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Health Care Issues in the 114th Congress

By Melissa Attias, CQ Roll Call

November 5, 2014 -- A quick look at how GOP control of the Senate changes the dynamic on major health care issues:

Health Law

The issue: Republicans have been trying to repeal the health care law (PL 111-148, PL 111-152) since its enactment in March 2010. Although they continue to campaign on repeal, GOP lawmakers have acknowledged that it's essentially impossible as long as President Barack Obama is in the White House.

What to expect: Republicans may symbolically pursue legislation to repeal the overhaul, including through budget reconciliation, but that would face Obama's veto pen. They're also likely to go after the law through the appropriations process and by targeting provisions some Democrats have opposed, such as the 2.3 percent excise tax on medical devices and the 30-hour definition of full-time work. While they may talk about proposals to replace the law, there's skepticism that they could be able to coalesce behind legislation.

Device Tax

The issue: The medical device industry has continued to lobby for repeal of the 2.3 percent excise tax on devices that took effect last year in the health care law, but it could come with a hefty price tag. The Congressional Budget Office estimated in June 2012 that eliminating the tax would cost about $29 billion over 10 years, although a 2014 Treasury Department inspector general report found that its collections were less than expected. The device industry says the tax has led to job losses and hurts innovation.

What to expect: Republicans are likely to try to repeal the tax, which could serve as a bargaining chip in a broader package. Some Democrats, particularly those from states with a sizable industry presence, oppose the tax and will support repeal, and more may join in if Republicans come up with palatable offset.

Mental Health

The issue: Lawmakers took a renewed interest in mental health after the December 2012 school shooting in Newtown, Conn., but only a couple of targeted measures have become law. Rep. Tim Murphy, R-Pa., introduced wide-reaching legislation (HR 3717) in late 2013 that has attracted some pushback and Rep. Ron Barber, R-Ariz., has competing Democratic legislation (HR 4574).

What to expect: Murphy has been energetically promoting his bill throughout the country and Republicans could try to move it forward in the new Congress if they decide it has enough support. The current measure has more than 100 cosponsors, including three dozen Democrats. But expect some mental health groups to fight the bill, including its support for court-ordered community treatment.

CHIP

The issue: Funding for the Children's Health Insurance Program (CHIP) expires at the end of September and advocates are pushing Congress to pass a four-year extension as part of legislation in the lame duck. They say states need to have certainty as they prepare their upcoming budgets and that many children would have no coverage if CHIP goes away.

What to expect: While CHIP has had bipartisan support, Republicans don't seem to be in a rush to renew the funding in the lame duck. A House Energy and Commerce spokeswoman has said any legislative action will occur next year. The top Republicans and Democrats on the Energy and Commerce and Senate Finance panels wrote to governors in July asking for feedback on their programs, which Republicans may use to propose changes before the funding expires.

IPAB

The issue: The Independent Payment Advisory Board, perhaps one of the most-criticized provisions of the health care law, is charged with making annual cost-cutting recommendations if Medicare spending exceeds a target growth rate. But it has yet to be triggered—it may be years before that happens—and Obama hasn't appointed any of its members.

What to expect: Although it's been out of the spotlight, Republicans could renew their efforts to repeal the board, whether on its own or part of a larger package, and some Democrats would likely support them. That may require an offset since the Congressional Budget Office estimated in 2012 that repeal would cost a few billion dollars over a decade. Republican control of the Senate also makes it almost impossible for Obama to get any nominees confirmed if the need arises, however unlikely that is.

Doc Fix

The issue: Congress passed a one-year patch to temporarily protect Medicare physicians from scheduled cuts after lawmakers were unable to agree on a way to pay for a permanent policy compromise. It expires at the end of March and several senior lawmakers want to use the lame duck to act.

What to expect: Doctors groups will fiercely lobby for Congress to pass a permanent fix ahead of the March expiration date. Although lawmakers came to a policy agreement in early 2014, finding a way to pay for its significant price tag—estimated in February to be about $138 billion over 11 years—will continue to be no easy lift and could result in Congress passing its 18th patch since 2003.

Publication Details

Publication Date: November 10, 2014