Fireworks, hot dogs and budget reconciliation? With the passage of the budget reconciliation bill from the House to the U.S. Senate, the White House, federal government and health care advocates attention will turn their attention from the crowded House to the centenary Senate. Senate Republicans and Senate Majority Leader John Thune have allegedly chosen the July 4 recess to have the budget reconciliation passed.
Key Implications for Health Systems
Limited Changes to Health Care Cuts
Despite a one vote margin and a 42-page manager’s amendment to the bill hours before the final vote, there were little changes to budget reconciliation provisions impacting Medicaid work requirements, ACA marketplaces and health insurance coverage losses in the coming decade. A final amendment in the bill passed in the House did limit “penalties” for states providing coverage to immigrants who didn’t fit certain qualifications like “qualified alien” or children or women who are not lawfully residing in the U.S., which according to KFF, could impact 14 states. This amendment connects to a recent announcement from CMS on reviewing state Medicaid spending reports.
Senate House Rules
Unlike the House, where Speaker Mike Johnson ran manager amendments, oversaw all night committee hearings and negotiated with aggressive Republican-led groups, the Senate budget reconciliation process is more centered on the input of Senate Parliamentarian Elizabeth MacDonough and what she may allow to qualify as related to federal spending under the budget reconciliation bill. While MacDonough’s rulings are non-binding, they could impact certain pieces of the bill or push Thune to use the Congressional Review Act, a sort of legislative loophole to remove federal regulations.
Potential Risks and Concerns
“Byrd bath” vs. CRA
Senate Parliamentarian Elizabeth MacDonough will use the “Byrd bath” process, or deciding if provisions in the budget reconciliation bill directly relate federal spending and can continue, or if any provisions are recommended to be removed. As we saw with California’s electric vehicle waivers, the Senate used the Congressional Review Act (CRA) to basically override a parliamentarian decision. We could see similar procedural decisions or votes related to health care provisions.
Other Health Care Cuts Lingering
While Medicaid cuts and work requirements are getting airtime, other pending health care changes could catch health systems and hospitals by surprise. A complete defunding of Planned Parenthood, new cost-sharing copays for Medicaid enrollees and decreasing subsidies for those purchasing ACA marketplace plans.
Goodbye Filibuster
Thune and Senate Republicans will have the Senate filibuster on their mind during the budget reconciliation process. Limiting and shutting down any attempts for Senate Democrats to use the filibuster and bring debate, attention and delays to the budget reconciliation process.
What’s Next for Health Systems
Sprint to July 4
Thune and the Senate are pushing to complete their hearings, changes and final votes before Congress goes on a Fourth of July recess. Nothing like planned PTO to drive a deadline.
House Still on the Hotseat
Any final changes will need to go back to the House for approval or a congressional conference committee will be formed for both the House and Senate to iron out budget reconciliation details, changes and final bill language.
Hurry Up and Wait for Health Systems
As health care cuts and already reported provisions remain intact, health systems will need to monitor, track and educate their respective lawmakers and staff about the possible impact to care, operations and services. These tactics and content should be partnered with state or national associations as well.
