| Some of the departing lawmakers have played prominent roles in health policy. The committees touch nearly every part of the health care system, including Medicare and Medicaid, private insurance coverage, and prescription drug prices. In the House, that includes exiting Reps. Lloyd Doggett (D-Texas) and Diana DeGette (D-Colorado), both longtime members of the Energy and Commerce Committee, and Rep. Vern Buchanan (R-Florida), a senior member of the Ways and Means Committee and current chair of its health subcommittee. Also departing is Rep. Richard Hudson (R-North Carolina), who led House Republicans’ campaign committee and championed pandemic preparedness legislation on the Energy and Commerce Committee. In the Senate, Sens. Bill Cassidy (R-Louisiana), Roger Marshall (R-Kansas) and Susan Collins (R-Maine) all lost their reelection bids. Their departures will leave openings on the Senate Health, Education, Labor and Pensions (HELP), Finance and Appropriations Committees — which, respectively, tackle issues such as public health and drug-pricing reforms, Medicare benefits, and funding for health agencies and programs. Cassidy’s loss is particularly consequential for the Senate HELP Committee, where he served as chair. Republicans will need to choose a new top member of the panel as they move into the minority, but the succession picture is not entirely clear. Three senators — Rand Paul (R-Kentucky), Lisa Murkowski (R-Alaska) and Tim Scott (R-South Carolina) — are already poised to be in ranking member roles on other committees. If they each opt to take those posts, Sen. Josh Hawley (R-Missouri) could be next in line for the Senate health panel. (None of the four responded to inquiries about their plans.) Several health care lobbyists have told me that a HELP Committee led by incoming chair Sen. Bernie Sanders (I-Vermont) and Hawley as the top Republican would be a “nightmare” for the health industry. Though they come from opposite sides of the political spectrum, both are populists who’ve decried corporate influence in the health care system. Sanders has previously used his HELP Committee gavel to haul pharmaceutical CEOs before the panel to answer for high drug prices, while pushing policies aimed at lowering prescription costs and increase access to affordable medicines. Hawley has partnered with Sen. Elizabeth Warren (D-Massachusetts) on legislation that aims to “break up big medicine” and co-sponsored a bipartisan bill that would make pharmaceutical companies pay taxes on money they spend advertising their drugs to consumers. There are also some high-profile races that remain unresolved. - Some of the potential departures in races that are too close to call include Rep. Virginia Foxx (R-North Carolina), who is trailing her Democratic opponent Chuck Hubbard by just 99 votes.
Foxx sits on the Oversight and Government Reform and the Education and the Workforce Committees, and previously served as the top Republican on the workforce panel for eight years. - Rep. Greg Murphy (R-North Carolina), a doctor who sits on the Ways and Means Committee, is just 233 votes ahead of Democrat Raymond Smith. Murphy is a key part of the debate over reforming the law meant to protect patients from surprise medical bills — an effort that has been accelerating.
Both North Carolina races could be heading to a recount. The shift in the balance of power also changes the level of staff and resources available to conduct oversight, investigations and the development of policy — an impact that’s more acute in the House. The incoming majority typically gets a larger share of committee seats. In the House, it also generally receives about two-thirds of committee staffing and resources, compared with one-third for the minority. (The Senate uses a more proportional funding formula, with the majority receiving between 50 percent and 60 percent of committee resources.) The change could have real consequences for health policy. New chairs can hire staff, set investigative priorities, call hearings and decide which legislation gets attention. “When it switches like it’s doing now, it’s very dramatic,” said Dave Rapallo, a longtime top staffer on the House oversight panel who has been on Capitol Hill during shifts in power. “Because going into the minority means cutting the staff [on House committees] in half.” And, likewise, going into the majority in the House means hiring up — big-time. Committee leaders can decide how to use the influx of resources, including determining the mix of more expensive senior staff and mid-level or junior staff. The additional staff can help committees pursue more investigations, conduct deeper oversight of federal health programs and develop legislation on a wider range of issues. Democrats have talked about overturning Republicans’ Medicaid cuts, reviving the enhanced Obamacare subsidies, expanding insurance coverage for Americans, in addition to probing the Trump administration’s drug-pricing deals with pharmaceutical companies and the overhaul of childhood vaccine policies. → There’s been questions about whether Democrats will spend more time legislating their policy agenda or going after Trump administration officials and executive actions. But people I’ve talked to on and off Capitol Hill say investigations don’t always have to mean splashy congressional hearings. Behind-the-scenes document requests and information-gathering can help lay the groundwork for legislation and policy changes. “It’s not a binary debate. I don’t think it’s about accountability on one side and affordability on another,” said Rapallo, now an associate professor at Georgetown Law and director of its Federal Legislation Clinic. “Without information, Congress is hobbled in terms of what policy goals they’re trying to achieve.” Sen. Raphael Warnock (D-Georgia) recently put it another way: “We can walk and chew gum at the same time,” he told CNN earlier this week. → Meanwhile, the committee shake-up creates opportunities for a new group of lawmakers with medical, scientific and health care backgrounds. The Washington Post reported Thursday on this collection of newly elected Democrats. This includes senators-elect Abdul El-Sayed of Michigan and Annie Andrews of South Carolina, and pediatrician Richard Pan, who beat Rep. Kevin Kiley (I-California), a member of the Education and the Workforce Committee. Their arrivals could bring new expertise to the panels overseeing the health care system, even as the departure of more senior lawmakers leaves some significant gaps. 25 percent Health care was responsible for roughly 1 in 4 jobs added to the economy in October, according to newly released Labor Department data. Overall, the sector added 42,000 jobs, accounting for about 25 percent of the 165,000 overall employment gain. That was also stronger than its average monthly gain of 31,000 over the past year, the Labor Department said. By the numbers: Hospitals led the way (16,000), followed by home health care services (11,000) and outpatient care centers (5,000). Why it matters: Health care is a large and steadily expanding part of the U.S. labor market, accounting for nearly 12 percent of total nonfarm payroll employment — a nearly 11 percent increase from 10 years ago, according to a KFF analysis published in September. The 165,000 in overall gains vastly exceeded analysts’ expectations, The Post reports. Medicare will pay home health agencies about 2.4 percent more next year under a recently released payment rule update — a boost of about $415 million. However, the industry is concerned about CMS keeping in place a 3 percent temporary cut to the base payment rate that it had urged the agency to drop. The home care industry says that the payment boost from the Centers for Medicare and Medicaid Services “offers greater stability amid a challenging operating environment,” but there are also larger concerns about the regulations. The National Alliance for Care at Home, an industry group, says the temporary cut “relies on flawed data tainted by bad actors,” and it is worried about provisions giving CMS more power to revoke providers’ Medicare billing privileges, which the industry fears could penalize legitimate providers. “This impact [of the temporary cut] may be compounded by provider enrollment provisions that fail to distinguish bad actors from providers operating in good faith,” said Jennifer Sheets, CEO of the alliance. “Taken together, there are still real risks to patient access to care that we continue to work to resolve.” CMS says the 3 percent cut is needed to recover about $4.9 billion it says Medicare overpaid home health agencies in previous years. It expects the 2027 cut to recover about $500 million, and writes in the rule that it “mitigates the need for a larger temporary adjustment in the future.” → The agency is expanding its authority to crack down on Medicare providers that don’t follow program rules, including broadening the circumstances in which CMS can retroactively revoke a provider’s enrollment. In addition, CMS can now impose a ban for up to 10 years on providers whose enrollment applications are denied, regardless of the reason why — but it backed off a proposal that would have allowed an enrollment denial to trigger revocation of a provider’s other Medicare enrollments. “We believe these revisions will help keep unqualified providers and suppliers out of the Medicare program, which, in turn will prevent improper Medicare payments to such parties,” CMS writes in the rule. → It comes as the Trump administration has made fighting health care fraud a major priority. Earlier this year, CMS imposed a nationwide pause on new Medicare enrollment for home health agencies and hospices, citing concerns about fraud. “Jay Rockefeller, Senate voice on health care and security, dies at 89,” Louie Estrada writes for The Post. “AstraZeneca Made $10 Billion Offer for Rhythm Pharmaceuticals,” write Lauren Thomas and Xavier Martinez at the Wall Street Journal.
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