Washington Update: Monday, February 13, 2023
CVS announces it will expand into yet another healthcare provider type.
As is often the case, the biggest news from an evolving American healthcare system didn’t come from Washington last week. CVS Health announced a deal highlighting the further consolidation of insurers and providers. CVS says it will acquire Oak Street, a network of 170 primary care clinics with a geriatric focus. The deal was valued at $10.6 billion. CVS already owns Aetna (the second largest insurer), Caremark (the largest PBM) and Signify Health (a large home health provider).
Both Democrats & Republicans say Medicare cuts won’t happen this year.
President Biden gave his State-of-the-Union speech last week and now both parties are saying they will not attempt to cut Medicare this year (and likely next year too). To parry Democratic criticisms and to show their own Medicare bona fides, Republicans are even criticizing the Biden Administration for trying to reduce Medicare Advantage (MA) rates. Republicans have generally believed managed care would be a better long-term model for Medicare’s future.
And so… what do Republicans want to cut before debt ceiling can be raised?
The latest Medicare positions are great news for hospitals, but it also begs the question about the impending fight over the federal debt ceiling. If both parties are now saying Medicare-Medicaid (25%), Social Security (22%), Defense (15%) and interest (7%) will not be cut, then that’s almost 70% of the federal budget that’s out of budgetary bounds. With $31 trillion in federal debt, it’s fair to say something needs to be done but it will be very difficult – especially in a polarized 50-50 environment.
What are the odds Donald Trump will win the Republican nomination?
The answer is higher than you may think. Polls show Trump might lose in a one-on-one matchup with a Republican like Ron DeSantis. But Trump is unlikely to face just one Republican opponent in the primaries and 2024 could be like 2016. Trump seems to retain a grip on about 25% of the Republican voter base who say they will vote for him in almost any circumstance. Trump was able to win in 2016 with a similarly small but committed plurality that allowed him to knock off other Republicans.
Senate Democrats will face a challenging 2024 campaign environment.
The 2024 elections for US Senate offer a difficult political map for Democrats, where they will have to defend 23 Senate seats, compared with only 11 for Republicans. The three most vulnerable Democrats, based on Republican voting trends, are Sen. Joe Manchin (D-WV) (+38% for Trump 2020) and Sen. Jon Tester (D-MT) (+16% for Trump 2020) and Sen. Sherrod Brown (D-OH) (+8% for Trump 2020). Still, in 2022, Republicans also lost a number of races thought to be winnable.
Sen. Bob Casey (D-PA) will likely run for reelection.
Sen. Bob Casey is up for reelection in 2024 and will likely be challenged by several Republicans (See below.) Sen. Casey was recently diagnosed with prostate cancer but says he is marching ahead in his campaign. Casey first won election to the Senate in 2006, beating then incumbent Sen. Rick Santorum (R-PA) by almost twenty points. Casey won reelection in 2012, beating Tom Smith (R), 53-44 and in 2018, beating Lou Barletta, 55.7% to 42.6%.
Republican David McCormick will likely challenge Sen. Casey.
David McCormick -- Pittsburgh native, former Army officer, and former hedge fund leader – may challenge Sen. Casey next year. McCormick also ran for the Republican nomination in 2022. McCormick was narrowly beaten by Mehmet Oz – each received 31% of the vote. Kathy Barnette may also run again; she received 25% of the 2022 Republican vote.
Pennsylvania special elections clarify Democratic control of state house.
After three months of uncertainty, special elections in three special Pennsylvania elections confirmed that Democrats will control the state house – for the first time in twelve years – but it will be a razor-thin margin on only one seat, 102 Democrats to 101 Republicans. Democrats won 102 seats on Election Day in November, but three vacancies led Democrats to be in the minority when the legislative session started in January.
Now the question becomes who will become Pennsylvania state speaker
After the uncertainty of the elections with Democrats and Republicans jockeying for control, state Rep. Mark Rozzi (D-Berks County) emerged as Speaker and became an independent in the hopes of getting both parties to acquiesce. But now that Democrats are formally, if narrowly, in control, the Democratic leader, Rep. Joanna McClinton (D.-Philadelphia) is expected to take the speakership. She would be the first African American woman to serve as state house speaker.
South may soon become the US population center for the first time in history.
With millions of Americans moving South, the nation’s population center may be moving south in near future. Texas, Florida, North Carolina and Georgia are booming as people move for cheaper homes, lower taxes, and warmer weather. If this trend outlasts COVID, it will impact the reallocation of political power through redistricting after the 2030 census. (The current population center is Wright County, Missouri and likely headed south.)