Healthcare & Social Safety Net - Meet the Freshmen

Healthcare & Social Safety Net

In the 117th Congress, Democrats’ signature legislation, the Inflation Reduction Act, combined tax policy, climate change provisions, and healthcare improvements – in particular, the ability for Medicare to negotiate prescription drug costs as a way to bring down consumer costs.[1]

The topic of universal healthcare promises to remain in the public eye during the 118th Congress. Last year, Rep. Ro Khanna (D-CA-17) introduced the State-Based Universal Healthcare Act of 2021 – a bill that would provide federal funds for states to create their own public, universal healthcare options to citizens.[2] The bill died in committee, but, despite Republican control of the House, its provisions could be reintroduced in the new Congress.

With concerns about COVID-19 waning, Congress has been tighter with purse strings when it comes to COVID relief funds and vaccine accessibility.[3] Additionally, Medicaid administrators are anticipating a decline in Medicaid enrollment.[4] This will dovetail with Republicans’ intent to reduce entitlement spending.[5]

While divided government is likely to make passing new, sweeping legislation difficult, prominent Republicans see an opportunity to impose limitations through the debt-ceiling and government funding process. Rep. Kevin Hern (R-OK-01), head of the Republican Study Committee’s Budget & Spending Task Force, and Rep. Jason Smith (R-MO-08), who was the ranking member on the House Budget Committee and will likely seek to be chair of the House Ways & Means Committee in the 118th Congress, both pointed to the debt limit negotiations as “obviously a leverage point,” and “one of those tools that a Republican-controlled Congress will use” to enact their priorities.[6]

[1] Alex Rogers, Clare Foran, Ali Zaslav & Manu Raju, “Senate passes Democrats’ sweeping health care and climate bill,” CNN Politics, August 7, 2022, available at

[2] HR 3775 – State-Based Universal Health Care Act of 2021, June 8, 2021,

[3] Katie Lobosco & Tami Luhby, “Here’s what’s in the $10 billion Covid-19 aid bill,” CNN Politics, April 4, 2022, available at

[4] Chris Lee, “State Medicaid Officials Anticipate the COVID-19 Public Health Emergency Will End During State FY 2023, Leading to Medicaid Enrollment Declines, Slower Total Medicaid Spending Growth and a Sharp Rise in States’ Share of Costs,” Kaiser Family Foundation, October 25, 2022, available at

[5] Jim Tankersley, “Republicans, Eyeing Majority, Float Changes to Social Security and Medicare,” New York Times, November 2, 2022, available at

[6] Jack Fitzpatrick, “Entitlement, Spending Cap Plans Linked by GOP to Debt-Limit Deal,” Bloomberg Government, October 11, 2022, available at

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