United States: Capitol Hill Healthcare Update - March 2017

House Sets Thursday Vote on ACA Repeal

House Republicans are scheduled to vote Thursday night on legislation to repeal most of the Affordable Care Act (ACA) even as GOP leaders scramble to secure the final votes needed to pass the bill.

House leaders said publicly this weekend that they are confident the needed 216 lawmakers will vote for the bill, but leadership aides cautioned Monday that the votes aren't there yet and more changes to the underlying legislation are likely as the internal lobbying continues.

No Democrat will vote to overturn the ACA, so it's up to GOP leaders to muster support among rank-and-file Republicans. But the party has been split since last November's election awarded them unified control of Washington and presented a pathway to upend the health law most Republicans have campaigned against since 2010.

Moderate House Republicans are concerned about ending the Medicaid expansion, especially in states that have already extended that coverage – including in some states led by GOP governors. Conservatives want a quicker Medicaid phase down, and they also oppose the refundable tax credit to incentivize individuals to purchase coverage, saying it's effectively a new entitlement program.

So far in the House, it's conservatives who are prevailing as leaders make concessions to woo votes. President Donald Trump, in a meeting last week with a group of conservative lawmakers, said the House bill would be changed to allow states to impose work requirements for Medicaid beneficiaries and allow states to choose block grants instead of the per-capita payment structure that's currently in the bill.

Those changes, which Trump touted in an Oval Office meeting, were enough to persuade several conservatives to publicly back the bill. But other conservatives, including members of the House Freedom Caucus, remain either opposed or undecided.

That caucus includes about 30 conservatives, more than enough to sink the bill if the group votes as a bloc. The Freedom Caucus is scheduled to vote tonight on the group's position on the bill. Under the caucus' rules, if 80 percent of the group votes to support or oppose a bill, it becomes binding and the caucus votes as a bloc.

But if the vote is below that 80 percent threshold, caucus members would become free agents and could vote however they chose – giving GOP leaders a fresh opportunity to seek their support.

But efforts to gain conservative votes in the House only complicate passage in the Senate, where leaders face opposition from conservatives but also from a larger group of moderate senators concerned about Medicaid changes.

Even though House GOP leaders don't yet have the votes to approve the bill, it's not uncommon to schedule votes on controversial bills even without knowing whether they would pass. Scheduling the vote forces undecided lawmakers into final negotiating positions – and ultimately forces them to make a choice.

The timing of the vote – likely Thursday night – is a function of House procedure, politics and also planning. Thursday is the seventh anniversary of President Barack Obama's signing the ACA into law.

Thursday also is the last scheduled voting day in the House this week. A nighttime vote, after most of the last flights out of Washington have already gone, effectively prevents lawmakers from voting on the bill and then heading to the airport. Leaders want rank-and-file members to remain in the chamber in case they need to extend the time for voting to allow for last-minute arm twisting.

House to Vote On 'Phase III' Health Bills

The House this week will consider legislation that would allow small businesses to pool together to offer insurance coverage and a bill that would remove antitrust protection for insurers.

The bills are part of Republicans' three-phase plan to replace the ACA. Because of Senate rules, these bills can't be included in ACA repeal legislation the House is scheduled to consider Thursday.

That means policy changes like the association health plans or allowing insurers to sell policies across state lines can be filibustered in the Senate and Republicans will need Democrats' support to enact them.

Other elements of the three-phase plan include an early April hearing by the House Energy and Commerce Committee on legislation allowing insurers to sell plans nationally as well as House votes this month on medical malpractice reform and on creating a self-insurance catastrophic-loss backstop.

Trump's HHS Budget Faces Bipartisan Opposition on Capitol Hill

Key lawmakers in both parties criticized President Trump's fiscal 2018 budget proposal for its deep spending cuts in many health and medical research programs.

Trump's first budget would reduce HHS spending by 18 percent, or about $15 billion from the current fiscal 2017 spending level. For NIH, Trump wants to reduce funding by $5.8 billion, even as Congress in December added $2 billion in new NIH funding.

The White House also wants to realign spending for FDA. About 60 percent of the agency's budget is appropriated annually by Congress, and the balance is funded by industry user fees. Trump wants to boost the industry's obligation and reduce what Congress approves.

Rep. Fred Upton (R-Mich.), whose "21st Century Cures" medical innovation bill last year boosted NIH funding, criticized the president's budget. Key House and Senate leaders on health spending – Rep. Tom Cole (R-Okla.) and Sen. Roy Blunt (R-Mo.) – also expressed concern about the proposed cuts. One lawmaker – Rep. Leonard Lance (R-N.J.) – called the proposed cuts "penny wise but pound foolish."

Congressional Democrats in both the House and Senate also criticized Trump's spending plan.

Trump's budget request is just that – a request. Congress isn't obligated to enact the White House's plan and in fact rarely does in total. A president's budget can directionally influence congressional spending, but in the case of NIH there's a bloc of bipartisan support for maintaining current funding levels.

User Fee Hearings This Week As Industry Opposes Trump Plan

House and Senate committees will hold hearings this week on the FDA user fee agreements, even as some industry stakeholders are calling for no changes to the negotiated terms.

The Senate HELP Committee on Tuesday will consider the user fee agreements for branded and generic pharmaceuticals, biologics and medical devices. FDA witnesses include Dr. Janet Woodcock, director of the branded pharmaceutical center; Dr. Peter Marks, director of the biologics center; and Dr. Jeff Shuren, director of the medical device center.

A hearing by the House Energy and Commerce Committee on Wednesday will focus on the branded pharmaceutical agreement. Witnesses include Woodcock, and officials of PhRMA, the Biotechnology Innovative Organization and Friends of Cancer Research.

Lawmakers are likely to use the hearings to speak out on President Trump's proposal to boost industry user fees and reduce congressionally appropriated funding. Several industry stakeholders, including AdvaMed and BIO, have issued statements saying they oppose Trump's position and instead want to preserve the already negotiated deals.

While policy changes can be added to the user fee agreements by Congress, it's unlikely that lawmakers will ultimately toss the agreements and seek to recalculate the industry fees.

Current user fee laws expire Sept. 30.

Gottlieb Hearings Not Yet Scheduled

With Congress scheduled to be on a more than two-week recess next month for Easter and Passover, the Senate HELP Committee's confirmation hearing and vote on Dr. Scott Gottlieb to lead FDA could slip into May.

President Trump last week nominated Gottlieb for FDA commissioner. Gottlieb is a former FDA deputy commissioner under President George W. Bush, and he also held a series of senior staff positions at the agency.

In addition to the planned congressional recess, the Senate calendar will be crowded in April and May, including a vote on Judge Neil Gorsuch's confirmation to the Supreme Court.

Senate Confirms Verma For CMS

President Trump's nominee to head CMS won confirmation in the Senate on a largely party-line vote.

Seema Verma won approval 55-42 to lead the agency that oversees $1 trillion in Medicare and Medicaid spending.

A former healthcare consultant, Verma has extensive experience with Medicaid – including expanding Indiana's program when Vice President Pence was that state's governor – but has less experience with Medicare.

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.

Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Mondaq Free Registration
Gain access to Mondaq global archive of over 375,000 articles covering 200 countries with a personalised News Alert and automatic login on this device.
Mondaq News Alert (some suggested topics and region)
Select Topics
Registration (please scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

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 or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq 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 of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions