Meet the healthcare leaders of the new GOP Congress

Modern Healthcare – Friday, January 3, 2025
By Michael McAuliff

President-elect Donald Trump will be the new sheriff in town when he’s sworn in Jan. 20, and he has a cadre of Republican deputies on Capitol Hill ready to lead legislative efforts on healthcare.

The 119th Congress, which commences Friday, will be quite different from the previous Congress. In addition to occupying the White House, the GOP now controls the legislative branch after retaining the House and snatching the Senate majority from Democrats on Election Day.
As happens every two years, 2025 brings a fresh start. All the legislation drafted and debated in 2023 and 2024 has ceased to exist.

Lawmakers will have to start negotiations again on issues affecting Medicare, Medicaid, providers, health insurers, pharmacy benefit managers and more.

The shift from a divided Congress to a legislature entirely in the GOP’s hands is the biggest and most obvious change.

House Republicans will worry less about Senate Democrats, and Senate Republicans are newly empowered to pursue their agendas. Democrats are mostly relegated to “loyal opposition” status but still hold some sway because the Republican majorities are slim.

Republicans and Democrats have already chosen the House and Senate committee chairs and ranking minority members for the next two years. These leaders traditionally are ratified by unanimous consent shortly after a new Congress convenes.

The Republican chairs of key committees that will take the lead on healthcare are mostly familiar to the healthcare sector.

Some stability may be a welcome to an industry facing an unpredictable administration, especially if Trump get his way and Robert F. Kennedy Jr., becomes Health and Human Services secretary and Dr. Mehmet Oz is confirmed as Centers for Medicare and Medicaid Services administrator.

Senate Finance Committee
New chair: Sen. Mike Crapo (R-Idaho)
New ranking member: Sen. Ron Wyden (D-Ore.)

Crapo has been in the Senate for a quarter century. He is regarded as a level-headed lawmaker who favors traditional GOP business priorities but keeps an eye on Idaho’s populist, pro-Trump leanings. Crapo is likely to be focused foremost on renewing Trump’s 2017 tax cuts, which will expire at the end of this year.

But Crapo has taken a strong interest in the committee’s considerable healthcare portfolio, which includes Medicare, Medicaid, the health insurance exchanges, and HHS and CMS themselves. Historically, Finance Committee leaders have tended to prefer consensus decision-making. Based on that history and his own track record, Crapo is expected to lend his ear to Democrats and healthcare interest groups.

In concert with Wyden, who led the panel for the last four years, Crapo shepherded a number of bipartisan healthcare bills during the last Congress, some of which unanimously passed the committee. That included the Modernizing and Ensuring Pharmacy Benefit Manager Accountability Act of 2023 and the Better Mental Health Care, Lower-Cost Drugs and Extenders Act of 2023.

The wild card is, of course, the new administration and how the staid Idahoan interacts with a volatile White House. Crapo will get an early test when he manages the confirmation hearings and votes for Kennedy and Oz, both controversial picks.

Crapo has characteristically kept his thoughts close and offered merely tepid support for Kennedy and Oz.

After meeting with Kennedy last month, Crapo only said he supports the goal of reducing chronic disease and that they had a “good discussion about his vision for HHS priorities and the opportunity to work with the Finance Committee.” That was less full-throated of an endorsement than many other Senate Republicans voiced.

Senate Health, Education, Labor and Pensions Committee
New chair: Sen. Dr. Bill Cassidy (R-La.)
New ranking member: Sen. Bernie Sanders (I-Vt.)

Cassidy, a gastroenterologist, is the first physician to lead this committee since it added “health” to its name in 1999. The HELP Committee has no authority over programs such as Medicare and Medicaid, but its jurisdiction includes employer-sponsored health plans, public health, and agencies such as the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health.

Before entering politics, Cassidy practiced in his home state, where he established clinics for uninsured patients and ran childhood immunization programs.

While the committee’s responsibilities extend well beyond healthcare, Cassidy has shown particular interest in issues relevant to his prior profession. As a member of both the HELP and Finance committees, he demonstrated a willingness to work with senators on the other side, including the progressive Sanders, who chaired the health committee during the last Congress.

Cassidy and Sanders worked closely on a number of projects, including an investigation into the bankruptcy of the Dallas-based health system Steward Health. They also clashed at times, such as when Sanders joined with Sen. Dr. Roger Marshall (R-Kan.) to advance legislation with more community health center funding than Cassidy supported.

Cassidy’s agenda will be informed by fact-finding inquiries he initiated on the HELP and Finance committees.

For instance, he and Sen. Sheldon Whitehouse (D-R.I.) sought information from doctors on legislation to update the Medicare physician pay system and extend greater support to primary care physicians. He similarly invited hospital and drugmaker perspectives on problems with the 340B Drug Pricing Program. Cassidy has also delved into health-related issues such as artificial intelligence, cybersecurity, privacy and NIH governance.

Like Crapo, Cassidy has been noncommittal about Kennedy and Oz. Cassidy is known for keeping his own counsel, which may require treading diplomatically in the Trump era. The HELP Committee traditionally holds hearings on HHS secretary nominees, but does not have a formal role in the confirmation process.

To be sure, Cassidy is a conservative and has, for example, joined the right-wing chorus critical of President Joe Biden’s policies supporting healthcare for transgender people.

Senate Appropriations Committee
New health subcommittee chair: Sen. Shelley Moore Capito (R-W.Va.)
New health subcommittee ranking member: Sen. Tammy Baldwin (D-Wis.)

Capito and Baldwin are trading seats on the Labor, HHS, Education and Related Agencies Subcommittee because of the change in party control.

House Energy and Commerce Committee
New chair: Rep. Brett Guthrie (R-Ky.)
Ranking member: Rep. Frank Pallone (D-N.J.)

The panel that oversees a huge swathe of the healthcare system, including Medicare, Medicaid, the Children’s Health Insurance Program, and insurance will have a new boss. Guthrie succeeds former Rep. Cathy McMorris Rodgers (R-Wash.), who retired from Congress. Guthrie headed its Health Subcommittee in the last Congress. His replacement on the Health Subcommittee will be chosen this month.

Guthrie graduated from the U.S. Military Academy at West Point and has a master’s degree from the Yale School of Management. He worked for his father’s car parts manufacturing business before getting into politics in 1998.

The Army veteran was not known for his health policy chops in the past, but his attention to the minutiae of healthcare legislation earned him a reputation as something of a policy wonk during his time helming the Health Subcommittee.

Guthrie’s subcommittee had primary jurisdiction over the Lower Costs, More Transparency Act of 2023, which overwhelmingly passed the House and signaled that Republicans had grown concerned about PBMs and healthcare consolidation.

He is likely to stay the course on healthcare issues, but would find himself at the center of controversy if the GOP follows through on plans to slash Medicaid funding and curtail the health insurance marketplaces. The Kentucky exchange, Kynect, is broadly popular.

Sweeping changes to Medicaid financing will be under consideration, Guthrie said. Specifically, he supports a plan to convert Medicaid from an entitlement program with automatic funding based on expenses to a per capita system that provides states with a set amount of money per enrollee, necessitating significant cutbacks that would impact benefits, eligibility and provider reimbursements. Guthrie also aims to revisit PBM legislation that stalled last year, he said.

Pallone stays on as the senior Democrat on the committee, which he chaired from 2019-2023.

House Ways and Means Committee
Chair: Rep. Jason Smith (R-Mo.)
Ranking member: Rep. Richard Neal (D-Mass.)

The panel with jurisdiction over Medicare has the same leadership as before.

House Education and Workforce Committee
New chair: Rep. Tim Walberg (R-Mich.)
Ranking member: Rep. Bobby Scott (D-Va.)

Walberg replaces Rep. Virginia Foxx (R-N.C.) atop the committee with authority over employer-sponsored health plans. Foxx had been the panel’s top Republican since 2017.

Walberg did not mention healthcare in the news release celebrating his ascent to the chair, as befits a committee predominantly concerned with other matters.

Yet the eight-term congressman can be expected to support long-standing Republican goals of relaxing rules on coverage for people with preexisting conditions and promoting less-comprehensive, less-regulated and lower-cost forms of health coverage.

The Employee Retirement Income Security Act of 1974 all but guarantees that large-group health plans cover people regardless of their medical histories and without additional cost, while the Affordable Care Act of 2010 extends that promise to the individual and small-group markets.

Walberg was the lead sponsor of the Association Health Plans Act of 2021, which would have expanded access to AHPs and short-term, limited-duration plans, which would not have been not subject to federal rules on benefits and preexisting conditions. Trump advanced these policies through regulations during his first term, but federal courts and the Biden administration undid them.

“We have a president right now that has done it in executive order,” Walberg said, referring to Trump. “We need to put it into law.”

Scott, who led this committee in the 116th and 117th Congresses, will continue to be its senior Democrat.

House Appropriations Committee
Health subcommittee chair: Robert Aderholt (R-Ala.)
Health subcommittee ranking member: Rosa DeLauro (D-Conn.)

The leaders of the Labor, HHS, Education and Related Agencies Subcommittee are unchanged from the 118th Congress.

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