By Melissa Attias, CQ Staff
September 4, 2015 -- House Republicans and Democrats joined this summer to pass a popular medical innovation package, but a slower pace on a similar effort in the Senate will almost certainly postpone any trip to President Barack Obama's desk until 2016.
That means the best prospects for getting health care legislation past the finish line this year may be catching a ride on one of several must-pass items expected to dominate the year-end agenda, from funding bills to a debt-limit increase to highway legislation.
One candidate could be a repeal of the health care law's medical device tax—a perennial GOP target that has some Democratic support but the opposition of President Barack Obama—particularly after a House vote in June suggested that canceling the tax could win enough support to overcome a veto in that chamber.
Attaching the language to a larger package would allow a Republican majority still intent on scrapping the 2010 overhaul to score a win without putting Democrats in the uncomfortable situation of directly rebuking their party leader.
But optimism that repeal would get worked into past negotiations never bore fruit, and this autumn may not be any different.
"Never underestimate the power of the White House to convince their own members that they shouldn't override the president," says Sen. Dan Coats, an Indiana Republican and a vocal opponent of the device tax.
Of course, the loudest shouting over health care will probably be reserved for issues that have no chance of becoming law in the 114th Congress.
Republicans may use the budget reconciliation process to send a repeal of as much of the health care overhaul as possible to Obama's desk, but it would be swiftly met with his veto pen.
Democrats have also shown they have the numbers in the Senate to filibuster any GOP attempts to defund Planned Parenthood—an effort that re-emerged after the family planning organization was targeted in a series of undercover videos and that some Republicans want to insert into the larger government funding debate.
The 21st Century Cures bill (HR 6), which passed the House on July 10 in a 344–77 vote, includes a number of provisions designed to speed development of medical cures and nearly $8.8 billion in extra money for the National Institutes of Health over five years.
Energy and Commerce Chairman Fred Upton, a Michigan Republican, spearheaded the package with Colorado Democrat Diana DeGette and has been pushing for Senate action this year to avoid the messy politics of the 2016 presidential race.
But the Senate Health, Education, Labor and Pensions Committee is working on a later timetable, having spent the summer moving its bipartisan elementary and secondary education package (S 1177) through the full Senate and with higher education also on the agenda.
At a Bipartisan Policy Center event before the summer recess, Chairman Lamar Alexander said his panel's work on a similar bill wouldn't be completed until Thanksgiving or the end of 2015.
"That's no delay, really, because Sen. McConnell wouldn't have time to put it on the floor anyway between now and the end of the year," the Tennessee Republican said, referring to the Senate majority leader.
"But with the kind of support it has now and I expect it to have at the end of the year, I fully expect it to be the kind of legislation that even could be considered by the Congress in an election year, something a lot of people could take pride in," Alexander said.
The Senate legislation, which is expected to be conferenced with the House measure, could include provisions designed to improve the electronic health records system—though Alexander said it would be easier if the fixes that his panel identifies can be accomplished administratively.
Despite a veto threat from the White House, 46 House Democrats joined with Republicans in June to pass Erik Paulsen's bill (HR 160) that would eliminate the health care overhaul's 2.3 percent excise tax on medical devices that took effect in 2013.
The Minnesota Republican says bipartisan support puts repeal in the mix for negotiations over big-ticket items this fall, including tax extenders.
Bolstered by its June win at the Supreme Court, however, the Obama administration may not see any reason to accept a repeal of one of the financing mechanisms of its signature law lying down—just as Republicans may not feel it is a significant enough concession to sweeten compromise legislation in a fall dominated by other hot-button issues.
The absence of an offset for the estimated $24.4 billion price tag may also give some otherwise supportive Democrats an excuse to balk, depriving device-tax opponents of the support necessary to slip repeal into a year-end package.
Efforts to scrap other health care law provisions with Democratic detractors would face similar complications, including a not-yet-appointed Medicare cost-cutting board and a tax on "Cadillac" employer health plans that begins in 2018.