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Election Recap and Preview of the 115 th Congress. December 2016 Chuck Ingoglia National Council for Behavioral Health

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1 Election Recap and Preview of the 115 th Congress December 2016 Chuck Ingoglia National Council for Behavioral Health The National Council s Vision *Expand access to care *Integrate behavioral and physical
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1 Election Recap and Preview of the 115 th Congress December 2016 Chuck Ingoglia National Council for Behavioral Health The National Council s Vision *Expand access to care *Integrate behavioral and physical health *Raise Awareness of the need for help *Spend money to accomplish these goals! $$$ Overview Part One: Election Recap Part Two: Leadership in Congress Part Three: Policy Implications Part One: Election Recap Donald Trump will assume office with the GOP in control of both chambers of Congress. GOP Maintains Majorities in Congress Senate Despite a slate of incumbents playing defense in many purple and blue-leaning states, Republicans won most of the closely contested Senate races and will hold a narrow majority of in the 115 th Congress. Republicans won close Senate races in Florida, Indiana, Missouri, North Carolina, Pennsylvania, and Wisconsin. Democrats won a toss-up race in Nevada, and defeated Republican incumbents in Illinois and New Hampshire House Democrats gained 6 seats. Meet the New Senators State Winner Notes California Illinois Kamala Harris (D) Tammy Duckworth (D) California s Attorney General was the first female, the first African- American, and the first Asian-American to hold her position in the State. The first disabled woman to be elected to the House of Representatives, and also the first member of Congress born in Thailand. Indiana Todd Young (R) A U.S. Marine Captain, Young was first elected to the House in Maryland Nevada New Hampshire Chris van Hollen(D) Catherine Cortez Masto(D) Maggie Hassan (D) A long-time ally to House Democratic leadership, van Hollenhas served as Assistant to the Speaker, DCCC Chairman, and Budget Committee ranking member. The former Attorney General of Nevada was buoyedby the support of Harry Reid. Currentlyserves as Governor of New Hampshire and Vice Chair of the Democratic Governors Association Political Subdivisions House and Senate Moderate Democrats 23 Senate Democrats and two Independents are up for reelection in 2018, many of them in red or purple states. Some of these senators will likely be the most likely to work with Republicans to accomplish legislative progress. In the House, the influence of moderate Democrats from New Dems to Blue Dogs could increase among the growing dysfunction in the House Republican Conference. The coalition of 50-something moderate Democrats could serve as a powerful voting bloc as divisions in the GOP persist. The House Freedom Caucus is already in discussions about how to expand their influence in the 115 th Congress. As their ranks remain at about 40 members in the Republican House, the Speaker will need to rely on many of their votes to pass legislation along party lines. National Council Champions We have successfully cultivated relationship with strategically placed and passionate Members of Congress: Sen. Debbie Stabenow (D-MI) and Sen. Roy Blunt (R- MO), Rep. Leonard Lance (R-NJ), Rep. Lynn Jenkins (R-KS) and Rep. Doris Matsui (D-CA). Unfortunately, this election we lost one of our key Senate champion Sen. Kelly Ayotte (R-NH). To remain positioned to achieve success, we must continue to recruit new congressional champions. Part Two: Leadership in Congress With the GOP maintaining control in both chambers, only a few key leadership changes are expected. Senate Leadership Leadership in the Republican Senate majority will remain unchanged, with Mitch McConnell (R-KY) retaining his post as Majority Leader, and John Cornyn (R-TX) remaining Majority Whip. After gaining the blessing of outgoing Democratic leader Harry Reid, Chuck Schumer (D-NY) is poised to become Senate Minority Leader in the 115 th Congress. Despite his reputation as a lawmaker obsessed with political tactics and strategy, Schumer is expected to emerge as more of a bipartisan dealmaker than his predecessor. Dick Durbin (D-IL), will remain minority whip, with an expanded leadership team. House Leadership House Speaker Paul Ryan will be back for another term! Nancy Pelosi survives a coup attempt to remain Minority Leader. Key Committee Leaders Committee Chairman in 2017 (GOP) Ranking Member in 2017 (Dem) Senate Finance Orrin Hatch (UT) Ron Wyden (OR) Senate HELP Lamar Alexander(TN) Patty Murray (WA) or Bernie Sanders (VT) House Energy and Commerce John Shimkus (IL) or Rep. Greg Walden (OR) Frank Pallone (NJ) House Ways and Means Kevin Brady (TX)? Part Three: Policy Implications What should you expect during the lame duck, and what are the key issues for the 115 th Congress? National Council Policy Priorities Fiscal Year 2017 Appropriations CARA Funding * Mental Health First Aid Primary Care Behavioral Health Integration (PBCHI) Grants Excellence Act Extension Mental Health Reform* Potential HHS Secretaries Candidate Rep. Tom Price Notes Rep. Tom Price (R-Ga.), the chairman of the House Budget Committee and an early Trump backer. First 100 Days Transition The First Hundred Days is a term first used by FDR in 1933 to describe his initial policy priorities, but within those first days, the President must also take certain steps to launch the new administration. Nominate a Cabinet and senior non-cabinet officials to the Senate Submit a Budget to Congress Present State of the Union Potentially suspend all pending regulations Begin the process of filling positions for over 4,000 political appointees In 2017, the new President will also face some unusual early must do tasks, as well. Nominate a Supreme Court Justice Address an expiring Debt Limit (which could be deferred from March until mid-summer) First 100 Days Policy Agenda A first-term president often has a narrow window to capitalize on the governing mandate that comes with winning a national election, and the first 100 days of a new administration is often seen as the most important in laying out their primary policy priorities. repealing Obama Executive actions movement on major reconciliation bill on Capitol Hill, which may include ACA repeal/replace provisions, structural individual and corporate tax reform, tariffs and trade deal restructuring legislation on building a wall on the southern border Supreme Court nomination Dodd-Frank reforms significant energy legislation doubling Clinton infrastructure plan to $550B Long Term Agenda Priorities When the 115 th Congress beings in January, the health care focus will be repeal and replace the Affordable Care Act (ACA) Reconciliation to repeal parts of the law (only requires 50 votes) Individual tax subsidy Medicaid expansion Individual mandate penalty Development of a bill/package of bills to reform the remaining parts of the law and replace the policies that were eliminated A number of healthcare packages are likely advance through Congress next year, including a pair of must-pass bills (CHIP Extension and Medicare Extenders) that could act as vehicles for mental health policies CMMI Demos and Authority The Center for Medicare and Medicaid Innovation (CMMI) has wide-ranging authority to test changes to the Medicare program and does not need to obtain approval from the Office of Management and Budget (OMB) to test innovative payment models that the agency believes could glean program savings while maintaining quality. Aside from creating a variety of Alternative Payment Models (APMs) including ACOs and bundled payment initiatives the administration could also use CMMI s authority to advance broad changes to reimbursement for drugs or managed care plans. CMMI s proposed Part B Drug Demonstration represents one example of a mandatory, nationwide demonstration through which the agency has proposed controversial program changes. Many lawmakers particularly Republicans have argued that CMMI s authority subverts that of the legislative branch, and may push for legislation to add constraints to CMMI or block specific demos. These potential guardrails, which are seen as priorities of the pharmaceutical industry, include: (1) limits on the scope and duration of CMMI models, (2) limits on mandatory tests, (3) judicial review of some CMMI decisions, (4) reaffirmation that legislative approval is needed to change statute to expand a model, and (5) more stakeholder and public engagement. Health IT Priorities As an issue that has largely avoided bitter partisanship fights thus far, health information technology, is likely to continue the foundation laid by the Obama Administration, with more and more focus on cybersecurity. Issues that are likely to be centerpieces during the 115 th Congress include: Ongoing efforts around interoperability, including questions about linking EHRs, as well as Patient Matching strategies. Appropriations fights around the Unique Patient Identifier ban. In efforts to curb opioid abuse, continued promotion of more robust regional PMDP networks and EPCS. Health care security, with a special focus during the MDUFA reauthorization. Possibility of Whitehouse/Portman behavioral HIT 5-state demonstration (S. 2961) attached to CMMI changes Medicare and Medicaid Reform Republican hopes of reforming the nation s entitlement programs could finally come to fruition as they maintain full control of the legislative and executive branch. While any significant overhaul of Medicare and Medicaid will be difficult without a 60 vote margin in the Senate, the odds of action on major changes are more likely than in recent history. House Republicans have proposed changing the Medicare program from a system where recipients are entitled to defined benefits to one that works more like a defined-contribution system, in which beneficiaries get a set amount of federal subsidy dollars to help them buy coverage. Transforming Medicare into a premium support system has been a clear goal for conservatives for years, but a genuine shift to such a system would need bipartisan support, which it does not currently enjoy. On the campaign trail, Trump was broadly opposed to changes to Medicare, and he has distanced himself from premium support proposals. Converting Medicaid from an entitlement to a fixed dollar, block grant or per capita cap program has also been a Republican priority for many years. They could have the ability to advance portions of this policy via reconciliation if the party comes to consensus. Trump, for his part, has expressed support or Medicaid block grants. Conclusion With a Republican president who will look to Congress to take the lead on policy, the dam could finally break on a legislative stalemate that has fomented over the last six years. The ability of the Republican-led government to govern will be severely tested over the next two years, and depending on how the House and Senate majorities manage to work in tandem could result in major legislative reforms being implemented during this period. With a President who is inherently more business-friendly than his predecessor, we anticipate a political atmosphere that is relatively open to certain industry-led policy initiatives rather than one that is shrouded in more academic undertones. This type of sea-change could lead to a break in the logjam over long-time third-rail issues such as tax and entitlement reform. NatCon17 April 3-5, 2017 Seattle 24
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