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A s t h e d u s t s e t t l e s o n t h e 2 0 1 4 m i d - t e r m e l e c t i o n s a n d e y e s t u r n t o w a r d t h e l a m e d u c k s e s s i o n a n d i n c o m i n g 1 1 4 t h C o n g r e s s , w h a t d o t h e r e s u l t s m e a n f o r p a t i e n t s a n d p a t i e n t a d v o c a t e s ?
A t a h i g h l e v e l , p a t i e n t a d v o c a t e s a r e f o r t u n a t e t o e n j o y s t r o n g b i p a r t i s a n s u p p o r t o n m a n y i s s u e s , p a r t i c u l a r l y f u n d i n g f o r m e d i c a l r e s e a r c h s u p p o r t e d b y t h e N a t i o n a l I n s t i t u t e s o f H e a l t h ( N I H ) . B u t w i t h f e d e r a l s p e n d i n g r e m a i n i n g c o n s t r a i n e d a n d t h e a c r o s s - t h e - b o a r d c u t s k n o w n a s s e q u e s t r a t i o n s e t t o r e t u r n i n F i s c a l Y e a r 2 0 1 6 , s i g n i f i c a n t t h r e a t s t o r e s e a r c h f u n d i n g a n d o t h e r h e a l t h p r i o r i t i e s r e m a i n o n t h e h o r i z o n .
T h e 2 1 t h C e n t u r y C u r e s I n i t i a t i v e b e i n g l e d b y E n e r g y & C o m m e r c e C h a i r m a n F r e d U p t o n c o n t i n u e s t o b e a b r i g h t s p o t f o r m a n y p a t i e n t o r g a n i z a t i o n s a n d o t h e r s t a k e h o l d e r s . U p t o n w o n r e - e l e c t i o n d e s p i t e s o m e l a t e - c y c l e b l i p s t h a t h e c o u l d b e v u l n e r a b l e a n d w i l l r e t u r n t o c h a i r t h e c o m m i t t e e f o r t w o m o r e y e a r s b e f o r e r e a c h i n g t h e R e p u b l i c a n c a u c u s t e r m l i m i t o f s i x y e a r s a t o p t h e p a n e l .
W i t h f o r m e r M a j o r i t y L e a d e r E r i c C a n t o r r e t i r e d f r o m C o n g r e s s , U p t o n i s n o w t h e m o s t s e n i o r a n d v i s i b l e R e p u b l i c a n c h a m p i o n o n m e d i c a l r e s e a r c h i s s u e s . H e a n d o t h e r m e m b e r s c o n t i n u e d h o l d i n g r e g i o n a l e v e n t s d u r i n g t h e f a l l f o c u s e d o n C u r e s a n d c o m m i t t e e s t a f f i s m o v i n g t o d e v e l o p a d r a f t l e g i s l a t i v e p a c k a g e . O n e k e y q u e s t i o n w i l l b e t h e s c o p e o f t h e d r a f t l e g i s l a t i o n a n d i f i t c a n c o n t i n u e t o a t t r a c t b i p a r t i s a n s u p p o r t . A n o t h e r w i l l b e w h e t h e r o r n o t C u r e s c a t c h e s h o l d i n a n o w R e p u b l i c a n - c o n t r o l l e d S e n a t e .
O n e p o t e n t i a l s c e n a r i o c o u l d b e a t w o - s t e p p r o c e s s i n w h i c h a m o r e l i m i t e d C u r e s p a c k a g e m o v e s t h i s y e a r , w h i l e o t h e r r e f o r m s a r e t e e d u p f o r d e b a t e a s p a r t o f t h e n e x t u s e r f e e p a c k a g e , d u e i n 2 0 1 7 .
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A b s e n t a c t i o n b y C o n g r e s s , t h e s e q u e s t e r r e t u r n s i n f u l l s t r e n g t h i n F i s c a l Y e a r 2 0 1 6 . P a t i e n t a d v o c a t e s w i l l r e c a l l t h e i m p a c t t h e c u t s h a d o n m a n y p r i o r i t y a g e n c i e s a n d p r o g r a m s , p a r t i c u l a r l y N a t i o n a l I n s t i t u t e s o f H e a l t h ( N I H ) r e s e a r c h g r a n t s , p u b l i c h e a l t h p r o g r a m s a n d r e l a t e d H H S i n i t i a t i v e s . A t t h e s a m e t i m e , t h e r e r e m a i n s n o e a s y a n s w e r t o t h e s e q u e s t e r , a n d C o n g r e s s h a s a l r e a d y d e m o n s t r a t e d o n c e t h a t a s u n p a l a t a b l e a s i t m a y b e , s e q u e s t r a t i o n p r o v e d e a s i e r t h a n d e v i s i n g a n a l t e r n a t i v e .
P a t i e n t a d v o c a t e s w i l l l i k e l y w a n t t o f o c u s o n t h e i m p a c t t h e c u t s h a d i n F Y 2 0 1 3 , p a r t i c u l a r l y i n t h e a r e a s o f l o s t o p p o r t u n i t i e s . T h e y m a y a l s o w a n t t o u s e e m e r g i n g c h a l l e n g e s , s u c h a s e n t e r o v i r u s a n d E b o l a , t o m a k e t h e c a s e f o r a d e q u a t e f u n d i n g w h i l e b e i n g m i n d f u l t o n o t o v e r r e a c h a n d b e c r i t i c i z e d f o r u s i n g a c r i s i s t o a d v a n c e a p o l i t i c a l a r g u m e n t . P a t i e n t g r o u p s w i l l a l s o w a n t t o r e m a i n f o c u s e d o n t h e F o o d a n d D r u g A d m i n i s t r a t i o n ( F D A ) a n d t h e i m p a c t s u c h c u t s m a y h a v e h a d i n t e r m s o f s l o w i n g r e v i e w a n d , u l t i m a t e l y , a p p r o v a l o f m e d i c a l p r o d u c t s .
B u t o v e r a l l , a R e p u b l i c a n m a j o r i t y i n b o t h c h a m b e r s w o u l d b e e x p e c t e d t o b r i n g a n e v e n g r e a t e r f o c u s o n r e s t r a i n i n g s p e n d i n g a l o n g w i t h a p r o c l i v i t y t o p r i o r i t i z e d e f e n s e a n d s e c u r i t y n e e d s o v e r d o m e s t i c d i s c r e t i o n a r y p r o g r a m s . N e w l e a d e r s o f t h e B u d g e t C o m m i t t e e s a n d o t h e r k e y p a n e l s i n b o t h c h a m b e r s w i l l b e a n o t h e r i s s u e t o w a t c h a s l a w m a k e r s t a k e o n t h e s e q u e s t e r a n d , p e r h a p s , m o r e l o n g e r - t e r m c h a l l e n g e s i n v o l v i n g e n t i t l e m e n t a n d t a x r e f o r m .
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P a t i e n t s a l s o c a n e x p e c t a d o s e o f a c t i v i t y a r o u n d t h e A f f o r d a b l e C a r e A c t t h a t c o u l d e r o d e o r s l o w s o m e o f t h e g a i n s i n h e a l t h i n s u r a n c e c o v e r a g e . W h i l e s o m e m e m b e r s w i l l b e a g g r e s s i v e i n p u s h i n g f o r o u t r i g h t r e p e a l v o t e s , a b i g g e r q u e s t i o n w i l l b e w h e t h e r s p e c i f i c p r o v i s i o n s w i l l b e i n d a n g e r t h r o u g h a c t i o n s t o r e p e a l , d e f u n d o r s i g n i f i c a n t l y a m e n d . T h e i n d i v i d u a l a n d e m p l o y e r m a n d a t e s , t h e 3 0 - h o u r w o r k w e e k a n d t h e m e d i c a l d e v i c e t a x a r e e x a m p l e s o f i s s u e s t h a t m a y b e a d d r e s s e d p i e c e m e a l . F u n d i n g f o r t h e d e l i v e r y a n d p a y m e n t r e f o r m w o r k o f t h e C e n t e r f o r M e d i c a r e a n d M e d i c a i d I n n o v a t i o n e s t a b l i s h e d i n t h e A C A a l s o c o u l d b e s q u e e z e d . A n o t h e r a r e a t o w a t c h w i l l b e i f a n y s t a t e s t h a t h a v e n o t e x p a n d e d M e d i c a i d w i l l r e s p o n d t o H e a l t h a n d H u m a n S e r v i c e s S e c r e t a r y S y l v i a M a t t h e w s B u r w e l l ' s o f f e r t o e n g a g e i n d i s c u s s i o n s a r o u n d m o r e f l e x i b l e e x p a n s i o n a l t e r n a t i v e s .
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E i t h e r d u r i n g a p o s t - e l e c t i o n l a m e d u c k s e s s i o n o r s o m e t i m e w i t h i n t h e f i r s t q u a r t e r o f 2 0 1 5 , C o n g r e s s i s e x p e c t e d t o a d d r e s s t h e M e d i c a r e p h y s i c i a n p a y m e n t s t r u c t u r e k n o w n a s t h e s u s t a i n a b l e g r o w t h r a t e . A l m o s t a n n u a l l y , C o n g r e s s p a s s e s l e g i s l a t i o n t h a t d e l a y s m a n d a t e d p h y s i c i a n p a y m e n t c u t s . R e c o g n i z i n g t h e s y s t e m i s b r o k e n , m a n y i n C o n g r e s s h a v e p r o p o s e d r e f o r m i n g t h e p a y m e n t s y s t e m , b u t t h e b i g g e s t o b s t a c l e i s t h e c o s t o f s u c h a p e r m a n e n t f i x t h a t c o u l d c o s t t a x p a y e r s $ 1 3 1 b i l l i o n o v e r 1 0 y e a r s . T h i s i s s u e i s o f o b v i o u s i m p o r t a n c e t o s e n i o r s a n d d i s a b l e d A m e r i c a n s w h o d e p e n d o n M e d i c a r e , a n d s u c h l e g i s l a t i o n c o u l d a l s o a t t r a c t o t h e r M e d i c a r e r e f o r m p r o v i s i o n s , i n c l u d i n g b e n e f i t c h a n g e s .
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T h e C H I P p r o g r a m p r o v i d e s h e a l t h i n s u r a n c e c o v e r a g e f o r l o w - i n c o m e c h i l d r e n w h o d o n o t q u a l i f y f o r M e d i c a i d c o v e r a g e . M o n e y f o r t h e p r o g r a m r u n s o u t i n S e p t e m b e r 2 0 1 5 . C o v e r a g e p r o v i d e d u n d e r t h e p r o g r a m o v e r l a p s w i t h c o v e r a g e e x t e n d e d u n d e r t h e A f f o r d a b l e C a r e A c t . W h i l e t h e r e a r e s i g n i f i c a n t p a r t i s a n d i s a g r e e m e n t s o n t h e A C A , t h e C H I P p r o g r a m h a s s u p p o r t e r s o n b o t h s i d e s o f t h e d i v i d e . H o w e v e r , r e a u t h o r i z i n g t h e p r o g r a m f o r a n o t h e r f i v e y e a r s c o u l d c o s t $ 8 8 . 7 b i l l i o n , a c c o r d i n g t o l e g i s l a t i o n i n t r o d u c e d b y o u t g o i n g S e n . J a y R o c k e f e l l e r . I t ' s n o t c l e a r h o w t h e A C A d e b a t e a n d e x p e c t e d b u d g e t b a t t l e s w i l l i m p a c t r e a u t h o r i z a t i o n , b u t C o n g r e s s w i l l n e e d t o a d d r e s s t h e p r o g r a m ' s l o n g - t e r m f u t u r e t o e n s u r e m i l l i o n s o f c h i l d r e n c o n t i n u e t o h a v e a c c e s s t o h e a l t h c o v e r a g e .
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N e w f a c e s w i l l g r a c e l e a d e r s h i p s l o t s o f m a n y k e y c o m m i t t e e s o f j u r i s d i c t i o n i n b o t h c h a m b e r s . T h e S e n a t e H E L P C o m m i t t e e a n d E n e r g y & C o m m e r c e C o m m i t t e e , b o t h o f w h i c h h a v e j u r i s d i c t i o n o v e r t h e N I H , F D A a n d o t h e r h e a l t h a g e n c i e s , w i l l h a v e n e w r a n k i n g m e m b e r s a s H E L P C o m m i t t e e C h a i r m a n T o m H a r k i n ( I o w a ) a n d E n e r g y & C o m m e r c e r a n k i n g m e m b e r H e n r y W a x m a n ( C a l i f o r n i a ) r e t i r e . A n i n t e n s e i n t r a - p a r t y b a t t l e i s o c c u r r i n g i n t h e H o u s e b e t w e e n R e p . F r a n k P a l l o n e o f N e w J e r s e y a n d R e p . A n n a E s h o o o f C a l i f o r n i a , b u t i n t h e S e n a t e , S e n . P a t t y M u r r a y i s e x p e c t e d t o t a k e t h e p o s i t i o n .
B o t h c o m m i t t e e s h a v e a d v a n c e d i n t o l a w a n u m b e r o f r e s e a r c h a n d p u b l i c h e a l t h b i l l s o v e r t h e p a s t C o n g r e s s . T h e s e i n c l u d e u p d a t e s t o e x i s t i n g m u s c u l a r d y s t r o p h y , a u t i s m , c h i l d r e n ' s g r a d u a t e m e d i c a l e d u c a t i o n a n d p a n d e m i c p r e p a r e d n e s s p r o g r a m s , a s w e l l a s n e w l a w s i n t h e a r e a s o f p e d i a t r i c r e s e a r c h a n d F D A r e f o r m s o f t h e d r u g c o m p o u n d i n g a n d p h a r m a c e u t i c a l s u p p l y c h a i n s e c t o r s . P a t i e n t s t a k e h o l d e r s w i l l c l e a r l y w a n t t o s e e t h i s r e c o r d c o n t i n u e i n t o t h e n e w C o n g r e s s .
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