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Category: Health/Medical

House Out, Senate Still Working

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The House is out for a pre-scheduled recess this week — and likely to do a victory lap about passing the AHCA last week — while the Senate continues to move through nominations, Russian investigations, and maybe health care reform.

Also last week, FY 2017 funding is finally secured, and Congress is beginning to take stock of how far behind schedule they are for FY 2018.  There are now only four-and-a-half months left before the new fiscal year begins on Oct. 1 – and that includes the month-long August recess. Typically, at this point in the Congressional calendar, at least one of the 12 standing appropriations bills has been marked up by committee and the House and Senate Appropriations Committees are well on their way to drafting the other standing bills.

However, there is no guidance for appropriators on the annual spending limits, which is something set up by the annual budget measurers, which has yet to be passed by the House and Senate. The House took a first step with the AHCA last week, but within hours of the passage of the House legislation, Republican Senators made clear they didn’t support the measure and would begin drafting their own version…and that might take a while…like August. 

President Donald Trump has yet to submit a full FY 2018 budget request, which is typically due in early February. While the President offered an outline of discretionary spending plans in March, his full budget is not likely to come before May 22, and even then, it is unclear how in depth the budget released might be.

Stay tuned.

House Passes AHCA, the ACA Repeal

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By a vote of 217-213, the House passed a bill that would repeal parts of the 2010 health care law and change Medicaid from an open-ended entitlement system to one that limits states’ federal funding.

Passage fulfills a core Republican campaign promise of the past seven years. The measure, HR 1628, moves to the Senate, where supporters will face major challenges in passing it.

The legislation would replace the income- and cost-based subsidies for insurance in the health care law with an age-based tax credit beginning in 2020. It would effectively end the law’s expansion of Medicaid in 2020. It would block federal funding for Planned Parenthood for one year.

The bill would result in the loss of medical coverage for 24 million people by 2026, under a March Congressional Budget Office projection that did not take into consideration recent amendments. That analysis has not been updated. The Senate will not take up the measure until a new projection is released.

The bill would repeal taxes in the 2010 law for wealthier people with investment income, medical device manufacturers, health insurers and others. The CBO estimated the bill would reduce deficits by almost $337 billion over 10 years, under the earlier projection in March.

The House modified the original version by adding three amendments. One, by Rep. Tom MacArthur (R-NJ) would let states get waivers so they could exempt insurers from Obamacare minimum benefit rules and a ban on charging sick people higher prices. Another, by Rep. Fred Upton (R-MI) would provide $8 billion over five years to help people with medical conditions whose insurance premiums rose after a state got a waiver. The third, by Reps. Gary Palmer (R-AL) and David Schweikert (R-AZ)  would create a $15 billion federal program to help cover the costs of high medical claims.

House to Vote on ACA Repeal Today

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Following an amendment that won the support of two Republican hold-outs on the American Health Care Act (AHCA), House GOP leaders move to consider the AHCA today. This vote will be a defining moment for President Donald Trump and House Speaker Paul Ryan, to say nothing of the rank-and-file Republicans.

The GOP also is planning to vote on a separate bill that would eliminate AHCA’s exemptions for members of Congress and their staff to avoid Budget Reconciliation issues with the MacArthur Amendment, which was unveiled last week. The latest amendment, from Rep. Fred Upton (R-MI), would add $8 billion to $9 billion in funding over five years for high-risk pools aimed at subsidizing more expensive premiums for people with pre-existing conditions. The amendment has persuaded reluctant House Members – including House Freedom Caucus member Billy Long (R-MO) – to switch their votes to support this new version of the bill..

Republicans have a members-only meeting planned for 9 a.m. to talk strategy, and the vote could be as et 1 p.m. Some members want a quick vote and to promptly leave for recess, but the need for arm-twisting and the potential for delays could push the vote itself late into the day.

 

House Passes Omnibus, Senate Next

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The House just passed a sweeping FY 2017 Omnibus appropriations bill (H.R.244) to fund the government through Sept. 30. The House is sending the $1.07 trillion spending package over to the Senate for a vote later this week, likely Friday. The House vote was 309-118. The lengthy legislation comprises 11 unfinished appropriations bills, along with an intelligence authorization bill and other provisions.

The White House has formally backed the spending agreement, and the Senate is expected to clear the legislation as soon as Thursday. The bill must pass the Senate and be signed by midnight Friday or government funding under a continuing resolution would expire causing a shutdown.

FY 2017 Omnibus Released

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At 2 am last night, House and Senate appropriators released the FY 2017 Omnibus, which  comprises the 11 unfinished FY 2017 appropriations bills, providing fresh spending instructions for nearly every corner of the federal government and formally appropriates more than $1 trillion in discretionary spending for FY 2017, in keeping with the spending limits agreed to last year. A high level overview is below.

Overall, the FY 2017 Omnibus provides an annualized total of $1.07 trillion in base spending for FY 2017, or $1.16 trillion including Overseas Contingency Operations (OCO) funding. Beyond the top line, and widely reported, the FY 2017 Omnibus includes a $2 billion increase to NIH or a 6.2 percent increase over current levels. The deal includes an extra $1.5 billion to enhance border security, but there is no money to begin construction of Trump’s wall along the Mexican border.  Additionally, appropriators absolutely rejected about $18 billion in cuts to domestic discretionary programs that Trump had suggested to avoid further expanding the deficit in his FY 2017 supplemental request. To boost funding for the military and border security, lawmakers increased by $15 billion the OCO spending, which does not count against statutory budget cap.

While the budget numbers will look big on paper, they will have less meaning in the real world because most of the money to be formally appropriated has already been spent, since there are only five months remaining in the current FY 2017, which runs through Sept. 30.

The most recent stopgap (H.J.Res. 99), enacted Friday, keeps the government open through May 5. The Omnibus legislation could see a House could vote as soon as Wednesday. Once the Omnibus passes the House, it will move on to the Senate.

The legislation did resolve a significant amount of big political sticking points, including:

  • provide a permanent fix for a depleted health fund needed by thousands of retired coal miners;
  • shore up Puerto Rico’s troubled Medicaid program with an extra $295 million;
  • provide $2 billion in disaster relief for California, West Virginia, Louisiana and North Carolina;
  • combat wildfires with an extra $407 million;
  • $68 million to reimburse local law enforcement agencies for the costs of protecting Trump and his family, predominantly in Manhattan;
  • provide $100 million to combat opioid abuse; and
  • preserve federal funding for Planned Parenthood.

 

 

Labor-H

                Health Provisions

  • NIH — $34.1 billion (+$2.0 million)
    • Fogarty Center receives $72,213,000 (+$1.7 million)
  • AHRQ received: $324,000,000 (Slight cut of ~$8 million)
  • SAMSHA — $3.6 billion (+ $130.5 million above the previous Administration’s budget request. Includes an increase of $150 million for treatment of opioid and heroin programs)
  • CDC – $7.3 billion (+ $22 million above the fiscal year 2016 enacted level. This includes $6.3 billion in appropriated funds, as well as $891 million in transfers from the Prevention and Public Health Fund.)
    • NIOSH– $335.2M (about + $4M)
  • ERC Program $29 million (+$500 thousand)
  • AFF Program $25.5 million (+$500 thousand)
    • Chronic Disease Prevention — $1.112 billion ($777.6 million in discretionary, $338.0 million in transfers)
  • Prevention research centers — $25.5 M
  • Worker Health will receive “not less than FY16 levels”
  • HRSA — $6.4 billion for HRSA (+ $77 million)
    • Health Professions Title VII – $301M (- , but language below in dentistry
    • Nursing Title VIII — $229 million (level)
  • National Institute of Nursing Research receives $150,273,000 for nursing research.

Report language of note:

NIH

“Funding from the 21st Century Cures Act was previously appropriated for fiscal year 2017 by section 194 of the Continuing Appropriations Act, 2017. Per the authorization, $300,000,000 is transferred to the National Cancer Institute for cancer research and $52,000,000 will be allocated from the NIH Innovation Fund, in this agreement reflected in the Office of the Director, for the Precision Medicine Initiative cohort ($40,000,000), the BRAIN Initiative ($10,000,000), and regenerative medicine research ($2,000,000).”

 

Education Provisions

  • IES — $605.267 million (- $13 million)
  • GEAR Up — $339.7 million (+$17 million)
  • TRIO — $950 million (+$50 million)
  • Pell
    •  Maximum award will be increased to $5,935, funded by a combination of discretionary and mandatory funds
    • Year-round Pell restored
    • $1.3 B in surplus reallocated
  • Title VI international– $72.2 million (flat)

 

Report language of note:

TRIO:

“There is concern that the Department has rejected and made ineligible for review several fiscal year 2017 grant applications based on minor formatting issues. The Department is strongly encouraged to provide flexibility to such applicants by permitting submission of a corrected application. The Department should include consistent formatting requirements across all TRIO competitions in the future.”

 

Defense

Research Accounts:

6.1:  $2.28 Billion (level)

6.2:  $5.30 billion (+$30 million)

 

USDA

AFRI — $375 million (+$25 million)

McIntire-Stennis — $33.9 million (level)

 

CJS

  • NSF– $7.4 overall
    • MREFC– $209.0 Million (+$8.7 million, $121.9 million for 3 research vessels)
  • NOAA
    •  Integrated Ocean Observing System– $30.7 million (+$1.2 million)
  • Adopts IOOS language from both bills (will need to go through again) and encourages use of HF radars
    • OAR CI’s– $60.0 M (level)
    • Sea Grant– $63.0 M (- $10.0 M)
  • NASA
    • Space Grant– $40.0 M (level)
    • Earth Science– $1.92 B (level)

E&W

  • EERE — $761 million (+$40 million)
    • Water Power Energy R&D $84 million (+$14 million)
  • ARPA-E — $276 million (+$15 million)
  • Office of Science – $5.4 billion (+$40 million)
    • Fusion — $330 million (+$7 million)

 

Interior

  • EPA Science and Technology — $91.9 million (-$9 million)
    The bill provides $713,823,000 to be partially offset by a $7,350,000 rescission for a net discretionary appropriation of$706,473,000. The bill transfers $15,496,000 from the Hazardous Substance Superfund account to this account.

    • Chemical safety and sustainability – $ 126.9 million (-$9 million)
    • National priorities — $4.1 million (-$10 million, but over the FY2017 request of $0)
    • Safe and sustainable water resources — $106.2 million (-$1.1 million)
    • Sustainable and healthy communities — $ 134.3 million (-$5.6 million)
  • USGS
    • CRU’s– $17.4 million (level)
    • Earthquake Early Warning– $10.2 M (+ $2 M)
  • NEH– $149.8 million (+$1.9 million)