Healthcare Policy Prospects in the 118th Congress

The U.S. House finally has a speaker and the 118th Congress is getting down to business. The proceedings to fill the speakership predict turbulence in the House for the next two years. In the 2022 election, Republicans won 222 House seats and Democrats won 213, representing a net gain of 10 seats for Republicans. One elected Democrat, Rep. Donald McEachin (Va.), died of colorectal cancer three weeks after the election. His seat will be filled by a special election scheduled for Feb. 21. As a result, the 118th House opened with 212 Democratic members.

Bucking historic midterm trends, the 2022 election was a relatively good one for House incumbents. Only eight House incumbents on the ballot lost—six Democrats and two Republicans. Fourteen other incumbents lost their party’s primary. Factoring in retirements and departures, the 118th House welcomes 75 first-term members of Congress (76 after the special election in Virginia).

In the Senate, Democrats picked up one seat, breaking what had been a 50–50 tie (when counting the Independents who caucus with the Democrats). There are currently seven new members, two Democrats and five Republicans. The Senate will also be adding an eighth new member, following Sen. Ben Sasse’s (R-Neb.) resignation in January to become president of the University of Florida. Nebraska Gov. Jim Pillen will decide who will serve until a special election is held in 2024 to fill the seat.

Fun Facts about the 118th Congress

• This is the oldest Congress since 1789. The average age in the Senate is 63.9 years. The oldest senator is Dianne Feinstein (D-Calif.), who will turn 90 in June; the youngest senator is Jon Ossoff (D-Ga.), who will turn 36 this month. The House average is 57.5 years. The oldest representative, Grace Napolitano (D-Calif.), is 86; the first Gen Z member of the House is 25-year-old Maxwell Frost (D-Fla.).
• It is the most racially and ethnically diverse Congress, with 133 members who identify as Black, Hispanic, Asian American, American Indian, Alaska Native or multiracial. Twenty years ago, the 108th Congress had 67 people of color among its membership.
• Women hold 149 seats, 27.9% of the total, with 58 held by women of color. The previous record was 147 seats held by women in the 117th Congress.
• This Congress has 97 members (90 men and seven women) who served in the military. 
• There are 19 physician members in this Congress, including four senators and 15 representatives.

What Should We Expect?

The government remains divided. Democrats hold the White House, and the Senate by one vote, and Republicans lead the House. This division may make it difficult for the 118th Congress to accomplish much. The House majority has been compiling a list of priorities over the past two years, but any measures it manages to pass through a divided majority party and tighter-than-normal lead are unlikely to be taken up by the Senate majority party, much less passed against its one-vote margin. Amid the gridlock in Congress, the ACR will focus even greater efforts to advance pro-rheumatology legislation in state houses across the country to improve high-quality access to care.

What Does This Mean for Healthcare Policy?

Although portions of the 8.5% Medicare physician reimbursement cut scheduled for 2023 were averted, the remaining 2% across-the-board reduction comes on the heels of two decades of stagnant payment rates. After adjusting for inflation in practice costs, Medicare physician pay dropped by 22% between 2001 and 2021.

The ACR will advocate for an inflation-based annual update to the Medicare physician payment system. This logical adjustment is automatic and yields a yearly increase for hospitals, skilled nursing facilities and others who bill Medicare, but not physicians who treat Medicare patients.

Congress should also reassess the financial burden imposed on physician practices by the budget neutrality rules and avoid the ACR’s annual, end-of-year scramble to avoid cuts. It should implement reforms centered on simplicity, predictability, relevance and alignment, as spelled out in the core principles released last year by the American Medical Association and supported by the ACR. The ACR’s first letter to this Congress asks for comprehensive reform of the Medicare payment system.

Medicare reimbursement is one of the ACR’s policy priorities for 2023, which also include addressing:

• Barriers to care, such as prior authorization, step therapy and copay accumulator policies;
• Workforce needs, including funding for training positions, student loan repayment and issues impacting international medical graduates and foreign-born professionals in the U.S. medical workforce;
• Drug pricing;
• Telehealth; and
• Research funding.

It’s important to know the committee assignments for your members of Congress. Hearing from constituents about the important topics they are working on in their committees can make a huge difference in legislative outcomes. All members of Congress can vote on the final version of a piece of healthcare legislation, the contents of those bills originate from, and are decided in, the committees with jurisdiction over the topic.

In the House, these are the:

1. House Energy & Commerce Committee: This was the originating committee of the Affordable Care Act and has legislative oversight relating to telecommunications, consumer protection, food and drug safety, public health, air quality, environmental health, the supply and delivery of energy, cybersecurity and interstate and foreign commerce.
   1. The House Energy & Commerce Committee Subcommittee on Health is a primary group for ACR advocacy, because it has jurisdiction over the following relevant policy areas: private health insurance; medical malpractice and medical malpractice insurance; programs authorized under the Social Security Act, including Medicaid, Medicare Part B, child health, long-term care and peer review; the Department of Health & Human Services; the National Institutes of Health; the Centers for Disease Control & Prevention; and the Indian Health Service.
      1. Republican Health Subcommittee Members:
         • Brett Guthrie (Ky.), Chair
         • Michael Burgess (Texas)
         • Bob Latta (Ohio)
         • Morgan Griffith (Va.)
         • Gus Bilirakis (Fla.)
         • Bill Johnson (Ohio)
         • Larry Bucshon (Ind.), Vice Chair
         • Richard Hudson (N.C.)
         • Buddy Carter (Ga.)
         • Neal Dunn (Fla.)
         • Greg Pence (Ind.)
         • Dan Crenshaw (Texas)
         • John Joyce (Pa.)
         • Diana Harshbarger (Tenn.)
         • Mariannette Miller-Meeks (Iowa)
         • Jay Obernolte (Calif.)
         • Cathy McMorris Rodgers (Wash.), Ex Officio
      2. Democratic Health Subcommittee Members
         • Anna G. Eshoo (Calif.), Ranking Member
         • John Sarbanes (Md.)
         • Tony Cárdenas (Calif.)
         • Raul Ruiz, MD (Calif.)
         • Debbie Dingell (Mich.)
         • Annie Kuster (N.H.)
         • Robin Kelly (Ill.)
         • Nanette Diaz Barragán (Calif.)
         • Lisa Blunt Rochester (Del.)
         • Angie Craig (Minn.)
         • Kim Schrier, MD (Wash.)
         • Lori Trahan (Mass.)
         • Frank Pallone, Jr. (N.J.), Ex Officio
2. House Ways & Means Committee: This committee’s jurisdiction includes Medicare and the CMS as well as taxation, tariffs and other revenue-raising measures, such as Social Security.
   1. The House Ways & Means Committee Subcommittee on Health is another target group for ACR advocacy, because it leads on policies that relate to programs providing payments (from any source) for health care, health delivery systems or health research.
      1. Republican Health Subcommittee Members
         • Vern Buchanan (Fla.), Chair
         • Adrian Smith (Neb.)
         • Mike Kelly (Pa.)
         • Brad Wenstrup (Ohio)
         • Greg Murphy (N.C.)
         • Kevin Hern (Okla.)
         • Carol Miller (W. Va.)
         • Brian Fitzpatrick (Pa.)
         • Claudia Tenney (N.Y.)
         • Blake Moore (Utah)
         • Michelle Steel (Calif.)
      2. Democratic Health Subcommittee Members
         • Lloyd Doggett (Texas), Ranking Member
         • Mike Thompson (Calif.)
         • Earl Blumenauer (Ore.)
         • Brian Higgins (N.Y.)
         • Terri Sewell (Ala.)
         • Judy Chu (Calif.), Vice Ranking Member
         • Dwight Evans (Pa.)
         • Danny Davis (Ill.)
3. House Appropriations Committee: The House Appropriations Committee has one of the largest jurisdictions of any committee because it is responsible for appropriating funding for most of the functions of the federal government, including NIH and CDC funding. It has 12 subcommittees with jurisdictions over specific factions.

In the Senate, the committees of jurisdiction for healthcare policy include:

1. Senate Health, Energy, Labor & Pensions Committee (HELP): This committee’s jurisdiction encompasses programs authorized under the Public Health Service (such as clinical laboratories, allied health and nurse training) and the Federal Food, Drug & Cosmetic Act. This committee has no jurisdiction over Medicare and Medicaid, but members hold hearings on expanding healthcare access for the medically indigent, healthcare costs containment and workforce issues, including Medicare payment for graduate and medical education. HELP also addresses issues related to education, labor and pensions.
   • The Senate HELP Subcommittee on Primary Health and Retirement Security has jurisdiction over a wide range of issues, including Health Resources & Services Act, substance abuse and mental health, oral health, health care disparities and private retirement plans.
   • Membership is available online
2. Senate Finance Committee: This committee has jurisdiction over all of the CMS and Medicare, as well as matters related to taxation and other revenue and health programs under the Social Security Act, including Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). These issues are centered mainly in the committee’s subcommittee on health. The policy in this committee encompasses nearly three-fifths of the federal budget.
   • Membership is available online
3. Senate Appropriations Committee: The Senate Appropriations Committee has jurisdiction to give out federal dollars from the budget to specific agencies and programs, making it important for NIH and CDC funding. Appropriations are generally limited to the levels set by a Budget Resolution drafted by the Senate Budget Committee. Twelve subcommittees are tasked with drafting legislation to allocate funds to government agencies within their jurisdictions. This committee is also responsible for supplemental spending bills, which are sometimes needed in the middle of a fiscal year for emergency expenses.
   • Membership is available online