Now that President Donald J. Trump has taken office and Republicans have unified control of the U.S. House and Senate, their 100-day agenda aims to take full advantage of post-election momentum. Top priorities include repealing and replacing the Affordable Care Act (ACA), Cabinet confirmations, raising the debt limit, and passing a spending package. As the new Administration and 115th Congress address health care issues in the coming months, the ACC will work to ensure relationships with federal agencies remain strong and collaborative, health care reform continues to preserve and expand coverage, and medical research is robustly funded.

Confirmations

The Senate has begun confirming the top 100 leadership positions, including Cabinet secretaries and core teams.

Trump has officially announced Rep. Tom Price, MD, as his pick to lead the Department of Health and Human Services (HHS). Price has served in Congress for six terms. A past recipient of the ACC President’s Award for Distinguished Public Service, he currently chairs the House Budget Committee and also sits on the Committee on Ways and Means. Price was a leading figure in the fight to repeal the Sustainable Growth Rate, and has played a key role in efforts to improve electronic health record usability; he has lately been extremely involved in the push to streamline and simplify Meaningful Use reporting requirements. Price has vigorously opposed the Affordable Care Act (ACA); introducing legislation to repeal and replace it in 2015. He has also been a frequent critic of the Center for Medicare and Medicaid Innovation. Should he be confirmed, Price and his policy priorities will be central to the future of these programs.

Trump has also selected Seema Verma, MPH, to be the Centers for Medicare and Medicaid Services (CMS) Administrator. Verma has been involved in health care policy for more than 20 years, focusing largely on state-based initiatives, and she has extensive connections to Vice President-Elect Mike Pence. She is the president, CEO and founder of SVC, Inc., a health policy consulting company. Much of her recent work has focused on health care in the state of Indiana. In 2007, Verma helped create and implement Indiana’s Medicaid, Healthy Indiana Plan. She also served as Indiana’s lead on ACA implementation.

"…the ACC will work to ensure relationships with federal agencies remain strong and collaborative, health care reform continues to preserve and expand coverage, and medical research is robustly funded."

Barring any unforeseen breaking in Republican ranks, these and other Cabinet nominations will likely be confirmed given Republicans only need a simple majority of 51 votes. Democrats could delay the more controversial confirmations by extending debates. Senate committees with jurisdiction over Cabinet departments will hold hearings on the most important picks before Trump is sworn in as president. After Jan. 20, committees can vote to place nominees before the full Senate.

Even as political appointees and some career staff may change, ACC’s ongoing engagement with federal agencies such as CMS, the U.S. Food and Drug Administration, National Institutes of Health, and others in 2017 will be similar to that occurring in 2016.

ACA and Budget Reconciliation

ACC’s leadership, guided by the Health Affairs Committee, is carefully considering how the College can best engage in this process on behalf of patients and the clinicians who care for them.

Both Trump and congressional Republican leaders are expected to move quickly to begin the process of making significant changes to the health insurance reforms and other policies implemented under the ACA.

Republicans have said they plan to launch a repeal effort during the first 100 days that would run the budget reconciliation process, allowing for expedited consideration of certain tax, spending and debt limit legislation. Budget reconciliation bills can be passed with a simple majority of 51 votes in the Senate and cannot be filibustered. Eligible ACA changes under budget reconciliation include: repealing individual and employer mandate penalties, rolling back Medicaid expansion, repealing ACA taxes, eliminating cost-sharing subsidies, and limiting medical liability.

"At the end of the day, the ACC has a long-standing history of working across political parties to advance the College’s mission of transforming cardiovascular care and improving heart health. — Richard A. Chazal, MD, FACC, and Thad Waites, MD, FACC

Republicans’ ACA replacement proposals have outlined measures to give more flexibility to states and small businesses, while encouraging people to maintain unbroken coverage and avoid higher premiums. The replacement timeframe is still being debated, but some Senators have estimated that it could take effect in two to three years. The exact manner and outcome of the ACA repeal effort remains uncertain, but it will be a highly contentious process that will absorb much congressional bandwidth early in the year.

Debt Ceiling

The current debt limit deal expires on March 16, the first time Congress will have to raise the $20 trillion debt ceiling since 2015 when former House Speaker John Boehner brokered an agreement that suspended the limit for more than a year. When the suspension lifts, the cap will need to be raised or suspended again to avoid default. If the debt ceiling is not extended before March 15, the Treasury Department will use “extraordinary measures” to allow extra time before the ceiling is reached. Lawmakers will have until mid-summer before further action is needed.

Spending Package

Congress must pass another spending bill by April 28 after passing the continuing resolution Dec. 9 to extend funding for federal government operations at Fiscal Year 2016 levels. The current continuing resolution imposes 0.19 percent across-the-board funding reduction and provides funding for the first full year of the 21st Century Cures Act. Senior appropriators speculate whether the political will exists to pass an omnibus – a bill that packages the smaller appropriations bills into a larger single bill – that will realign funding for Fiscal Year 2017 because Republicans are eager to move as many conservative policy measures as possible within the first 100 days.

“At the end of the day, the ACC has a long-standing history of working across political parties to advance the College’s mission of transforming cardiovascular care and improving heart health,” said Richard A. Chazal, MD, FACC, president of the ACC, and Thad Waites, MD, FACC, chair of the ACC Health Affairs Committee, in a recent email to members. “We look forward to working with the new presidential administration and Congress in the New Year around policies that protect patient access to quality, cost-effective care and ensure continued funding for things like cardiovascular research and graduate medical education.”

Stay tuned to ACC.org/Advocacy and the ACC Advocate newsletter for updates.

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