United States: Capitol Hill Healthcare Update - January 10, 2017

A growing number of moderate and conservative Republicans in Congress are voicing concerns about the party's strategy to repeal the Affordable Care Act (Act) in February but then wait months – and possibly even into 2018 – before developing a replacement plan. Republicans, including President-elect Trump, have said the party's No. 1 priority is repealing the law, which they say is already in a death spiral that's causing insurance premiums to rise and coverage choices to shrink. Final repeal votes in the House and Senate are likely in mid-February. But Republicans are far from achieving internal consensus on a replacement plan, so GOP leaders want to vote quickly to repeal the ACA – with a delayed effective date of at least two years – and use the intervening time to develop a new policy.

Sens. Bob Corker (R-Tenn.), Tom Cotton (R-Ark.), Rand Paul (R-Ky.), and Bill Cassidy (R-La.), have recently voiced support for delaying the ACA repeal vote until Republicans can simultaneously unveil a replacement. Additionally, an increasing number of Republican governors in Medicaid expansion states are expressing concern about losing ACA funding, saying they will be forced to drop coverage for low-income families and individuals if the billions of dollars in federal funds are cut off. Republicans are desperate not to get tripped up politically by healthcare, but they face two competing political pressures: fulfilling a longtime campaign promise to quickly repeal the ACA, and the likely messy and lengthy process of achieving consensus on what comes next.

An acceptable middle ground according to some congressional staff could be for GOP leaders to release a set of detailed principles outlining the party's replacement plan at the same time as the ACA repeal vote. This could buy time for party leaders to work on finding policy consensus among rank-and-file lawmakers. Still, senior GOP Senate staff are confident that lawmakers will vote for a repeal-only bill despite the recent comments of GOP senators.

President-elect Trump is the wild card. So far he hasn't addressed the issue publicly. But one comment – or tweet – could upend Republicans' plans for how to navigate the hazardous policy and political shoals of ACA replacement. Trump is scheduled to talk this week with House Speaker Paul Ryan (R-Wis.), about Republicans' ACA strategy.

Democrats pressure Trump, GOP on drug prices

Saying they want to hold President-elect Trump to his campaign promises to bring down prescription drug prices, congressional Democrats introduced legislation last week that would permit the government to negotiate prices for drugs covered by Medicare Part D. Allowing Medicare to negotiate directly with drug companies – a policy long championed by Democrats – won support from Trump last year on the campaign trail. Sen. Bernie Sanders (I-Vt.) and Rep. Peter Welch (D-Vt.), introduced legislation last week that would do just that, and they called on Trump to endorse their bills.

Democrats will also push the issue with a series of amendments in the Senate this week on budget legislation that will set the stage for Republicans to advance their efforts to repeal the ACA. In addition to Sanders, Sens. Al Franken (D-Minn.), Amy Klobuchar (D-Minn.) and Sherrod Brown (D-Ohio), are expected to lead that effort, which will include an amendment authorizing drug importation. Republicans are expected to beat back the amendments, though importation has previously gained traction in the Senate and does enjoy some bipartisan support.

Democrats target HHS pick Price

One week before the Senate confirmation hearings of Rep. Tom Price (R-Ga.), begin, Democrats are stepping up criticism of the President-elect's nominee for secretary of the U.S. Department of Health and Human Services (HHS). Senate Minority Leader Chuck Schumer, (D-N.Y.), and other Democrats are calling for an ethics investigation of Price over his ownership of and trading in healthcare stocks. Democrats haven't offered evidence that Price's holdings or trades were improper, but they are demanding an outside review.

The Senate HELP Committee on January 18 will hold a hearing on Price's confirmation. Price, an orthopedic surgeon, also will be vetted next week by the Senate Finance Committee, which will be the panel that votes on advancing Price's nomination to the full Senate. Most Democrats will likely vote against the conservative Georgia congressman, who's called for the repeal of the ACA and taken other healthcare-related positions opposed by Democrats. But Democrats at the moment lack the votes to block Price from succeeding current HHS Secretary Sylvia Mathews Burwell.

Burgess to lead key House health panel

A physician will be the next chairman of a key House subcommittee that will draft ACA replacement legislation and approve new FDA-industry user fees. Rep. Michael Burgess, (R-Texas) was named last week to lead the Energy and Commerce Subcommittee on Health, which has legislative jurisdiction over the FDA and Medicare Parts B and D. First elected in 2003, Burgess has been active in healthcare policy, including the 2015 repeal of the Medicare physician reimbursement formula.

Burgess has long been critical of the ACA, and his subcommittee will play a leading role in developing legislation to replace the healthcare law. He will be active in the first six months of the year as the panel leads the effort to renew the pharmaceutical and medical device industries' user fees, which finance almost half of the FDA's budget, and to reauthorize the Children's Health Insurance Program (CHIP). Both the FDA user fees and CHIP reauthorization expire on Sept. 30.

Trump fills two key White House health posts

The staffer who will lead President-elect Trump's White House Domestic Policy Council has a long history working on healthcare policy at the HHS, the Senate and for a governor. Andrew Bremberg will become director of the council, which ensures domestic policy decisions and programs align with the president's stated goals, as well as monitors implementation of the president's domestic policy agenda.

Bremberg was chief of staff for former HHS Secretary Michael Leavitt during former President George W. Bush's administration. He previously worked for Senate Majority Leader Mitch McConnell, (R-Ky.), and Wisconsin Gov. Scott Walker. He started this summer on the Trump transition team, where he led HHS transition efforts.

Trump also announced Katy Talento will oversee healthcare policy at the council. Talento, an infectious disease epidemiologist, previously worked in the Senate, including for the HELP Committee and as a healthcare staffer for Sen. Thom Tillis (R-N.C.).

Rep. Paulsen reintroduces device tax repeal

Rep. Erik Paulsen (R-Minn.), last week introduced stand-alone legislation that would repeal the ACA's 2.3 percent excise tax on the domestic sale of medical devices. Paulsen has long opposed the device tax and has introduced legislation to repeal it in successive congressional sessions. His new legislation has 221 bipartisan House co-sponsors. The tax is currently in the second year of a two-year suspension. Without action by Congress, it is scheduled to come back into effect in 2018. It is expected that Senate Finance Committee Chair Orrin Hatch (R-Utah) will soon introduce bipartisan legislation to repeal the device tax.

The repeal of the device tax is caught up in the larger issues that surround Republican plans to repeal and replace the ACA. Some lawmakers want the ACA taxes immediately struck down, while others say the tax revenue will be needed to fund coverage while transitioning to a new healthcare plan. Another suggestion by some Republican staff would be to only suspend the device tax in an effort to keep the industry engaged in helping to propel passage of the GOP replacement plan.

Grassley expands Mylan probe

Senate Judiciary Committee Chair Chuck Grassley (R-Iowa), who has criticized the Centers for Medicare and Medicaid Services (CMS) for failing to investigate Mylan's potential overcharging of Medicaid for the EpiPen, is now questioning the agency about drugs from AstraZeneca and Purdue. In a letter last week to acting CMS Administrator Andy Slavitt, Grassley questioned whether CMS investigated the companies for misclassifying their drugs in a way that shielded them from mandated Medicaid drug rebates. Grassley said the misclassifications, which according to the senator began in 2009, have cost taxpayers "hundreds of millions of dollars" in higher Medicaid costs. He asked Slavitt for responses by January 18, just two days before President-elect Trump is sworn in.

Lawmakers object to HHS liver transplant plan

A bipartisan group of more than 70 House lawmakers is calling on HHS to change a proposal for liver transplants that they say will reduce access to transplants and increase their cost. Congress created the Organ Procurement Transplantation Network to ensure policies on organ allocation were medically based, and that patients in rural areas wouldn't be at a disadvantage compared with liver transplant patients who live closer to cities. But the lawmakers, led by Reps. Kevin Yoder (R-Kan.), and Eddie Bernice Johnson (D-Texas), say the network's plan would unfairly penalize rural communities and minority populations. The lawmakers urged HHS Secretary Burwell to withdraw the plan and solicit additional stakeholder input.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

In association with
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.