The Inside Scoop on Congress’ 2018 Healthcare Agenda

Like the rest of us, Congress has a lot of plans for what it wants to do this year. Zelis spoke with two Washington insiders – one from each side of the aisle (“R” and “D”) with a combined experience of over 40 years on the hill – to speculate on the top payer issues for Q1 2018.

Q1: What are Congress’ priorities for 1st Quarter 2018?

R and D: High on the list of congressional priorities are an infrastructure bill, DACA, entitlement reform, healthcare market stabilization, children’s health insurance plan, and sexual harassment reform.

Q2: Should we expect any healthcare legislation out of Congress in 1st Quarter 2018; for instance, will the Alexander-Murray healthcare market stabilization bill be introduced – and is it expected to pass?

R: There will definitely be bills introduced and possibly passed regarding market stabilization. I think it will be on Speaker Ryan to get his caucus in line to get this passed.

D: We have been hearing that Senator Alexander and Senator Patty Murray are starting to schedule hearings on market stabilization. I just do not think letting the market fail is palatable for Republicans for 2018. I think vulnerable House Republicans will be open to a fix even if it is a bipartisan measure.

Q3: More generally, do we expect there to be much work on healthcare legislation in the coming year; for instance, can we expect more attempts at repeal of the Affordable Care Act?  

R: It seems unlikely that Congress will be bringing up ACA repeal and replace. Senator Graham said this is dead on arrival.

D: I do not see how Congress will be able to repeal the ACA now that they used their reconciliation efforts to pass tax reform. With the Senate at 51-49, they would need 60 votes to pass a repeal effort. McConnell also assured Senator Collins that there would be fixes to the individual market in order to get her vote on tax reform.

Q4: The tax law passed at the end of 2017 “zeroed out” the Affordable Care Act individual mandate penalty, but burdensome reporting requirements for employers still remains. (For instance, employers must report the healthcare insurance status of all of their FTEs to the IRS.)  Are there any indications of whether or how the administration would roll back these now-meaningless IRS reporting requirements?

D: I think with Trump trying to drain the swamp and getting government out of the way of business, I can see this happening. Since tax reform just was enacted, it may take some time before we know the process.

R: Agree here. Nothing in Washington works in a timely fashion. I think much of what you will see is a repeal and rollback of many of the Obama regulations.

Q: How much of a role will the 2018 elections play on getting work done in Washington?

R: 2018 will be underlying for everything that will be done in Washington. Democrats are on the offensive across the country in multiple house races. Democrats are in a position to only work on issues that happen in a bipartisan fashion. If Congress tries to pass things that only appeal to the base such as entitlement reform, Democrats will target those vulnerable members on those key votes.  The Senate is still a favorable map for Republicans as they are defending less vulnerable seats.

D: Politics is always going to be a factor especially after what we saw in the Virginia and New Jersey governor races. I think Democrats will target tax reform and the individual mandate repeal. Additionally, I think the Democrats would be dumb not to engage on an infrastructure package and market stabilization. I think 2018 is tough for House Republicans. You are seeing many retirements of moderate Republicans due to the toxic nature in DC.


Zelis is always listening – to our clients’ needs and to marketplace dynamics. We continue to monitor healthcare laws and bills so that we can help you understand specific requirements at the state level and the impact those requirements could have on your business.