Republicans on the House Ways and Means Committee are considering dozens of proposals that could affect federal health-related programs and tax rules.
The proposals are on a long list of ideas for what could go into a big budget reconciliation package.
House Ways and Means Republicans hoped to keep the idea list confidential. Copies leaked. Democrats posted a copy on their section of the House Ways and Means website.
For a look at 10 of the ideas that could affect relatively high-income individuals, ranked according to the negative or positive size of the list creators' budget impact estimates, see the gallery above.
The proposal descriptions are edited versions of the descriptions given in the idea list.
What it means: Some of the proposals on the Ways and Means list could get through the many sources of policymaking friction and become law.
Budget reconciliation packages: Congress has been relying heavily on budget reconciliation packages to pass legislation in recent years. Special Senate budget legislation rules let the packages get to the Senate floor with just 51 votes, rather than the 60-vote majority that ordinary bills need.
The budget backdrop: Federal budget analysts estimate that the federal government will record a deficit of $1.8 trillion on $5.5 trillion in revenue this year, and $16 trillion in deficits on $70 trillion in revenue from this year through 2025 through 2034.
Members of Congress are looking hard for ways to narrow the deficit, and they are still promoting ideas for making health care better and more affordable.
Many of the proposals would affect how government programs interact with health care providers or how the government serves the low-income people who qualify for Medicaid.
Some of the ideas could have a direct effect on higher-income people who use employer-sponsored health coverage, individual major medical insurance or Medicare to pay for care.
The Ways and Means list: The new Ways and Means list resembles compilations of cost-reduction ideas prepared regularly by the Congressional Budget Office and revenue-raising ideas prepared by the U.S. Treasury Department.
Few of the CBO and Treasury Department proposals have become law.
House Ways and Means leaders asked for members' opinions about how viable each item on the health care budget reconciliation package idea list might be. At press time, members' proposal viability ratings were not publicly available.
There is no guarantee that any of the items on the Ways and Means list will get into a budget reconciliation package, no guarantee that any budget reconciliation package created will become law and no guarantee that Congress will continue to use budget reconciliation packages to pass ordinary legislation.
In December, for example, Republicans were unable to move a 1,547-page spending bill through Congress. They ended up passing the 117-page American Relief Act 2025 package instead.
Rep. Tom Cole, R-Okla., suggested on the House floor that legislation drafters should try to get away from creating giant spending packages and instead write shorter, more focused bills that can attract 60 votes in the Senate.
The U.S. Capitol. Credit: Shutterstock
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