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Chuck Ingoglia

, National Council for Behavioral Health

Post-Election Update: What Does It Mean for Behavioral Health?

November 5, 2014 | Uncategorized | Comments
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Yesterday’s election provided a Republican wave that outpaced most pollsters’ predictions. As of this morning, Republicans picked up 7 seats, giving them a 52-43 advantage and control of the Senate.  The most likely breakdown for the 114th Congress is a 54-46 Republican majority in the Senate and with 17 races yet to be called, the GOP holds an advantage of 243-175 in the lower chamber.

What does this mean for the prospect of ending Congressional gridlock?

When it comes to enacting major legislation in the 114th Congress, Republicans need to strike a balance between demonstrating they can govern by passing moderate, bipartisan legislation and satisfying their conservative base by striking a contrast with President Obama.  There could be opportunities where both of those conditions are met, such as authorizing the Keystone pipeline and repealing Obamacare’s medical device tax, and in the long term it might portend advances on tax reform and trade measures.  For the GOP to send the President more conservative policy priorities, they may need to rely on the budget reconciliation process to overcome the threat of a filibuster.

What’s next for Congress in the next two months?

Unlike several recent lame duck sessions that saw compromises reached on major legislative items, it’s possible that extending the continuing resolution (CR) could be the only notable accomplishment ahead of 2015.  Aspiring deals are emerging on issues including tax extenders, Ebola, and Syria, but there’s no certainty as to how Senate Republicans will choose to cooperate on these measures with a pending majority in the 114th Congress.

With the government funding bill expiring in early December, leaders of the House and Senate Appropriations committees have indicated that they want to shepherd a $1.1 trillion omnibus package—containing all 12 spending bills—to enactment by mid-December.  But some Republican senators would prefer to enact another stopgap spending bill, which could give the party more say in determining the shape of the omnibus next year.

Senate Finance Committee Chairman Ron Wyden has said his top priority for the lame-duck session is a two-year deal for extending expired tax provisions.  The differences between the House and Senate about making some tax breaks permanent could complicate achieving a bipartisan agreement.  House Republicans have yet to determine whether to run with an omnibus tax bill or reauthorize the provisions individually or in smaller packages, but it’s clear that the GOP doesn’t favor extending all of the tax provisions.  A few lawmakers have been in discussions on a post-election deal that would lock in permanent tax cuts for major corporations and low-income families.  Such a deal could involve sweeteners for both Republicans and Democrats, potentially including a permanent tax break for corporate research and development, and expansions of the child tax credit, earned income tax credit and higher education tax credit.

What’s next for Congress in 2015?

Initial reactions from Senate Republican members have them encouraged from early conversations with President Obama that the changeover to Republican control in the Senate will mean less gridlock versus continued gridlock.  At the very least, it is a good sign that Senate Republicans are reaching out (and were before the election) to lay the foundation for a productive 114th session. However, only time will tell whether these efforts will lead to any major legislative agreements being achieved in 2015.

In the Senate, Majority Leader McConnell will likely face some of the same challenges that House Speaker John Boehner (R-OH) has experienced in wrangling what can be a fractured Republican caucus.  Conservatives are relishing the idea of controlling both chambers of Congress, and will be eager to pursue an agenda focused on combating the Obama administration. While there will likely be disagreements within the GOP on how to legislate while controlling both chambers of Congress, the slim majority that Republicans hold in the Senate will ultimately require them to focus on measures that can achieve bipartisan support.

What does this mean for health care policy and spending priorities?

With President Obama retaining control of the veto pen for the next two years, Congressional Republicans will not be able to fulfill campaign promises of repealing the Affordable Care Act “branch and root.” However, experts expect that Congress may be able to reach agreement on smaller-scale changes to the law, such as a repeal of the medical device tax or changes to the definition of “full time employee” that trigger the employer mandate to provide health insurance. When it comes to the Labor-Health and Human Services funding bill, House and Senate fiscal conservatives are likely to try to make their mark on health policy through adjustments to annual spending. Expect a tight fiscal climate moving forward, as advocates play defense on key priorities like SAMHSA funding and medical research.

Will Republicans be able to sidestep the threat of filibusters?

The reconciliation process is intended as a way for Congress—at the end of the year—to tweak spending and/or revenue legislation that had been passed earlier that year to take account of economic developments. The fast-track feature of the process means that the Senate’s normal safeguards for the minority would not apply – and since debate would be limited, supermajorities to end debate would be unnecessary and the filibuster would be irrelevant.

Senator McConnell has been straightforward about his willingness to use reconciliation to frustrate the administration and advance legislation that could not meet the 60-vote threshold to pass through regular order. Now that the GOP will be controlling both chambers of Congress, they risk taking the brunt of responsibility for the perception of a gridlocked Congress.  However, it is believed that instead, the next two years may actually be far more productive than the previous four, if Republicans used the threat of their budgetary power to forge compromises with congressional Democrats and the White House.

How will this affect President Obama’s nominees?

With Republicans holding a majority in the Senate, it will be even more difficult to advance President Obama’s executive and judicial nominees – a process that hasn’t exactly been easy even with Democrats controlling the upper chamber. Republicans are unlikely to support any of the President’s potential nominees.  President Obama will also need to fill numerous other executive branch, ambassador and federal judicial nominations in his final two years in office – all of which require Senate confirmation.