Mike's Blog

It’s hard to believe we’re now a quarter of the way through the 21st century!

I’m writing this blog during the week before Christmas. As such, I can’t predict how the new year will start, nor exactly how the old one may end. At the moment, the CR we’re operating currently under runs through midnight tonight (12/20). The House had intended to release their version (what is now referred to as Plan A) for the next CR last Sunday, but that deadline slipped due to issues with the farm bill. Disaster funds (from the major hurricane as well as the Baltimore bridge) were also under discussion. Some degree of health care reform was also on the table with an eclectic potpourri of items. Every year, Congress acts to counteract the projected decrease in Medicare physician reimbursement and this time is no different (with a 2.5% boost to the 2.8% pay cut). Other odds and ends included a two-year extension of Medicare telehealth flexibilities and a five-year extension of the ‘hospital-at-home’ waiver from CMS that has been in place since COVID became a public health emergency. FDA priority review vouchers for rare diseases would have been renewed for another five years. Surprisingly, PBM reform was also in the mix, but with intense activity by the PBM lobby against these measures. All of this was rolled into a huge 1500+ page CR that went through March 14th, but the House vote failed Wednesday evening.

One other salient issue hanging over Congress when they return is dealing with the suspension of the debt ceiling (as of June 3, 2023) that was part of the Fiscal Responsibility Act. Technically, the suspension ends on January 2, 2025, but due to the ability of the Treasury Department to undertake extraordinary measures, the true ‘drop dead’ date is likely to extend into at least April and perhaps even into early summer which implies that resolution of the next CR will likely require addressing the debt ceiling at the same time. 

And so, Plan B was developed which, sadly jettisoned all those health care reforms listed above and tweaked the disaster and farm subsidy components, but also introduced a continued suspension of the debt ceiling into 2027. But Plan B failed to pass the House Thursday evening.

And so, as I write (and have rewritten throughout the day), Plan C is in the works which is looking like Plan B but without addressing the debt ceiling. Right now, it looks like it will be a long evening. 

Between now and January 20th (Inauguration Day, which incidentally is also a federal holiday), expect more announcements of potential presidential appointments. At least for the highest profile nominees, you can follow their status here; unfortunately, the NIH director is not considered ‘high profile.’ Traditionally, assistant secretaries and agency heads in terms of Senate confirmation hearings typically occur after Cabinet secretaries have been confirmed. The Ballotpedia website has some interesting info regarding confirmation times. Comparing Trump in 2017 with Biden in 2021 has the former averaging 37 days for the fifteen major Cabinet level confirmations versus 32 days for the latter. Both of these administrations have been a tad quicker than previous administrations (66 days for Obama and 45 days for Bush). Thus, it may not be until early to mid-March when agency heads have their day in the sun (assuming smooth sailing for their future boss). Also of note is that for the first time, the CDC director will be Senate confirmed. Previously, this position was merely a Presidential appointment similar to the NCI director.

Have your popcorn at the ready as while the outcome for all of these actions cannot be predicted, things are likely to be anything but boring. Happy New Year!

Prudence, indeed, will dictate … long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off …, and to provide new Guards for their future security.

-Thomas Jefferson, Declaration of Independence