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Election Recap and Preview
of the 115th 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 52-48 in the 115th 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
Kamala Harris (D)
California’s Attorney General was the first female, the first AfricanAmerican, and the first Asian-American to hold her position in the State.
Illinois
Tammy Duckworth (D)
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 2010.
Maryland
Chris van Hollen (D)
A long-time ally to House Democratic leadership, van Hollen has served as
Assistant to the Speaker, DCCC Chairman, and Budget Committee ranking
member.
Nevada
Catherine Cortez Masto (D)
The former Attorney General of Nevada was buoyed by the support of Harry
Reid.
New Hampshire
Maggie Hassan (D)
Currently serves 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 115th 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 (RMO),
– 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 115th 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
115th 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
Notes
Rep. Tom Price
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 115th 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 115th 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