Health Care on the Hill: Week of September 9, 2013

This week Congress returns to Washington, DC following their August recess and are jumping right back into legislative matters. Listed below are a few health-related hearings scheduled for this week.

Each Monday Capitol Health Record will be providing health-related highlights for the coming week.

Tuesday, September 10, 2013

10:15 a.m.
PPACA Pulse Check: Part Two
House Energy and Commerce Subcommittee on Health Hearing
2322 Rayburn House Office Building

Wednesday, September 11, 2013

2:00 p.m.
The Threat to Americans’ Personal Information: A Look into the Security and Reliability of the Health Exchange Data Hub
House Homeland Security Subcommittee on Cybersecurity, Infrastructure Protection, and Security Technologies Hearing
311 Cannon House Office Building

Thursday, September 12, 2013

10:00 a.m.
Dental Crisis in America: The Need to Address Cost
Senate Health, Education, Labor, and Pensions Subcommittee on Primary Health and Aging Hearing
430 Dirksen Senate Office Building

Thursday, September 12, 2013 and Friday, September 13, 2013

In addition to the above Congressional hearings, the Medicare Payment Advisory Commission (MedPAC) will be meeting in Washington, DC on Thursday and Friday to discuss recommendations regarding Medicare payment policies. MedPAC will meet at the Ronald Reagan Building and International Trade Center (1300 Pennsylvania Avenue, NW) from 9:30 a.m. to 5:15 p.m. on Thursday and 9:00 a.m. to 12:00 p.m. on Friday (agenda).


Dewonkify – Filibuster

The Word: Filibuster

Definition: A filibuster is a procedural tactic that is used to extend debate, delay a vote, or prevent legislative action. It is used in the U.S. Senate to require 60% of members to vote in favor of “cloture” to bring legislation up for consideration.  The House can cut off debate with a simple majority vote.

Used in a Sentence: “Senate leaders reached a deal on Tuesday morning to preserve the filibuster in exchange for Senate confirmation of President Obama’s long-sought first director of the Consumer Financial Protection Bureau, as well as other stalled nominees.” from “Senators Reach Agreement to Avert Fight Over Filibuster,” by Jonathan Weisman, New York Times, July 16, 2013

History:  The word “filibuster” is derived from the Spanish term filibustero which means “freebooting” and the Dutch word vrijbuiter meaning “pirate.”

Ezra Klein of the Washington Post walks through history of the filibuster and the increasing frequency with which it has been used in his May 15, 2012 article, “The History of the Filibuster in One Graph.”

Senate Advances LHHS Appropriations

The Senate Labor, Health and Human Services, and Education (LHHS) Appropriations Subcommittee met on Tuesday, July 9, 2013 to mark up their fiscal year (FY) 2014 legislation (S. 1284). The bill passed by voice vote.

On Thursday, July 11th, the full Senate Appropriations Committee took up the FY 2014 LHHS bill for consideration. S. 1284 passed the full Committee with a vote of 16-14. The bill and accompanying report are included below.

Senate Fiscal Year (FY) 2014 Labor, Health and Human Services, and Education (LHHS) Appropriations Bill by DrinkerBiddle

Senate Labor, Health and Human Services, and Education (LHHS) Appropriations Fiscal Year (FY) 2014 Committe… by DrinkerBiddle

It is unclear what will happen next. Senate Appropriations Chairwoman Barbara Mikulski (D-MD) made it clear that she would like to see this bill, and the others that have been approved by the Committee, considered on the Senate Floor. She stated in her introductory statement:  “I was dismayed to hear comments recently that we should not even consider Appropriation bills on the Senate Floor until there is a Conference Agreement on the Budget Resolution. But at the same time, six Senators have objected to a conference on the budget resolution, where this problem should be resolved.” Her full statement is available on the Appropriations website.

To date, the House has been silent on the LHHS bill. The most likely scenario is a Continuing Resolution (CR) before September 30th.

While the Senate bill may never become law, it will be used to negotiate the CR. The report is also a clear message to agencies and in many cases, agency responses to the report language are included in President’s budget the following year.

Senate Progress on FY 2014 LHHS Appropriations

The Senate Labor, Health and Human Services, and Education (LHHS) Appropriations Subcommittee met yesterday, July 9th, to mark-up its version of their fiscal year (FY) 2014 bill. The bill now heads to the full Senate Appropriations Committee for a mark-up on Thursday, July 11th at 10:00 am in Room 106 of the Dirksen Senate Office Building. The complete bill and report will likely be posted to the Senate Appropriations website after the full Committee meets (and likely approves the bill). There is still no word from the House regarding language or a mark-up.

The Senate Committee has posted a summary and chart of their bill on their website.

Dewonkify – Cloture

The Word:  Cloture

Definition:  A Senate procedure used to end a filibuster. It has become, essentially, a vote to end debate on a certain piece of legislation.

Used in a Sentence:  “The NRF [National Retail Federation] side is pretty darn near certain to prevail in this round, since the Senate’s already cleared the procedural hurdle of invoking cloture on the measure with 63 votes, leaving only a simple-majority vote ahead.” From Roll Call, “Cruz Decries Forcing Texans to Support Bloomberg’s ‘Nanny Statism’” by Niels Lesniewski, May 6, 2013

How it Works:  Prior to 1917, Senate debate could only be ended through unanimous consent. In 1917, the Senate adopted the cloture rule (Rule 22) as a method of ending filibusters. A motion for cloture requires signatures from 16 Senators; once the motion has the signatures a vote is held. Three-fifths, or 60 votes, are needed for the cloture motion to pass; if passed, debate on the bill is limited to 30 hours. Once cloture has been filed, an individual Senators may speak for no more than one hour during the 30 hour period. Any amendments to the legislation filed after cloture must be germane, or relevant to the legislation at hand.

In addition to ending a filibuster, cloture motions are a way for a Majority Leader to prevent Senators from the minority party from introducing non-germane amendments. In a closely divided Senate, continued negotiations on a bill may be necessary, since 60 votes for cloture can be unlikely.

History:  The number of cloture votes has skyrocketed, beginning in the early 1970s and experiencing another marked increase in the early 1990s. Between its invocation in 1917 and the late 1960s, zero to seven cloture votes during a two-year session of Congress was typical. In the 1970s and 1980s, cloture was used more frequently, between 20 to 60 times. The number in a single Congress spiked in the 110th Congress (2007-2008), with 139 cloture motions. In the first five months of the 113th Congress, 12 cloture motions already have been filed.

For additional information, reference the Congressional Research Service (CRS) reports, “Filibusters and Cloture in the Senate” and “Cloture: Its Effect on Senate Proceedings.”

Dewonkify – Hold

The Word: Hold

Definition: An informal practice by which a Senator informs his or her floor leader that he or she does not wish a particular bill or other measure to reach the floor for consideration. The Majority Leader need not follow the Senator’s wishes, but is on notice that the opposing Senator may filibuster any motion to proceed to consider the measure.

Used in a Sentence:

Sen. Tom Harkin (D-Iowa) has placed a hold on one of President Obama’s top healthcare nominees.

Marilyn Tavenner had previously seemed poised for an easy, bipartisan confirmation as the administrator of the federal Medicare and Medicaid agency.

But Harkin placed a hold on Tavenner’s nomination Wednesday. Harkin’s office noted his frustration at the way the Obama administration plans to spend a $15 billion fund for prevention and public health programs.

From The Hill, “Harkin places hold on top healthcare nominee”

History: The hold is an informal custom of the Senate and not a part of the formalized rules.  The Congressional Research Service notes that “the origins of the practice are unclear and lost in the mists of history,” but “probably emerged from features long associated with the Senate, such as its emphasis on minority and individual interests, the informality and flexibility of its procedures, and a legislative culture that encourages accommodation for individual Senators’ policy and personal goals.”  Since the 1970s, however, the practice has been widely used by Senators to push their policy goals and extract concessions.

How it Works: The Senate usually proceeds to its business by a series of unanimous consent agreements.  A hold is essentially a threat by a member to his or her party leader that the senator intends to object to unanimous consent and use parliamentary procedures to stall consideration of a piece of legislation or a nomination if it is brought to the floor.

The Majority Leader can still place the item on the Senate calendar, but given the amount of business that must be considered in a relatively small number of working days, the threat of extended debate is usually enough to keep the item off the agenda, at least temporarily.

Oftentimes the senator placing the hold will remove the hold if certain concessions are made.  In fact, it is now not uncommon for members to place holds on bills they don’t necessarily oppose, simply as a means of negotiating another point or issue.

While Senator Harkin made public his intention to place a hold on the Tavenner nomination, holds are more often done in secret, earning them the nickname of the “silent filibuster.”

Vote-a-Rama Ends with Passage of Senate FY 2014 Budget Resolution

Just before 5:00 a.m. on Saturday, following more than 13 hours of debate on 70 amendments, the Senate passed their fiscal year (FY) 2014 budget resolution (S. Con. Res. 8). The resolution passed 50-49. This is the first time the Senate has passed a budget resolution in four years.

In total the Senate considered over 100 amendments touching on range of policy areas. As the budget resolution is non-binding and does not carry the weight of law, the votes on these amendments can be viewed as political posturing or “test votes” on future legislation.

In regard to health policy, notable amendments included one introduced by Senator Hatch (R-UT) calling for the repeal of the medical device tax (approved by a vote of 79-20) and rejection of an amendment offered by Senator Cruz (R-TX) calling for the repeal of the Affordable Care Act (voted down by a vote of 45-54). Additionally, the Senate voted down an amendment on the House GOP Budget Plan (40-59) and voted on a number of Medicare-related issues. The CQ article “Senators Register Health Policy Positions in Budget Votes” (subscription required) provides an overview of health-related amendments considered.

Dewonkify – Vote-a-Rama

Definition: A series of stacked votes in short succession

Used in a Sentence: “A big chunk of the upcoming Senate budget vote-a-rama will be a waste of time — like votes on senators’ pet causes or generic partisan issues. But there’s some good news buried in the dozens of amendments that are coming across the Senate floor between now and Friday: A handful of them will matter.” From Politico, “‘Vote-a-rama’: The Senate budget votes that tell the tale

History: Senate rules allow for special consideration of amendments during the budget process. After 50 hours of debate on the budget, Senators may bring any remaining amendments, as long as they are germane (relevant to the legislation at hand), to the floor for a vote. The budget is not subject to filibuster and only 51 votes are needed to pass a measure. When a vote-a-rama starts, Senators are given a few minutes introduce their amendment and state their case. The opposition is usually then given a short period of time to present their argument. Then the Senate votes; each vote lasts about ten minutes. This process repeats for each amendment presented and ruled germane. Amendments may be filed any time before the vote-a-rama begins, or they may be presented any time before the voting concludes.

What it Means: Today, starting around 3:00 p.m., the Senate will begin a “vote-a-rama.” There are expected to be votes on dozens of amendments to the Senate budget resolution, some of which may be mere political posturing, some of which will serve as “test votes” for later votes on related legislation. As of Thursday evening, 130 amendments had been filed. Amendments may touch on topics ranging from the Affordable Care Act, to the Ryan Budget, to drones (for more information on what could be offered, see Roll Call’s “10 Senate Budget Amendments to Watch For“). This marathon session will allow the Senate to (hopefully) make progress on their fiscal year (FY) 2014 budget resolution – their first budget resolution in four years – before they adjourn for a two week recess.