John Williams: Hello again, everybody. Welcome to another episode of Inside Baseball, a look at healthcare, politics, and policy in Washington, part of Hall Render’s Practical Solutions podcast series. I am John Williams, managing partner of Hall Render’s Washington, D.C., office. As always, I am joined by my colleague and D.C. cohort, Andrew Coats. Andrew, how are you?

Andrew Coats: Doing good. How we doing?

John Williams: We’re doing all right. We’re doing all right. Not sure what I can say about Congress in that regard. I mean, they’re continuing to do what I can only refer to as a slow roll into the first session of the 118th.

Andrew Coats: One of the slower starts to a Congress that I can remember.

John Williams: Yeah, it has been. It has been really slow. And speaking of slow, I’m going to touch base on some of that stuff real quick, but we have something rather exciting in store for the podcast later. You want to tell everybody about it?

Andrew Coats: So everyone… Not everyone, but a lot of people do fantasy sports, and you draft players that you think will have a good year in whatever league. We’re going to do a fantasy draft for D.C., and by this I mean there’s going to be a healthcare focus, but also just we’re going to draft items that we think you’re going to be reading about or hearing about in 2023. How we score this, I don’t know. There’s no first-based way, but I think it’s a fun way to kind of hit on some of the big issues that we’re going to be hearing about this year. And we’ll look back at the end of the year and see who had the better team.

John Williams: Or at least a way to fill up this podcast since there’s not too much to talk about, at least as far as Capitol Hill is concerned. And I’ll sort of do some housekeeping on that side real quick before we dive into the draft. When I say it’s slow, I mean slow as in the Senate has passed one bill that makes technical corrections to the Controlled Substances Act and nothing else. They’re really moving slowly over there. I mean, they’re doing confirmations for judges and executive-branch positions, but nothing really on the legislative front. The House has passed 28 bills. Only three of them are even related to healthcare. And those three deal with either ending the vaccine mandate or the public health emergency, so not much legislative productivity.

The Senate HELP committee did hold a hearing on workforce shortages. It was the first HELP hearing for the new chairman, Bernie Sanders, and ranking member, Bill Cassidy. That may result in some legislation down the road, but really nothing for now. On the administrative executive-branch side of things, I do want to note for everybody that the DEA released a long-awaited proposed rule on prescribing controlled substances via telehealth. That does not seem to have made anyone very happy. They did it after 6:00 PM via a press release, which is essentially an agency’s way of hoping nobody’s going to notice for a few days. Normally, that stuff goes to the Office of Information and Regulatory Affairs, which then publishes it in the Federal Register. Everybody gets notice that it’s at OIRA. We got nothing but a press release. It has reached the Federal Register and been published.

So the gist there is that they’re not adopting what has been in place during the pandemic as far as the prescription of controlled substances via telemedicine. During the pandemic, DEA-registered practitioners could issue prescriptions for controlled substances without conducting an in-person medical evaluation if they met certain conditions. Under these new rules, there is some flexibility, in that telemedicine prescriptions would be authorized when a qualifying telemedicine referral has been made by another practitioner. So there is that flexibility that didn’t exist before. But under the new rule, when you don’t have a prior in-person exam or a qualified referral that I just mentioned, prescriptions are limited to 30 days, a 30-day supply. You have to search the state Prescription Drug Monitoring Program. The prescriber must be licensed in the originating and the distant site location. So wherever the doc is, he’s got to be licensed. And whatever state the patient’s in, the doc has to be licensed.

No Schedule II drugs or opioids can be prescribed except subject to the 30-day supply limit up above, unless you’re talking about buprenorphine, which is for opioid-use disorder. And they’re giving everybody a six-month grace period to comply. So there’s more on that on Hall Render’s website under our resources tab if you would like more information on that proposed rule.

Andrew Coats: Real quick on just the workforce shortages HELP hearing, I tracked that. I thought it was interesting. I wanted to see kind of how Bernie and Cassidy would get along in their first meeting. But it was, I think, just worth noting, Bernie talked about kind of legislation that was needed regarding workforce shortages this year from the Senate. And he mentioned expanding the GME program, which actually I think that’s finance committee. He mentioned that as a must-do and expanding the Teaching Health Center Program as well as nursing shortages and emergency medical services.

John Williams: That’ll be interesting because there were 200 new GME slots in the omnibus last December. A hundred of those went to psychiatry. So it’ll just be interesting because some people will argue, well, we already did that in December, but-

Andrew Coats: Right.

John Williams: It’s certainly something that… I agree with you. It’s certainly something that needs to be addressed. I had a chance to talk to Bill Cassidy a couple of weekends ago, and we touched on this, and he also noted that that’s something he’s looking forward to working with Chairman Sanders on.

Andrew Coats: Right. And Cassidy did mention the government doesn’t have to do everything, and he talked about how they need to address physician burnout, which he thinks is partly due to overregulation by the government. So there’s certainly differences there between the two of them, but also some areas that they can work on.

John Williams: Exactly. Okay. So with those housekeeping items out of the way, we thought we’d have a little fun in the prognostication department. Andrew, do you want to tee this up?

Andrew Coats: Yeah, absolutely. We put together about eight different items, and between the two of us, we’re going to draft those items, which we think will be newsworthy this year. John, I think we did a coin flip beforehand, and you won the toss. So you get the first pick of our 2023 Fantasy D.C. things draft.

John Williams: Very good. Well, I will go first and not defer, and my first selection is Ron DeSantis is running for President. I know, surprising. But he will not announce until after Memorial Day. So I’m walking out on a really big limb with that one. I know. He’s got a book that’s come out this week, apparently doing very well, at least as far as Amazon’s concerned. He’s been making visits to other states. He’s doing all the things that you’re supposed to do when you’re preparing to run for President. So, DeSantis running for President, but not announcing until after Memorial Day.

Andrew Coats: Why do you think after Memorial Day? Any reasoning behind that?

John Williams: Well, because he’s really in no rush. It doesn’t, at least, seem like it. The legislative session in Tallahassee is, I think, getting close to finishing up. And I know that he’s going to want to… Or at least he plans to highlight a lot of the legislative accomplishments he will have had in that session of the general assembly down there. So I think he’s waiting until that’s wrapped up. And frankly, I don’t know if there’s anything in it for him to announce sooner rather than later, unless Trump-

Andrew Coats: I agree. When you have a national kind of name and platform that he does… I mean, I guess you could say the local politics of Iowa and New Hampshire, you want to get up there and start locking down votes and donors. But he has such a big platform. It’s not like Nikki Haley to John Sununu, someone who’s not known that needs to get out in front and get people to recognize them.

John Williams: Well, and somebody else had an article, I think it was maybe The Washington Post, talked about this weekend summit he had down in Miami a couple of weekends ago, where he had all these big-dollar donors in the Republican Party fly down there and spend the weekend meeting with him and his political team, and a lot of people down there at that event who have previously supported Trump. So he’s courting the donors. He’s releasing the book. He’s making the visits. I found it interesting that he’s… Instead of going to Iowa or New Hampshire, he’s been to New York and Illinois. So a little bit out-of-the-box strategy there early, where most people running for President, their first trips are usually to Iowa or New Hampshire or some early primary state. So yeah, so running for President, not announcing until after Memorial Day.

Andrew Coats: Little history note. You know who announced really early, and this has always been kind of the case study of why you announce early, was Jimmy Carter announced a month after the ’74 midterms. His famous kind of stump speech on that was he told his mom he’s running for President, and she always said, “President of what?” But that’s always been regarded as why you get in. But of course, Carter wasn’t really known then, right? So he had to get out there and get up and get to those states early on.

John Williams: Did not know that. Did not know that.

Andrew Coats: A little Jimmy Carter history for you.

John Williams: There you go. All right, your turn.

Andrew Coats: All right. So I’m looking across the board here, and with my first pick, I’m going to take Kevin McCarthy’s 2023 playbook. I think be prepared to read a lot of, if you’re a Politico or Bloomberg reader, a lot of headlines mentioning McCarthy’s playbook. And of course, this is true with all Speakers of the House, right? We’re all eyes on Kevin McCarthy. But it raises a good point. What are McCarthy’s top goals for this year? And I think we’re starting to see that slowly trickle out. But like any Speaker of the House, probably your number-one job is maintaining the majority, right? That’s how you’re ultimately going to be measured, is if your party stays in power after the next election. So his main job, it’s a little bit under the radar, but it’s flying around the country with his most vulnerable members, a lot of the freshman members who are… That’s the easiest time to beat an incumbent, is their first term before their name gets known. So to get out there and travel and raise money with them.

Oversight is going to be huge in this Congress. I mean, this Congress is shaping up to be a massive oversight Congress, and I don’t just mean from your former committee, government reform, but it seems like all the committees are dipping their toe in the oversight water. And the plan just seems to be investigate everything right now and tie up the White House with having to respond to these investigations and hearings and subpoenas and kind of control the message, as opposed to the White House getting to dictate what the messages are.

So, we’re already seeing the big ones that are all over cable news, the handling of COVID, the Twitter censoring, the train derailment in Ohio. Those are the big ones that the administration wants to avoid, but then you have the more kind of in-the-weeds investigations going on. So waste, fraud, and abuse of authority in federal agencies, federal regulations and the burdens they create on Americans, everything down to even like hospital CEO compensation is going to be a big item this year for a number of the different House committees. So we’re starting to see that play out already.

John Williams: Yeah, you mentioned my former committee, Oversight. Well, it used to be called Government Reform and Oversight, and now I think it’s just called Oversight and Reform. Its chairman, Jamie Comer of Kentucky, I know earlier this year mentioned that how hospitals spent their provider relief fund monies is something that they were going to look at. So I think that fits… I think you’re right. That fits within that more niche area of oversight so that they’re not just looking at Hunter Biden’s laptop. They’re actually going to look at what they view as more substantive policy-related oversight and how those agencies… The same thing with PPP. They’re going to look at the PPP loan stuff. So yeah, I think you’re right.

And McCarthy overall with what, a four-vote, a five-vote majority, yeah, that playbook’s going to come in handy because it just takes one person getting sick. I mean, you see it in the Senate right now with Senator Fetterman of Pennsylvania having had a stroke and now unfortunately suffering from depression and being admitted to the hospital. The reality is it puts the Democrats in the Senate down a vote, and nobody’s sure when he’s going to be coming back. So that significantly changes the voting dynamics there. And McCarthy’s got the same problem really in the House with his narrow majority.

Andrew Coats: I certainly hope the best for Senator Fetterman.

John Williams: Yep.

Andrew Coats: Never like to see that, but it’s going to bring Kamala Harris back up to the Hill quite a bit to break ties in the Senate with the closer margin. And to your point on McCarthy kind of holding his party in line, he has to maintain the fringe element of the House, these members who grab a lot of headlines. I think we saw a certain member from Georgia calling for a national divorce last week. And let’s be honest. Every Congress has these members, and this goes back to the days when we were on the Hill, right?

John Williams: Right.

Andrew Coats: But the problem is or McCarthy’s problem is he really called in a favor to get the gavel with this group.

John Williams: Made a lot of promises. Yep.

Andrew Coats: Yep. I liken it to… One of my favorite movies is Goodfellas, and that scene when the restaurant owner goes to Paulie and asks to partner with him in running his restaurant, and there’s that moment when Paulie looks at him and says, “Yeah, that’s not even a fair deal.” It’s kind of similar to the Speaker vote, where I think one of the House members, maybe it was Chip Roy, I’m not sure which one, said they finally agreed to McCarthy, to vote for McCarthy as Speaker when they couldn’t think of anything else to ask for. So…

John Williams: That’s true.

Andrew Coats: How will the far right treat this Congress? Will it be similar to the restaurant in Goodfellas, which essentially burned down, right? I think that’s going to be interesting and see how McCarthy deals with that. And then he also has the debt-ceiling fight coming, whether that gets raised or lifted. I think that comes to a head as early as July and September at the latest. So you’re going to have this stare-down between the White House and McCarthy. Republicans never win on these.

John Williams: No. Well, you’re going to have a stare-down between McCarthy and the people in the caucus that you’re talking about.

Andrew Coats: Right.

John Williams: You’re going to have that stare-down first before he even gets to negotiate with Schumer or the White House.

Andrew Coats: Exactly. So be prepared to read a lot about extraordinary measures and the federal government on the brink between now and then. In the past, it’s always worked its way out. It’s worked itself out somehow, but that’s certainly going to be in the news. That’s kind of an overview of his playbook, so I shift back to you with your second pick.

John Williams: Well, my second pick in our draft is the highly entertaining DSH cuts fix.

Andrew Coats: Ooh.

John Williams: Yeah. Disproportionate share hospitals. If everyone will recall, there’s about $8 billion in ACA-related DSH cuts that have been postponed ever since the ACA passed. Folks will remember that part of the structure of the ACA is that because everyone was going to do Medicaid expansion in the states, that states didn’t need as much Medicaid funding. So there’s $8 billion in Medicaid cuts that can be made. Well, we all know how that worked out in states that chose not to expand Medicaid. So in order to prevent these cuts from taking place, Congress has passed legislation sort of kicking that can down the road for so many years at a time, and the last postponement expires at the end of this fiscal year, so September 30th. And the cuts will then start again on October 1st if Congress doesn’t do anything.

It is my pick that Congress will pass legislation to postpone the DSH cuts again. That will be obviously a healthcare bill, which means that, given the political dynamics and the makeup on the Hill and divided government, it might be the only healthcare-related bill that passes this year. And if that’s the case, then we may see more items in that bill than just the DSH cuts fix. But that is my second pick for our draft, is the DSH cuts fix.

Andrew Coats: Yeah. I like that pick because, as you mentioned, there’s not a lot of healthcare vehicles moving this year, and that’s going to be the one that everyone kind of tries to get a hook into. So we’ll see if Congress keeps that clean or what it does with it. But there certainly will be a lot of news items, and that will be mentioned in no shortage of meetings up on the Hill this coming year. With my second pick, and I really like this pick. I feel like I’m getting a good value pick here. I’m going to go with Biden getting challenged in a primary. And we haven’t seen… It’s been a long time. We haven’t seen a sitting president get challenged since the pre-internet days. But if President Biden does get challenged, and I’m talking about a major candidate, not-

John Williams: So not Marianne Williamson, because she’s already announced that she’s challenging him. So you’re saying that Marianne Williamson is not a serious candidate?

Andrew Coats: I guess I am.

John Williams: Not that I disagree with you, but…

Andrew Coats: But if a bigger name… Think back when Eugene McCarthy challenged Johnson, someone of that ilk.

John Williams: Oh, yeah. Well, you mentioned Carter, right? I mean Ted Kennedy, right?

Andrew Coats: Oh, in 1980.

John Williams: Yeah.

Andrew Coats: He challenged Carter, and that really weakened him. And I think Kennedy, he was clearly… He wasn’t going to win that primary, but he wouldn’t pull out of the race.

John Williams: No. He went all the way to the convention and gave that famous speech. Yeah.

Andrew Coats: Exactly. And the final moment… Back when this was just you had the major networks showing the convention. The final moment of that convention was Carter’s acceptance speech and Kennedy up on the stage, and they didn’t join… They didn’t do the political kind of hands of unity.

John Williams: Right, right.

Andrew Coats: So that’s another example. Ford got challenged by Reagan in ’76.

John Williams: Indeed. Sure did. Does the challenge against Biden come from the progressive Bernie Sanders/AOC wing, or does it come from, I guess, the more moderate wing?

Andrew Coats: You’re right. You’d think it would be the progressive wing. But at the same time, President Biden has been a fairly progressive president in the policies he’s pushing and the White House are pushing. And I would think… If I’m in the White House advising President Biden and he wants to run again, I’d be saying, “You may want to start shifting to the center here sooner than later and start running on some issues that can grab more moderate voters.” So I don’t know where that challenger would come from, but I do know if you’re the White House, you certainly want to do what you can to sort of weaken potential challengers that would be a threat.

John Williams: Well, and I think they’ve done that systematically by the way that they’ve changed up the primary system so that they’re not going to Iowa. They’re not going to do that. They’re going to go to the states where Biden is strongest, right? South Carolina. Right out of the gate, they’re going to go to states where they know he’s not at risk of losing.

Andrew Coats: Yeah, no, I completely agree with that. And I think you look back at when there were a lot of challenges to sitting presidents, and that was what? The late ’60s, ’70s, Watergate, Vietnam, just a general sense of government overreach. And we’re in a very similar… There’s different reasons, but there’s a lot of anti-Washington sentiment right now. So I think this is something we could see. And if it were to happen, I think it’s bad news obviously for President Biden and national Democrats in 2024.

John Williams: Very good. Well, I guess we’re what, to my third pick?

Andrew Coats: Third pick.

John Williams: All right. Well, and my third pick in our fantasy, I guess, draft or whatever we’re calling this, I am going to tee up the ever… Oh, I don’t even know what the right word for it is. It’s certainly not entertaining, but it is interesting, I think, is a workplace violence regulation. The administration… And every administration does this. They put out a regulatory agenda at least twice a year, and it lists all of the regulations that are either in the process of being finished or mid-draft or whatever. But it also lists the regulations that are in the pre-writing phase. So this agenda is what we look to to get a sense of what might be coming up on the regulatory front coming out of HHS. And this one actually is not an HHS rule. It is a Department of Labor rule called the Prevention of Workplace Violence in Healthcare and Social Assistance.

It’s in the pre-rule stage. It’s being handled by OSHA. So it is a DOL, again, a DOL rule. OSHA published a request for information way back in 2016, where they solicited information mostly from healthcare employers, workers, other healthcare subject-matter experts on the impact of violence and prevention strategies and anything else along those lines that would be useful to the agency, to OSHA. There was a broad coalition of labor unions, the nurses’ unions, that petitioned OSHA to do something, to set some sort of standard along those lines. OSHA recognized the need to do that. Of course, 2016, 2017, we’re talking about when we had a change of administration, right? So that went on the back burner during the Trump years, and now it looks like it’s come back.

The House of Representatives during the last Congress when Democrats were in the majority, they did pass a workplace violence rule that was never taken up by the Senate. That rule would’ve given OSHA a significant amount of regulatory authority in this area. For that reason, it was strongly opposed by the American Hospital Association, the Chamber of Commerce, other business groups, I guess, if you will, and a lot of healthcare or hospital-related groups opposed it too. So this may be the administration’s attempt to jumpstart that again. So sometime this year, I think we are going to see a proposed rule on workplace violence come out of OSHA.

Andrew Coats: Yeah, it’s interesting the timing with Marty Walsh just leaving DOL as secretary and taking another position. So we’ll see what the new labor secretary that they… if they can get the nominee in confirmed, if it has to wait for them to kind of go through the confirmation process, which could be controversial from the sounds of it. So that’s definitely going to be in the news and something to watch. It’s a good third-round pick.

John Williams: Thank you.

Andrew Coats: With my third pick, I’m going to go with a subject you hear a bit about, and it’s really kind of ratcheted back up in the news of late, and that’s congressional earmarks. Now, recall in what, two years ago, the Democrats ended a 10-year moratorium on federal earmarks. And earmarks are, they’re basically small grants to projects in congressional districts or states. And by small, I mean in the $100,000 to $4 million range. The thinking is you attach these projects to annual spending bills to ensure bipartisan buy-in, so bills are passing with not just party-line votes.

John Williams: Yeah, let’s call it greasing the wheel, right? That’s greasing the legislative process. Let’s just call it what it is.

Andrew Coats: Yeah. The optics have never been good really for either party here, but particularly for Republicans. The bridge to nowhere, right? Google earmarks, and you come up… One of the first hits is the Heritage Report that calls into question… This is recent. This is 2022. 1.6 million for the equitable growth of the shellfish industry in Rhode Island, or 4.2 million for sheep experiment station infrastructure improvements in Idaho, and 3 million for the Mahatma Gandhi Museum in Houston.

So we’re starting to see these get brought back up again and bandied about in the news. But at the same time, the members that bring these up know that if it’s Congress not giving out the grants, then it’s going to be unelected bureaucrats and the agencies doing it. So it’s an interesting kind of dichotomy here. I think one of the wow moments, and we often will send each other texts or headlines, was late last year, and I forget if you sent it to me or I sent it to you. But it was House Republicans voting to keep earmarks in place for this Congress and by a big margin. It was over a hundred votes. So I’m playing a little bit of a long game here, but I’m predicting by fall, you’re going to continue to see earmark bashing in the Congress, especially in the House.

John Williams: Well, yeah, yeah, earmark bashing in the House. And we just learned in the last 24 hours that there are certain types of earmarks that House Republicans are just not going to do. And the House Appropriations Committee has announced that there are certain accounts, they refer to them… you can think of them as agencies, in general, that they’re not going to do earmarks for this year. And one of those is the Labor HHS appropriations bill. They’re not going to do earmarks. So whether it’s… Take a pick of an agency under HHS, whether it’s SAMHSA or-

Andrew Coats: HRSA.

John Williams: … CMS or HRSA or whoever it, HRSA and SAMHSA being good examples of agencies that have been responsible for distributing earmarks that were approved by Congress in the past. Well, House Republicans said last night that “We’re not doing them. We’re not going to do Labor HHS earmarks.” So hospitals, health systems, a lot of folks in the healthcare space that were hoping to get the House of Representatives to… or their congressperson to put in an earmark request for them are going to be out of luck this year. So yeah, you’re right. The bashing is going to continue.

Andrew Coats: What’s interesting is under that Heritage Report, the next link was a Brookings Report. Now, Heritage being the conservative think tank, Brookings being the more liberal. They talked about that while Democrats sought more earmarks in 2021, 2022, the Republicans actually asked for more money. So I think they eliminated the defense account. They eliminated, as you mentioned, the HHS account. By doing that, that may be a way of controlling the spending that comes out.

John Williams: Yep, yep. I think you’re right.

Andrew Coats: All right. Last pick.

John Williams: Okay. For my last pick in our political draft, I’m actually going to go with the relationship between Bernie Sanders and Bill Cassidy will be more amicable than folks might have anticipated. The interesting thing about that committee is that if Republicans would’ve gone by seniority, then Rand Paul would’ve been next in line to be the highest-ranking Republican instead of Bill Cassidy. And the idea of Rand Paul and Bernie Sanders being responsible for running a committee together would’ve been just the height of political theater. That would’ve been must-watch TV as far as political geeks like me are concerned. But there would’ve been areas too where they would’ve worked together, I think. They would’ve both enjoyed bashing drug companies together.

But I do think that Cassidy and Sanders are going to work better together than people think. And I have a little bit of insight on this, in that I was able to talk to Dr. Bill Cassidy about this a couple weekends ago and asked him about his relationship with Sanders, and he said that he gets along with Sanders pretty well. There’s not a lot of animosity there. There are going to be certainly things that they don’t agree upon. Dr. Bill, being a doctor, certainly wants to decrease the regulatory burden on physicians so they can spend more time practicing instead of doing paperwork and complying with regulations. I’m not sure there’s a regulation Bernie ever saw that he didn’t like.

But there is other areas where I think there is room to work together. We talked about workforce shortage being one of those earlier, but also in behavioral health. Behavioral health is a huge issue for Bill Cassidy for personal family reasons, and I know that’s also been one that’s been a big issue for Bernie Sanders as well. And Cassidy is a member of what’s known in the Senate as the Gang of Eight. It’s these eight Republicans that have a history of working across the aisle on bipartisan legislation to get bipartisan legislation through the Senate. So I think you’re going to see a better working relationship between Cassidy and Sanders than I think a lot of people had anticipated.

Andrew Coats: Yeah, I agree. And both these members are not afraid to jump in the water on any healthcare-related issue. So there’s going to be no shortage of headlines and news coming out of that committee and action coming out of the HELP committee on healthcare.

John Williams: Indeed.

Andrew Coats: All right.

John Williams: All right. Last one.

Andrew Coats: The last one. And with every fantasy draft, you need a good sleeper, and I think there’s no better sleeper than what I’m going to take in the fourth and final pick: nonpartisan advisory commissions and panels. And by this I’m talking about MedPAC and MACPAC. Now, who is MedPAC? MedPAC is the Medicare Payment Advisory Commission, which was created by Congress in 1997. It advises Congress on issues impacting Medicare, particularly Medicare reimbursement. For over a decade now, John, you and I, we’ve written newsletters and D.C. updates, and for the large part, this decade has been filled with a lot of healthcare news, whether it’s passage of the ACA, the attempts to repeal the ACA, COVID, all the massive spending to deal with COVID. There’s been no shortage of news. But one constant is always, in the healthcare world, there’s always reports coming out of MedPAC and MACPAC. MACPAC is kind of the sister to MedPAC in that it deals with Medicaid.

These are important, these reports that come out, and they come out… They meet monthly or bimonthly, and they have annual and semi-annual reports. They’re important, and it’s really how healthcare policy is made. John, you and I have both been congressional staffers, and you don’t just learn things by sitting inside of Longworth and Rayburn and Cannon. You have to read these reports and find out what nonpartisan experts are advising Congress on in regards to Medicare payment. And I think in the first year without major healthcare policy news coming out of D.C., get ready to hear a lot more about these MedPAC reports. They’re highly technical. They’re in the weeds. Hence, the sleeper nature of my pick. But it’s a very much underrated facet of healthcare policy.

John Williams: You’re right. It is certainly in the weeds over there. They’ve got some pretty deep policy expertise. People that get appointed at MACPAC or MedPAC, they’re typically from outside of Washington. These commission members are hospital CEOs or physicians or people who work in their day jobs in healthcare, and they’re certainly subject-matter experts. And then you’ve got the staff at these commissions who are also really good subject-matter experts on this stuff. So yeah, I think you’re right. I think they’re going to get a lot more attention just because there’s not going to be a ton happening on the Hill, so people are going to be focused… At least folks in the D.C. healthcare media who need stuff to write about are going to be looking to these commissions a lot more.

The interesting part I’ve always found is that… Take MedPAC, for example. They make all these recommendations to Congress on what Congress should do on Medicare policy, and that’s what they’re charged with doing. That’s what Congress asked them to do. That’s why they exist. Yet, you see all these recommendations that they make to Congress all the time that Congress doesn’t pay attention to. I mean, they pay attention to some of them, but a lot of them they don’t, but…

Andrew Coats: Yeah.

John Williams: I think we’ll just have to wait and see what they come up with that’s new, but I think they’re definitely going to get some more attention. You’re right. Well-

Andrew Coats: So that does it.

John Williams: Yeah, I guess we’ll have to see how it all plays out, as always. And however it all plays out, we’ll be there to tell you about it here on Inside Baseball. So thank you for joining us on this edition. As always, if you’d like to receive more information about what Andrew and I do or how we provide federal advocacy services to our clients, please visit our website at hallrender.com or reach out to me at jwilliams@hallrender.com or Andrew at acoats@hallrender.com. And one last disclaimer: Please remember, the views expressed in this podcast are those of me and Andrew only and do not constitute legal advice. So long, everybody.