Appropriations and Budget, Hill, Administration, and Health Policy Updates

Appropriations and Budget Updates

As Congress reconvenes for its lame-duck session, lawmakers are under pressure to complete appropriations and other key legislation before the CR expires on December 20. In addition to government funding, priorities include the National Defense Authorization Act (NDAA), the Farm Bill, and hurricane relief aid, all of which may serve as vehicles for additional policy reforms. Senate Democrats and President Biden are also aiming to confirm judicial appointments before the GOP takes control of the Senate in January.

In the House, key Republican appropriators, including Representatives David Valadao (R-CA), Dan Newhouse (R-WA), and Juan Ciscomani (R-AZ), secured victories in their elections this week, strengthening the GOP’s House majority for the 119^th Congress.

With internal party dynamics in focus, Speaker Mike Johnson (R-LA) is balancing differing views within his caucus with respect to FY 2025 appropriations. While some conservatives push to extend the government funding deadline into early 2025 to avoid compromises with Senate Democrats and the Biden administration, Punchbowl reported that Majority Leader Steve Scalise (R-LA) advocates for completing the FY25 appropriations by extending government funding thought September 2025, instead of punting it until the beginning of next year (subscription required).

Additionally, congressional Republicans are assessing the potential of budget reconciliation for advancing legislative priorities next year, with incoming Senate Majority Leader John Thune (R-SD) urging tempered expectations due to procedural limitations, while House Budget Chair Jodey Arrington (R-TX) emphasizes the importance of seizing all reconciliation opportunities without targeting major entitlement programs. The outcome of these discussions will shape Congress’s closing agenda and set the stage for the incoming administration’s policy direction.

Hill Updates

• This week one of the first priorities was selecting leadership, with House GOP members unanimously re-electing Speaker Mike Johnson (R-LA) and Majority Leader Steve Scalise (R-LA) for the new Congress. The full House must vote to elect Speaker Johnson when the next Congress convenes in January.
• Senator John Thune (R-S.D.) will become the next Senate Majority Leader after winning a 29-24 vote among Senate Republicans, succeeding current Minority Leader Mitch McConnell (R-KY), who is stepping down from the role in January. Senator Thune defeated Senator John Cornyn (R-TX) in the second ballot, with Senator Rick Scott (R-FL) eliminated in the first round.
• Republicans in Congress are considering major changes to Medicaid as they prepare to take control of Washington. Senator John Cornyn (R-TX) suggests providing states with a lump sum to cover medical expenses, known as a block grant (subscription required). Republicans would need a budget reconciliation package next year to make substantial cuts to Medicaid.
• House Republicans Brett Guthrie (R-KY) and Bob Latta (R-OH) are competing to lead the House Energy and Commerce Committee, which will shape health policy in the 119th Congress, including possible changes to the Affordable Care Act (ACA). Both have extensive policy experience and voted to repeal the ACA, though neither supports another outright repeal attempt (subscription required). The decision will depend on factors like seniority, relationships within the committee, and fundraising ability.
• In a new letter to Government Accountability Office Comptroller General Gene Dodaro, House Energy and Commerce committee Republicans have requested a review of the laboratory safety program structures at the CDC, FDA, and NIH. The full letter is available here.
• Representative Kathy Castor (D-FL) is seeking the lead Democratic position on the House Energy and Commerce Committee’s Energy, Climate, and Grid Security Subcommittee while also prioritizing hurricane recovery and advocating for a disaster aid package (subscription required). Meanwhile, current top Democrat on the subcommittee, Representative Diana DeGette (D-CO), has announced her bid for the ranking member role the Health Subcommittee.

Administration Updates 

• President-elect Donald Trump announced a new “Department of Government Efficiency” led by Elon Musk and Vivek Ramaswamy, promising large-scale structural reform and the goal of cutting $2 trillion from the federal budget. Congress still holds the purse strings for any planned cuts.
• President-elect Donald Trump will nominate Robert F. Kennedy Jr. as Health and Human Services secretary, if confirmed, Kennedy has signaled he will make drastic changes at federal health agencies including FDA, CDC, and NIH.
• Amy Comstock Rick, former president of the Food and Drug Law Institute, has been appointed director of strategic coalitions at the FDA’s Rare Disease Innovation Hub (subscription required). She will facilitate stakeholder engagement and analyze drug approval data, aiming to bridge policy gaps between drug and biologic centers and enhance dialogue with rare disease advocates.
• The FDA and the Department of Veteran Affairs (VA) are set to launch the first intergovernmental health artificial intelligence lab, allowing AI tools to be virtually vetted for safety and effectiveness. The lab will allow testing with VA data, ensuring security and privacy.
• The National Academies of Sciences, Engineering and Medicine has warned that FDA enforcement of diversity and post-market requirements for trial sponsors pose challenges to improving diverse representations in clinical trials (subscription required). The report highlights the Food and Drug Omnibus Reform Act of 2022, which encourages more diversity in clinical trial enrollment and decentralized trials.

Health Policy Updates

• A new study found that alcohol consumption in the U.S. rose during the Covid-19 pandemic, with heavy drinking increasing from 5.1% in 2018 to 6.29% in 2022. This rise, alongside higher rates of school absenteeism, educational setbacks, overdose deaths, and mental health challenges, highlights lasting effects of pandemic stress, particularly impacting women.
• The US budget deficit widened in October, reaching $121 billion, driven by higher spending on health and defense and slowed debt-interest costs.