Ilisa Halpern Paul, president of the District Policy Group at Drinker Biddle & Reath, said the Senate and House previously ignored each other, so no one was crafting serious legislation. “When you know the outcome of your work is going to be the trash can, you're not as invested in it,” she said.
Republicans are trying to prove to voters they can govern effectively before presidential politics ratchets up partisan tensions again, said Dean Rosen, a partner at Mehlman Castagnetti Rosen Bingel & Thomas and former top GOP congressional staffer. “A lot of people are pleasantly surprised that progress is finally being made on some of these issues,” he said.
But having legislation move isn't necessarily a desirable thing for healthcare interest groups. For instance, trade legislation that cleared the House Ways and Means Committee on Thursday includes $700 million in reduced Medicare spending that's achieved by extending the budget-sequester cuts. Healthcare providers fear this would set a precedent of raiding Medicare to pay for provisions unrelated to healthcare.
Rep. Joseph Crowley (D-N.Y.) offered an amendment to eliminate the Medicare cut and instead extend the statute of limitations for going after tax deadbeats. “We can't expect our healthcare providers to be used as a piggybank for every bill that comes before us,” he said.
But his amendment was ruled out of order. As of late last week, Republicans were seeking an alternative funding source for the $700 million, according to a knowledgeable source.
Healthcare groups are girding themselves for the renewed legislative activity. There was a significant increase in lobbying spending by major stakeholders in the first quarter.
The American Hospital Association, the Pharmaceutical Research and Manufacturers of America and America's Health Insurance Plans all reported double-digit percentage increases over the first quarter of 2014, according to the Senate's Lobbying Disclosure Act Database.
The American Medical Association, which successfully pushed for the Medicare physician-payment reform legislation, spent more than $7 million on lobbying during the first three months of 2015, up 7% from the same period last year.
Overall, healthcare lobbying totaled $130 million in the first quarter, according to an analysis by the Center for Public Integrity. If that pace continues throughout the year, healthcare groups will have spent more in 2015 than in any year since the 2010 passage of the Affordable Care Act.
Hanging over all healthcare policy discussions is the King v. Burwell case before the U.S. Supreme Court, which could erase premium subsidies in about three dozen states and throw the health insurance market into chaos. A ruling is expected by the end of June.
Republicans have made tentative moves to offer an alternative if the court strikes down the subsidies, seeking to at least delay the pain for millions of Americans who would lose coverage. Sen. Ron Johnson (R-Wis.) has introduced legislation, with the support of GOP leaders, that would extend subsidies until 2017. Sen. Ben Sasse (R-Neb.) has proposed replacing the current subsidies with a new system that reduces premium subsidies over time.
Still, that looming apocalypse hasn't discouraged Congress from taking up other healthcare measures. In fact, Drinker Biddle's Halpern Paul argues that it's had the opposite effect by eliminating the politically toxic issue of Obamacare from the agenda. “That kind of opened up some room on the dance card,” she said.