Dear ACH Members,
Ten days have passed since the election, and we have more to share with you about what we know, what we don't know yet, and potential opportunities for health centers in 2025. Community health centers have always been a bipartisan priority, and we are confident in our ability to continue to move our ambitious policy agenda on behalf of health centers forward. We have built important relationships, developed good policies, and created a smart strategy, and we plan to use that foundation to make important progress in 2025.
Things are constantly evolving, so we will continue to keep you up to speed with everything we are learning. Please let us know if you ever have any questions, or if we can help facilitate meetings with your Congressional delegation.
Presidency
This week, President-elect Trump arrived in Washington, DC to meet with Republicans on the Hill and President Biden. Upon arrival, Trump met with the House Republican Conference where he delivered relatively high-level remarks. In a private Oval Office meeting, Biden and Trump discussed issues to address in the lame duck session, including funding the government and passing a supplemental emergency relief fund, as well as foreign relations and national security issues. Following a two-hour meeting, both Biden and Trump called for a smooth transition and peaceful transfer of power.
Cabinet Announcements: President-elect Trump has already announced a large number of his Cabinet picks, which include Elon Musk and Vivek Ramaswamy running a new “Department of Government Efficiency.” A full list of appointments can be found here, but for now our primary focus is the long-anticipated nomination of Robert F. Kennedy Jr. to lead the Department of Health and Human Services. Kennedy’s stances on vaccines, NIH, CDC, and his “Make America Healthy Again” platform have been widely known; what’s less clear are his thoughts on the current public health infrastructure including Medicaid, Medicare, and HRSA. (POLITICO breaks down Kennedy’s key priorities.) It’s unclear whether Kennedy will have enough Republican support to be confirmed by the Senate. ACH is prepared to work with the Trump Administration’s HHS and will make the strong case that health centers are essential to the pillars of the Make America Healthy Again agenda.
Other positions in the Department of Health and Human Services, including key agencies like the Centers for Medicare and Medicaid Services, have yet to be announced. We will continue to engage with the transition team and new administration officials to prioritize health centers on the Trump agenda and ensure that the needs of community health centers and their patients are met.
Other Cabinet nominations include sitting Republican members of Congress – Senator Marco Rubio (R-FL), Reps. Mike Waltz (R-FL), Elise Stefanik (R-NY), and now former member Matt Gaetz (R-FL). Waltz and Stefanik will be sworn in in January and will remain voting members until their confirmation processes begin, but Gaetz resigned his seat effective immediately. Florida has not filled a congressional vacancy in fewer than 148 days this century, so how long Republicans are down these votes will ultimately come down to Governor Ron DeSantis.
Finally, one thing to watch in the coming weeks is whether the Senate will allow for recess appointments. Many of Trump’s cabinet announcements have been fairly controversial, Kennedy and Gaetz are no exception, raising the question of whether the Senate will confirm them. Recess appointments, however, would allow Trump to make unilateral appointments without congressional approval. After winning his election for Senate Majority Leader, Senator John Thune (R-SD) has said “all options are on the table” to appoint Trump’s cabinet, signaling an openness to recess appointments. AP provides a thorough rundown of the recess appointment process.
Senate
Outstanding Races: Pennsylvania is the only state with a Senate race outstanding – incumbent Senator Bob Casey (D) trails his opponent David McCormick by a vote margin of .4%. While the AP has declared McCormick the victor, Senator Casey has yet to concede the race. (Under state law, vote totals within one-half of a 1 percent margin triggers a mandatory recount.) Unless Senator Casey concedes, we can expect this race to take several more days – if not weeks – as well as several legal challenges before the victor is declared. It’s worth noting that Republicans have clear control of the Senate, so this race will not impact which party is in the majority.
Leadership: On Wednesday, Senate Republicans held leadership elections, which included, most notably, a replacement for Senator Mitch McConnell (R-KY) as the next Senate Majority Leader. Senators John Cornyn (R-TX), John Thune (R-SD), and Rick Scott (R-FL) were in the running, with Senator Scott as the Trump-favored candidate. After the first round of voting (by way of secret ballot), Senator Scott came in third and was removed from the ballot. By a vote of 29-24, Senate Republicans elected John Thune (R-SD) to serve as the next Senate Majority Leader. Thune is seen as an establishment figure, while Senator Scott is seen as more aligned with the MAGA movement and incoming President Trump.
Legislative Impact: Senator Thune is a current member of the Senate Finance Committee and has a reputable history on health policy. He is one of the six bipartisan senators working on 340B program updates (SUSTAIN Act), sponsored two bills to crack down on pharmacy benefit managers, and visited a South Dakota health center during this year’s National Health Center Week. In 2008, he cosponsored the bill to reauthorize the health center fund and went on record as supporting annual increases in the fund. South Dakota, which Thune represents, relies on telehealth and rural health clinics so he’s well versed in these issues as well.
Where health policy fits into Thune’s agenda will largely depend on Trump’s priorities, which will likely include changes to the ACA and Medicaid cuts (or block grants), (Health Affairs lays out potential impacts on health legislation). ACH will continue advocating for policies to support and protect health centers and look forward to partnering with Thune on these issues.
House Races
While there are still eight races that have yet to be called, earlier this week, Republicans officially won control of the House, reaching the majority threshold of 218 members. As of writing, Democrats and Republicans each flipped seven seats.
Leadership: On Wednesday, President-elect Trump spoke to the House Republican Conference before they held their leadership elections. In his remarks, Trump told members he was with Speaker Johnson “all the way.” Despite threats from the House Freedom Caucus to put up a challenger, Speaker Johnson ultimately ran unopposed and won the GOP nomination for Speaker of the House in the 119th Congress. Of note, Johnson has relied on Democratic votes to pass legislation multiple times this year, including to save his Speakership and pass continuing resolutions to keep the government funded.
In other leadership races, Rep. Steve Scalise (R-LA) retained his seat as House Majority Leader, Rep. Tom Emmer (R-MN) retained his seat as Whip, and Rep. Lisa McClain (R-MI) was elected over Rep. Kat Cammack (R-FL) to replace Rep. Elise Stefanik (R-NY) as Conference Chair.
We expect the Republican Party factions to be less fractured with President Trump at the helm, mitigating the need to work across the aisle in the House to pass legislation. That being said, with the House looking at razor-thin margins, Majority Whip Tom Emmer (R-MN) will have his work cut out for him maintaining party-line votes.
It's worth noting that Speaker Johnson still has to survive a formal vote on the House floor in January and has no room for error. With the looming government funding deadline on December 20, whatever type of spending package is eventually negotiated is sure to ruffle feathers. We will likely see rule negotiations and Committee seats used as bargaining chips for Johnson to keep his conference united on the floor vote for Speaker.
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