What the 2014 Midterm Elections Mean for Home Care & Hospice
November 9, 2014 09:16 AM
While partisans are either celebrating or lamenting the outcome of the recent Midterm elections – the GOP expanded its majority in the House by 13 additional seats and reclaimed control of the Senate by picking up at least seven seats – home care and hospice advocates can look at the makeup of the new Congress with optimism in the fact that access to home care and hospice is neither an ideological nor partisan issue, but one that is supported by members of both parties in both chambers of Congress.
Some of home care and hospice’s biggest champions will be at the helm of powerful committees that drive the nation’s agenda when the 114th Congress convenes. The challenge NAHC will face is working with these champions while fending off any proposals that would reduce Medicare to a voucher system, cut the federal contribution to Medicaid, or call for more payment cuts and copayments for home care and hospice.
NAHC congratulates all the new members of the House and Senate, and looks forward to working with the new Congressional leadership. With several Senate races still too close to call, this is what is known about the makeup of the new Congress:
The GOP picked up at least seven seats, and the majority, in the Senate. The race in Alaska is still too close to call, and the race in Louisiana is going to a runoff next month. While it is clear that the Republicans will control the Senate, the size of their majority is still in question. Since committee assignments are divided up proportionately between the parties, the ratio of seats between Democrats and Republicans is unknown at this point.
What is known is that the powerful Senate Finance Committee, which has jurisdiction over Medicare and Medicaid issues, will most likely be chaired by Senator Orrin Hatch (R-UT) when the 114th Congress convenes next January. Senator Ron Wyden (D-OR), the current Chairman, will become its Ranking Member. NAHC’s positive and productive history with both Senator Hatch and Senator Wyden should allow for a continuing dialogue between home care and hospice advocates amongst both Democrats and Republicans on the Committee.
Senator Susan Collins (R-ME) will most likely chair another committee of interest to the home care and hospice community, the Special Committee on Aging, when the new Congress begins. Senator Collins has been one of the home care and hospice community’s strongest Senate allies over the years, and from her new position, she can be an even more forceful voice for some of NAHC’s key issues – including allowing nurses to write home health plans of care, extend the home health rural add on payment, and modifying the ACA to designate a “full time employee” as someone that works 40 hours a week for the purposes of the ACA employer mandate. Senator Collins currently holds the record for the most consecutive appearances at NAHC’s annual March on Washington with 14. NAHC believes that there couldn’t be a better champion of the nation’s elderly to take the helm at the Committee on Aging.
Republicans have stated that current Minority Leader Mitch McConnell (R-KY) will become the new Majority Leader. Senator McConnell has been a strong supporter of home care and hospice in the past – having spoken to NAHC members at past conferences and in drafting a scathing letter on the Center for Medicare and Medicaid Services’ (CMS) flawed rebasing rule. NAHC looks forward to continue its very constructive and positive working relationship with Senator McConnell in his new role as Majority Leader. Senator Lamar Alexander (R-TN), who has supported NAHC in its fight to preserve the companionship exemption, is slated to take over the Health, Education, Labor and Pensions Committee.
Another home care champion, Steve Daines (R-MT), who introduced a bill to delay implementation of the ACA employer mandate for Medicaid and Medicare providers, won his election to the Senate, where it is expected that he will continue to fight for relief. Senator Pat Roberts (R-KS), who has spoken at NAHC’s March on Washington, won the closest reelection of his Senate career. Many attribute Senator Roberts’ success, in part, to the last minute efforts by home care and hospice allies Jerry Moran (R-KS), who is the head of the National Republican Senatorial Committee, and former Senator Bob Dole (R-KS), who has served as NAHC’s champion for many years.
On the House side of Congress, Republicans added to their majority, meaning that there will not be a switch between the parties for power, but expanded committee assignments and a broader governing majority for the GOP. The entire House was up for reelection, and some of NAHC’s biggest House champions – such as Greg Walden (R-OR), Tom Price (R-GA), Walter Jones (R-NC), John Lewis (D-GA), Jim McGovern (D-MA), and Jim Langevin (D-RI) – were reelected. Langevin has led the fight on the House side to preserve the companionship exemption. House Speaker John Boehner (R-OH) is all but certain to retain his post. Speaker Boehner has worked with NAHC on several key issues in the past.
One of the most important Committees in the House – Ways and Means, which has jurisdiction over Medicare – will either be chaired by Rep. Paul Ryan (R-WI) or Kevin Brady (R-TX). Most observers are saying that Paul Ryan will most likely chair Ways and Means in the coming Congress. NAHC has shared its concerns over home health and hospice payment cuts and copayments with Rep. Ryan in the past.
Rep. Brady, who will likely continue to chair the Ways and Means Subcommittee on Health, has held several hearings during his tenure on issues that affect the home care and hospice community, and has supported NAHC on some of its key policy positions.
Rep. Fred Upton (R-MI) and Joe Pitts (R-PA) will continue to chair the Energy and Commerce Committee and its Subcommittee on Health respectively. With jurisdiction over Medicaid and Medicare, each has been supportive of home care and hospice. The ranking minority member of the Subcommittee on Health, Rep. Frank Pallone (D-NJ), a big champion of home care and hospice, is expected to vie for the ranking minority open position on the full committee.
NAHC welcomes the return of many of its champions on both sides of the aisle, and looks forward to building relationships with the newly elected Representatives and Senators of the 114th Congress. Before the new Congress convenes, the 113th Congress will meet one more time for a “lame duck” session beginning Wednesday November 12. It is likely to be a short session to fund the government past the December 11 deadline, either through a continuing resolution or an omnibus spending bill, before being gaveled out.
There has been talk of possible action by Congress on some other issues during the lame duck—such as changing the Affordable Care Act (ACA) definition of full time from 30 hours a week to 40 hours, delaying implementation of the ACA employer mandate, and replacing the flawed Medicare physician payment formula (SGR). Stay tuned to NAHC Report for more on developments during the lame duck session.
As the new Congress gets acclimated to life in Washington, NAHC urges all of its members to continue to highlight the issues of importance to the providers and recipients of home care and hospice services.