Advocacy News Briefs

Inside Washington: What to Expect from the New Congress

The 114th Congress officially opened January 5 in WAshington, D.C., with Republicans in the majority in both the House of Representatives and the Senate setting up one agenda while Democrat Barack obama has the authority of the presidential veto in the White House. The Endocrine Society will continue to advocate on issues of importance to our members including: federal funding of biomedical research, physician payment, diabetes, obesity, endocrine-disrupting chemicals, hormones and aging, and quality improvement. Below is the summary of the major issues that loom large on the congresssional agenda this year and what to expect:

Affordable Care Act

The issue: Republicans have been trying to repeal the healthcare law since its enactment in March 2010. Although they continue to coampaign on repeal, GOP lawmakers have acknowledged that it is essentially impossible as long as President Obama is in the White House.

What to expect: Republicans may symbolically pursue legislation to repeal the overhaul through both the budget and appropriations process by targeting provisions some Democrats have opposed, such as the excise tax on medical devices, the Independent Payment Advisory Board (IPAB), and the 30-hour definition of full-time work. While they may talk about proposals to replace the law, there is skepticism that they could be able to coalesce behind legislation.

Doc Fix

The issue: Congress passed a one-year patch to temporarily protect Medicare physicians from scheduled cuts after lawmakers were unable to agree on a way to pay for a permanent policy compromise. It expires at the end of March.

What to expect: The Endocrine Society and others in the physician community will fiercely lobby for Congress to pass a permanent fix ahead of the March expiration date. Although lawmakers came to a policy agreement in early 2014, finding a way to pay for its significant price tag — esitmated to be about $138 billion over 11 years — will continue to be no easy lift and could result in Congress passing its 18th patch since 2013 to avert a Medicare physician payment cut.

21st-Century Cures

The issue: Last spring, House Energy and Commerce Committee Chairman Fred Upton (R-MI) announced the launch of 21st-Century Cures, a new initiative that aims to accelerate the pace of cures and medical breakthroughs in the U.S. Chairman Upton, along with committee member REpresentative Diana DeGette (D-CO) led the committee in taking a comprehensive look at the full arc of this process — from discovery to development to delivery — to determine what steps Congress could take to ensure we are taking full advantage o f the advances this country has made in science and technology and use these resources to keep America as the innovation capital of the world. During 2014, the committee received input from the National Institutes of Health (NIH), Food and Drug Administration (FDA), and other agencies, as well as the Endocrine Society and other leaders in academia and industry. Now, the committee has announced it plans to introduce legislation early in the Congress with the aim of passing by Memorial Day.

What to expect: Because support of medical research is one of the truly bipartisan issues within Congress and the committee has engaged all stakeholders, many Congress watchers believe this is one of the pieces of legislation that has “legs.” The Endocrine Society has weighed in on several issues related to reducing burdens on scientists, and recognizinig sex as a critical bilogical variable in pre-clinical and clinical research. We will continue to advocate on these issues and keep members apprised of developments.

Budget Process

The issue: The Republican leadership wants to show that it can use its newfound control of Congress to make progress on fiscal and economic issues. It is almost a sure thing that the House and Senate Budget committees will employ a filibuster-proof process known as reconciliation, which can be used to make changes in mandatory spending programs, taxes, and the debt limit. Behind the scenes, Republicans are debating whether to use the reconciliation process to pass more modest changes in policies that have a chance of being signed by the president, or to send President Obama a more sweeping product. One of the most pressing questions is how the budget plans will treat discretionary spending in the upcoming fiscal year, which begins October 1. Under the current debt limit law, the defense cap will rise by $1.7 billion while the non-defense cap will fall by about $1 billion. Many Republicans contend that defense is underfunded, but not all of them are willing to break the budget caps unless Democrats agree to offset spending cuts elsewhere.

What to expect: Like a budget resolution, a reconciliation bill only needs 51 votes to pass in the Senate, not the 60 needed to end debate. But unlike a budget resolution, it is regular legislation, which means it must be signed by the president to become law. In the House of Representatives, it is likely Republicans will craft a plan that shows a balanced budget and the deficit disappearing in 10 years, if not less. The House Democrats are also likely to offer an alternative budget. In the Senate, it is also clear that Democrats will fight any attempts to cut Social Security and other mandatory programs.

Appropriations

The issue: Republican leaders are eager to show voters that they can govern in full control of Congress. But other political factors — mainly the push for higher defense spending and the desire to challenge the president on immigration, healthcare, the environment, and Wall Street regulations — will significantly complicate any efforts to pass spending bills in the 114th Congress.

What to expect: A big factor that could determine whether appropriators can complete their work will be what defense and non-defense top-line spending levels the Budget committees set for the fiscal year 2016, which will guide the work for the appropriations panels. Ther is pressure from many Republicans to increase defense spending for FY 2016 above the level in the current deficit law. Democrats, whose votes would be needed to get spending measures through the Senate, whill insist on equal boosts for non-defense spending. Any budget deal that does not include such a compromise would likely draw a veto threat from the White House. If Republicans pass a budget resolution that boosts defense spending at the expense of domestic programs, like funding for the National Institutes of Health, it could imperil action on non-defense bills. The Republican desire to fight the Obama administration’s signature domesitc policy pieces could also make some sort of spending agreement tough to secure this year. But, any provisions that too severely challenge the president would Cause Democrats to fight and would likely draw a veto from the president, which could put appropriations work in jeopardy and threaten another government shut-down.