OK, campers, rise and shine.
With choruses of Auld Lang Syne relatively fresh in my ears and New Year’s resolutions still miraculously intact (well, mostly), I’m kicking off 2020 and a new decade with bright eyes and high hopes. At the same time, looking ahead to 2020, I can’t help but think of the outstanding 1993 Bill Murray classic, Groundhog Day. For those few who may not have had the privilege – or time – to watch this brilliant movie, the basic plotline has Bill Murray’s character forced to relive February 2 (Groundhog Day) over and over until he finally gets it right.
Washington D.C. in 2020 reminds me of that for two key reasons. First, we are revisiting and re-litigating legislative issues that we literally just spent all of 2019 debating. Namely, surprise bills and drug prices. Second, after years of working in Washington, I recognize very familiar patterns that one should expect to see in presidential election years like this.
Of course, we don’t have a crystal ball, and as we’ve already seen, there will certainly be unexpected developments or significant geopolitical events that may render these predictions completely moot. But looking ahead, I would break 2020 down into four unique time frames: return to Washington and budget season; getting down to business; the endless campaign and elections, and finally, the post-election, lame-duck session.
First, like me, Congress returned to Washington with grand ambitions for a big year. These first few weeks are not expected to be overly productive, and will likely be occupied with discussions about Iran and articles of impeachment. Then the State of the Union Address will be in early in February when President Trump will lay out his agenda for 2020, followed shortly thereafter by the release of the president’s budget request. While we can’t see the future, we can say with certainty that both of those items will lead to headline-grabbing stories; although neither are likely to lead to significant policy changes in the immediate future as both are probably best viewed as ambitious proposals that, to be enacted, still require congressional approval (that is probably unlikely to come).
As the year progresses, we do anticipate an extremely busy (and uncharacteristically productive) period where we may actually have some serious negotiations and potential for concrete legislative agreements on issues important for hospitals. Congress is expected to continue where it left off last year with ongoing efforts to address surprise medical bills, a focus on broad health care cost-containment legislation, and of course, ongoing efforts to pass legislation to curb the growth in drug prices.
While it’s still unclear exactly how those issues will be resolved, those decisions will all be made with an eye on May 22 because that’s how far Congress kicked the can down the road to extend multiple health care programs and delay scheduled Medicaid DSH cuts at the end of last year.
Because Congress seems to rarely pass individual bills these days, they need a “vehicle” (without wheels) to which they can attach every pet project of every member of Congress. As of now, May 22 is the real Groundhog Day in Congress because that’s when it must again pass legislation to address those unfinished issues. That vehicle seems likely to not only include those big-ticket items noted above, but potentially a wide range of additional health care provisions, such as elements of a possible “21st Century Cures 2.0,” updates to the new Medicare home infusion benefit, legislation to place limitations on the use of personal data (which could impact current HIPAA requirements), restrictions on hospital insurance network contracting, price transparency and much, much more!
Diverging from my loose groundhog theme, it could be a veritable legislative Christmas in May. And regardless of any thematic holiday ties, and at risk of mixing metaphors, that‘s possibly going to be the last health care train leaving the station in 2020.
The summer will be marked by the presidential nominating conventions, and campaigns not only for the White House, but also campaigns for roughly a third of the Senate and the entire House of Representatives. Once the campaign season kicks off in earnest and Congress abandons Washington for much of August and October, it’s hard to see a lot more getting done until after the votes are cast in November. There will be a brief blip in September, when Congress will again have to figure out how to fund the government (talk about Groundhog Day), but at this point we’ll be fully gripped in the election season so hopefully it will be addressed relatively painlessly.
Finally, as we look ahead just a short while to the post-election lame-duck session, only one thing can be certain: uncertainty. The outlook for the lame-duck session will be dictated by the election results, and there are multiple permutations to consider that I won’t even begin to entertain just yet. We’re going to hear plenty about the elections this year, starting very soon – so let’s just enjoy a bit more time ignoring it!
While this all feels like it has been done (over and over and over again), in all seriousness, it could be a big year in health policy. So while it can feel like a broken record, or a classic Bill Murray and Punxsutawney Phil movie, it’s vital to stay engaged and not be lulled into the familiar routines.
“Don’t forget your booties, because it’s cold out there today.” Maybe this is the year Congress gets it right.
About the author. As government relations director for the Vizient office of public policy and government relations, Steve Rixen closely tracks legislative and regulatory challenges for hospitals, and helps shape advocacy strategies to effectively communicate with policymakers on behalf of Vizient and our members. He previously served as a strategic policy and communications consultant and also worked as a professional staffer for U.S. Senator Byron Dorgan.