Month Ahead in Congress


With the House and Senate returning from August recess today, Congress faces a to-do list of issues for the final work period before Election Day. Before leaving at the end of the month, the items below are possible for action:

Continuing Resolution (“CR”): Funding for the federal government expires on September 30. Congress must pass a new funding bill before October 1 to avoid a shutdown. While both chambers did not finish considering every appropriations bill, the focus is now on what Congress will do with a CR, which extends existing funding levels. The House Freedom Caucus is seeking a CR through March to deny Congress the opportunity to have a must-pass vehicle during the lame-duck period after the election. However, other lawmakers are seeking either a three-month CR, setting up the lame-duck period with a must-pass vehicle, or a one-year CR, taking appropriations off the table until next year to allow the next administration to tackle other early priorities. One possibility is that Congress could pass a “CR-minibus,” approving some appropriations bills where there is bipartisan agreement while punting others to December through a CR.

Zika Virus: Congress left Washington in July without approving funding to address the spread of the Zika virus in the United States. Over the August recess the issue has become more pressing, with the virus spreading in Miami, Florida, and the Centers for Disease Control and Prevention has nearly exhausted its allocated funding for the virus. Democrats have opposed legislation that ties Zika virus funding to reproductive health issues. It is likely Congress will consider a Zika funding bill without contentious riders this work period, possibly as part of the CR.

Innovation: House supporters of the 21st Century Cures Act are eager for the Senate to move on its own Innovation initiative. Developments this month could spur the Senate to consider a package of Senate HELP Committee approved bills.

Mental Health: The House’s approval in July of H.R. 2646, the Helping Families in Mental Health Crisis Act, also puts the focus on the Senate for action. The Senate HELP Committee’s Chairman Lamar Alexander (R-TN) has his own package that could be considered this month, but the issue may be slowed down by additional proposals on criminal justice and guns.

Trump and Clinton Unveil Transition Teams


As Election Day and Inauguration Day quickly approach, both the Trump and Clinton campaigns have announced the formation of their transition teams to ensure the next administration has an efficient transfer of power. Transition teams work to lay the ground work for the nearly 4,000 political appointee positions in the executive branch and review agency operations and policies.

Trump has named New Jersey Governor Chris Christie as Chairman of his transition team. Rich Bagger, Christie’s former Chief of Staff, will serve as Executive Director. The team will also include William Hagerty, a former economic advisor to President George H.W. Bush, and Jamie Burke, who worked in President George W. Bush’s administration. Both have experience from former Massachusetts Governor Mitt Romney’s transition team.

The leadership of Clinton’s transition team was laid out in a press release in August. Former White House Chief of Staff John Podesta will serve as the President of the Transition and former Secretary of the Interior and former Colorado Senator Ken Salazar with be Chair. The team will include four Co-Chairs: former National Security Advisor Tom Donilon; former Michigan Governor Jennifer Granholm; Neera Tanden, President of the Center for American Progress; and Maggie Williams, Director of the Institute of Politics at Harvard University. In addition, two Clinton campaign advisors, Ed Meier and Ann O’Leary, will serve as Co-Executive Directors, while Heather Boushey, Executive Director of the Washington Center for Equitable Growth, will serve as Chief Economist.

RWJF Report Compares Exchange Experience to Part D, MA


In August, the Robert Wood Johnson Foundation (RWJF) released a report, entitled, “Strategies to Stabilize the Affordable Care Act Marketplaces: Lessons from Medicare.” The report reviews strategies used to support Medicare Part D and Medicare Advantage (MA) and how the structure and length of these strategies compare and could be applied to the Affordable Care Act’s exchanges to improve the market and encourage participation.

The report notes that the exchanges, MA, and Part D are all private plans subsidized with federal funds. The report suggests improving existing programs, such as the reinsurance, risk adjustment, and risk corridors provisions, known as the 3R’s. The report notes that Part D includes permanent risk adjustment and reinsurance, while the exchange’s reinsurance and risk corridors provisions end after three years.

The report also draws on examples from Part D and MA to suggest more unconventional approaches to encourage insurer participation and support price-sensitive consumers, such as incentivizing participation in the exchange market through regulatory relief to insurers; having the government assume a health plan’s risk if insurers decline to participate in a geographic area, similar to a provision in Part D that has not been used; and modifying participation requirements for easier market entry by insurers. The report also discusses improvements to auto-enrollment, outreach campaigns and consumer assistance, and challenges with penalties for consumers.

Given concerns about increasing premiums coupled with UnitedHealthcare and Aetna’s withdrawal from some markets next year, Congress and the administration may be considering improvements in the new year. In addition, the recent proposed rule on Benefit and Payment Parameters for 2018 includes changes to risk adjustment, such as factoring in prescription drug data and partial-year enrollments.