March 9, 2017

House Committees Work to Advance Health Care Repeal Bill

Key congressional committees worked through the night Wednesday and into the afternoon Thursday in an attempt to expedite passage of legislation that would repeal and replace significant portions of the Affordable Care Act (ACA).  House GOP leaders unveiled the 168-page bill, called the American Health Care Act, on Monday night and urged committee leaders to move quickly to advance the measure.

For its part, the Ways and Means Committee – which has jurisdiction over the tax provisions of the GOP proposal – approved its section of the bill after nearly 18 hours of deliberations.  As of this writing, the Energy and Commerce Committee is still embroiled in its own marathon markup session.

As expected, the debate has been highly partisan in both committees, with Republicans insisting that the ACA has made health care unaffordable and unsustainable.  Democrats, on the other hand, contend that millions of Americans have gained coverage since the law was enacted in 2010.  Notably, the nonpartisan Congressional Budget Office (CBO) has yet to prepare an analysis describing the AHCA’s impact on the federal budget or how it may affect the uninsured rate.  Until such an analysis is available, Democrats have vowed to continue using a variety of legislative tactics to delay consideration of the bill.

The CBO is expected to release its analysis sometime early next week.  This will no doubt generate further debate on the potential impacts of the legislation on the federal deficit and the health insurance market.  A number of analysts predict that the CBO score will not be kind to the Republican effort and could put the GOP in a politically perilous position.   This has prompted some in the party to preemptively express their doubts about the accuracy of the CBO estimates.

Prior to committee consideration, CSAC, along with the County Welfare Directors Association of California (CWDA), sent a joint letter to the California congressional delegation urging them to oppose the AHCA.  Pursuant to the correspondence, CSAC and CWDA have a number of significant concerns, which include:

• Eliminating the ACA’s Medicaid expansion in 2020;
• Placing a per-capita cap on federal Medicaid spending;
• Instituting a number of administrative changes to Medicaid that will make it more difficult to maintain coverage;
• Eliminating the enhanced federal match used to cover recipients of In-Home Supportive Services (IHSS);
• Repealing the Prevention and Public Health Fund used by local health departments; and,
• Maintaining the so-called “Cadillac tax” on high cost employer sponsored plans, which would be delayed from 2020 to 2025.  

It should be noted that members of the conservative House Freedom Caucus and the Republican Study Group are also critical of the GOP proposal, arguing that it does not go far enough and does not move fast enough to repeal the ACA.  Across Capitol Hill, a number of conservative senators have expressed the same frustrations.  Additionally, moderate GOP senators have signaled their concern that the AHCA will increase the uninsured rate in their respective states.

Looking ahead, the AHCA provisions adopted by the aforementioned authorizing committees will go to the House Budget Committee, which will then combine them for floor action.  The full chamber could consider the bill as early as the week of March 20, but GOP leadership will need to ensure that there is sufficient support among its rank-and-file members before proceeding.

Pending House action, the Senate is expected to bring the healthcare reform bill straight to the floor and vote on it before a two-week recess that begins on April 9.  By utilizing a special budgetary process, known as “reconciliation,” Senate Republican leaders will be able to move the measure under expedited procedures and without the threat of a Democratic filibuster.

Senate Panel Examines Infrastructure Financing Options

On March 8, the Senate committee with jurisdiction over transportation spending held a hearing entitled “Investing in America: Funding our Nation’s Transportation Infrastructure Needs.”  The panel heard from several major stakeholder organizations, including the U.S. Chamber of Commerce, the American Association of State Highway Transportation Officials (AASHTO), and Transportation for America.

Convened by the Senate Appropriations Subcommittee on Transportation-Housing and Urban Development (T-HUD), this week’s hearing was the latest in a series of discussions on the Trump administration’s intent to spend $1 trillion on infrastructure in the coming decade.  While previous hearings have largely focused on the various infrastructure investment needs across America, the T-HUD Appropriations Subcommittee centered its discussion on how to finance the administration’s plan.

Incidentally, there was general agreement among hearing witnesses that there is likely no single financing solution when it comes to modernizing and maintaining the nation’s infrastructure.  Rather, witnesses indicated that a combination of revenue sources may be needed to adequately increase transportation investment.  As expected, there was considerable discussion surrounding the current 18.4 cents per-gallon federal gasoline tax, which has not been increased or indexed in nearly 25 years.

For its part, AASHTO recommended to Senate committee members that any increase in federal transportation funds should flow through the formula-based program structure that was created in the recent highway reauthorization law (FAST Act).  Furthermore, the organization urged that any major infrastructure package should focus on direct federal funding, rather than on federal financing support, which is not a viable funding source for most transportation projects.

In related developments, President Trump indicated this week that he is considering a plan that would require states to commence infrastructure projects within 90 days of receiving federal funding.  According to reports, the administration may push states to streamline their local permitting processes and may be emphasizing the need to prioritize the renovation and maintenance of existing roads and highways over new road construction.