insistence that any candidate “must agree to Recess Appointments.” This attempt to bypass the traditional Senate confirmation process to put together his administration quickly could also be an attempt to appoint more controversial nominees that would otherwise have trouble with the confirmation process. Below are the appointments that were announced over the weekend:
- Chief of Staff: Over the weekend he named Susie Wiles, his campaign manager, Chief of Staff. A longtime Republican political operative, Ms. Wiles will be the first woman to hold the position.
- Deputy Chief of Staff: Longtime adviser, Stephen Miller has been reported to be the deputy chief of policy. Miller, an immigration hard liner, will head policy in the transition before transitioning to Deputy Chief of Staff.
- Ambassador to the United Nations: President-elect Trump has indicated that he will nominate New York Congresswoman, and current Republican Conference Chair, Elise Stefanik to be the U.S. Ambassador to the United Nations. This role will require Senate confirmation.
- Secretary of State: It was reported that Florida Senator Marco Rubio will be nominated to be Secretary of State. Currently the top Republican on the Senate Select Intelligence Committee, Senator Rubio has been an advocate for maintaining alliances such as NATO. This role will require Senate confirmation.
- National Security Advisor– Florida Representative Mike Waltz has been tapped to be the National Security Advisor. Waltz is also a retired Army Green Beret and National Guard colonel.
- EPA Administrator: President-elect Trump will nominate former New York Representative, Lee Zeldin, to serve as the administrator of the Environmental Protection Agency (EPA). Mr. Zeldin is expected to take the lead in repealing much of the Biden Administration’s clean energy agenda. The position will require Senate confirmation.
- Border Czar: Former head of the U.S. Immigration and Customs Enforcement (ICE), Tom Homan, was appointed as “border czar”, in charge of the southern and northern U.S. borders, as well as “all Maritime and Aviation Security,” according to President-elect Trump’s post on Truth Social.
Regulatory Update
The Office of Management and Budget (OMB) is reviewing the following:
Medicare
- Medicare Advantage – The proposed rule would make policy and technical changes to the Medicare Advantage, Medicare Prescription Drug Benefit, and Medicare Cost Plan Programs, and PACE for contract year 2026 (September 2024).
Other Topics
- Healthcare System Resiliency and Modernization – The proposed rule would revise and update national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers (was set for December 2023).
- Retail Pharmacy Standards – The final rule would require pharmacies and vendors to modify the currently adopted National Council for Prescription Drug Programs (NCPDP) standards to the Telecommunications Standard Implementation Guide Version F6 (F6); Batch Standard Implementation Guide version 15; and Batch Standard Subrogation Implementation Guide version 10 (was set for February 2024).
- Organ Transplants – The final rule would establish a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model), that would test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures.
- Cybersecurity – The proposed rule would make modifications to the Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). These modifications will improve cybersecurity in the health care sector by strengthening requirements for HIPAA regulated entities to safeguard electronic protected health information to prevent, detect, contain, mitigate, and recover from cybersecurity threats.
- Telemedicine – The final rule would extend COVID-19 telemedicine flexibilities for prescription of controlled medications.