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Former Congressman Dr. Phil Gingrey provides public policy and government relations counsel to clients on a variety of issues. Here at Phil on the Hill, Phil draws upon his long career in public service to provide perspective and context on policy topics such as health care, the federal budget, annual appropriations, regulatory reform, and life sciences.



2018 — After CHIP Reauthorization, Legislative Chipping Away

Tuesday, January 23, 2018

Despite national frustration over the brief government shutdown, 2018 could still turn out to be a more productive legislative year than conventional wisdom has been suggesting. After all, it was yesterday morning that many thought the Children’s Health Insurance Program (CHIP) was in mortal danger. Now it will be extended for six years.

Reauthorizing CHIP is a smart move by Republicans to address to address the neediest and most vulnerable of our society. And why not? The recent CBO score shows that the program almost pays for itself, easing pressure off the need to find offsets.


In my last blog summing up 2017, I concluded that Americans should look ahead to 2018 with optimism. After a tumultuous year, when many questioned if the Republican majority in Congress could ever pass meaningful legislation — let alone keep President Trump on the same page — Republicans finally broke the gridlock in late December.

With the passage of the Tax Cuts and Jobs Act, and the subsequent short-term funding deal, Republicans seem to be moving more in lockstep.
 
What does this newfound GOP unity mean in practical terms for the 2018 legislative agenda? We are facing one of the most consequential mid-term elections in memory, one that will either support or stymie the Trump Administration. Everything that happens in the next 10 months will be framed in terms of how it might reshape Congressional majorities.

The fact remains, of course, that many of the president’s famous campaign promises have been met with little legislative success. Outright repeal and replace of the Affordable Care Act (ACA) now seems unlikely. Despite President Trump’s plan to visit border wall prototypes, it’s hard to imagine his wall plan coming to fruition anytime soon.

After surging to victory in 2016, however, Republicans can’t go into 2018 empty handed on key issues like health care and immigration — and I don’t expect them to.

Instead of the grandiose plans extolled by the president during the campaign, I expect the congressional GOP to adopt a more realistic approach of chipping off small pieces of some of those plans. Instead of sweeping and comprehensive reforms to American health care and immigration policy, Republicans will instead attempt a series of smaller, targeted legislation. Here are some of my predictions for 2018.

Health Care
In terms of health care, Republicans likely will explore the removal of state-line restrictions on purchasing health care. Combined with the repeal of the individual mandate in the recent tax bill, actions like these will represent a piecemeal approach to repeal and replace. Expect some targeted changes. For example, consensus is building against the Independent Payment Advisory Board (IPAB), which takes a meat-axe approach to Medicare. IPAB itself may be the one to get the axe. Some ACA-related taxes like the Cadillac tax and the medical device tax were delayed in the short-term funding deal.

There is more yeoman’s work to be done in health care beyond CHIP reauthorization. The Community Health Centers Program also needs to be reauthorized and funded beyond the current short-term patch. Programs governing generic drugs and veterinary drugs face important September deadlines. Millions of Americans depend on these programs and Congress must not let its eagerness to address new issues cause these old ones to fall by the wayside. Speaker Paul Ryan has identified entitlement reform as a key priority but recently indicated it is unlikely to occur this year. This is one area where Congress must tread lightly. I’ve already said that Medicare providers are not the government’s ATM, and that Republicans must be wary of doing more harm than good. When you factor in President Trump’s promise to not touch entitlements, and this being an election year, I caution my colleagues that anything other than efforts to strengthen Medicare and support providers and beneficiaries seems unwise.

Immigration

To apply Trumpian terminology to immigration — who knew that comprehensive reform could be so complicated? A complete overhaul seems unlikely, while the border wall is mostly a sideshow. But urgent issues remain. Senate Majority Leader Mitch McConnell seems prepared to meet these issues head on, and we should expect eventual resolution on issues like the continuation of Deferred Action for Childhood Arrivals (DACA) and increased border and interior immigration enforcement. Congress might also explore the president’s suggested fixes to issues like chain migration and visa lotteries. 
 
Finally, though it might be a fool’s errand, a few predictions for President Trump in 2018 can be made. He will issue his first full budget in early February, which will give us great insight into how he will reconcile his vaunted promises with political reality. If the president can continue to work with Congressional leadership and at least some Democrats in the Senate, he has a good chance of seeing many of his priorities become policy.

Now with results to show for his efforts, I hope the president continues to collaborate with the legislative branch in the year to come. The president almost certainly has a few curveballs up his sleeve, but if he and Congress can stay the course, we should continue to see legislation move and arrive on the president’s desk for signature.