(Feb. 19, 2025) - After an eventful month and a half to kick off the 119th Congress, the House is in recess for a week while the Senate plows forward on nominations. From a health care policy perspective, the beginning of the new administration generated uncertainty as it looked initially as if the government was going to pause or cancel many Federal health care grants and loans before eventually reversing course. Attention then shifted to Congress and its role in advancing various policy changes requested by the Trump Administration related to taxes, border security and government efficiency.
The key tool at Congress’ disposal to enact widespread changes with a simple majority vote in both chambers is "budget reconciliation". Procedurally, this requires Congress to agree on a joint budget resolution that fast-tracks the subsequent reconciliation legislation. However, agreeing on a budget resolution is proving trickier than expected as the Senate seeks to address border security and defense spending separate from taxes while the House prefers one bill that would include all budget spending.
Both chambers’ budget committees forwarded their respective budget resolutions to the full House and Senate late last week. The Senate has already begun debate on their smaller, less controversial version this week. Eventually, there will be a so-called “vote-a-rama” on Democratic messaging amendments, the list of which could reach into the hundreds. Passage of any amendments will be on a party-line vote after an exhausting debate. The House meanwhile would like to take up their version as soon as possible, but the narrow Republican majority in that chamber, 218-215 as of today, means that more or less every GOP congressperson has to be on board with voting aye. It is unlikely they will have enough votes at present to pass the House Budget Committee version before amendments are voted upon.
The Senate budget resolution would shift $86 billion per year toward border security and defense, while the House budget resolution proposes roughly $4.5 trillion in tax cuts over ten years with a corresponding cut of $2 trillion in spending over those ten years. Neither chamber is clear as to where these cuts or reallocations will be made, relying instead on instructions to other committees to determine.
There are indications that many of the cuts associated with the House’s budget resolution will focus on Medicaid and Medicare. On Wednesday morning, President Donald Trump put his thumb on the scales coming out in favor of the House's broader budget rather than the Senate's, but verbally noted that Medicaid cuts should be off the tabel, teeing up an uncertain path forward.
In meetings with Kansas’ House of Representatives offices last week, a Kansas Hospital Association-led group was told that work requirements for Medicaid eligibility are likely to be a part of the package. Block grants are unlikely to gain traction, but Federal Medical Assistance Percentage changes for expanded Medicaid populations are on the table. The attendees spoke extensively with delegation members and staff about our opposition to Medicare site-neutral payment schemes for Hospital Outpatient Departments, any extension of Medicare sequestration beyond its 2032 expiration date and allowing the enhanced premium tax credits on the insurance exchange to lapse.