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Category: Health/Medical

Lame Duck Priorities

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Congress is scheduled to return next week for a Lame Duck session of Congress and many items still remain on the 2016 agenda before Trump takes office, including wrapping up the 11 remaining FY 2017 spending bills and a 21st Century Cures bill that both Majority Leader McConnell and Speaker Ryan said was a priority for passage in the Lame Duck session.  While President-elect Trump won’t be signing any bills in the lame duck, he will influence decisions on how to wrap up the 114th Congress.

While it is too soon to tell whether or not Congress will try to address its remaining legislative business in a Lame Duck session of Congress, or wait until President-elect Trump is sworn in on January 20 and Republicans control both the House and the Senate, a few things are fairly certain, dealing with the FY 2017 and the 21st Century Cures bill will be the Lame Duck priories.

FY 2017, Finishing the Fiscal Year

The current Continuing Resolution keeping the federal government open expires on December 9.  Prior to the elections, Republican leaders expressed support for passing a series of “minibuses” that would group appropriations bills together, while Democrats were leaning toward an omnibus bill that would include all of the remaining FY 2017 bills.  House Appropriations Committee Chair Rogers (R-KY) has said no decisions have been made yet on the process, but as of today, the House Appropriations Committee has put conference negotiations on hold pending further analysis.

However, Majority Leader Mitch McConnell said this week that funding the government remains a top priority heading into the lame duck and that lawmakers will wrap up spending bills this year rather than punt to the next Congress via another stopgap spending bill. McConnell said he plans to talk to House Speaker Paul Ryan and President Obama about how the FY 2017 bills could be enacted, but gave little in the way of specifics on how this would be accomplished.

That plan, though, was criticized by conservative House Freedom Caucus prior to the election as the Caucus continues to pushing for a continuing resolution to extend government funding into the next calendar year so that congressional Republicans can negotiate a spending package with Trump rather than Obama.

Must Pass? Should Pass? Legislation

Additionally, outstanding legislative priorities include the 21st Century Cures medical innovation package and mental health reform.  The Cures package is a particular priority of House Energy and Commerce Committee Chair Upton (R-MI), who is term limited as Chair. Upton has been vocal on having a package on the House floor next week when the House returned to session.  However, it’s unclear if the measure will be considered. Prior to the election, Democrats voiced wanting the mandatory funding for the National Institutes of Health in the bill, but also expressed desires to insert prescription drug controls and concerns about offsets. In addition, bringing a large mandatory spending bill to the floor may not help Ryan keep his speakership with his contentious caucus.

Several other issues remain before Congress, including the FY2017 National Defense Authorization Act (NDAA), which has seen some hiccups this year, but must pass annually. Also in limbo is the Water Resources and Development Act (WRDA), which passed the House and Senate respectively and is currently being conferenced.

Trade

The 12-nation Trans-Pacific Partnership agreement, which was a priority for The Obama Administration in the Lame Duck, will not be considered, according to House Ways and Means Chairman Kevin Brady (R-TX).  It will remain ”on hold” until President-elect Donald Trump decides whether to take action on the agreement in the next Congress.

SCOTUS

Supreme Court Justice Nominee Merrick Garland will not receive a confirmation hearing or a vote.  With the Senate remaining in Republican control, it will wait for President Trump to submit a new nominee for the Supreme Court after he is sworn in on January 20, 2017.

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At this juncture, there are two likely scenarios for Congress to deal with these issues, and the outlook will be clearer in the coming days.

Clear the Decks

Under this scenario, President-elect Trump would indicate to Congress that he would like them to complete as much business as possible in the remaining days of the 114th Congress.  This would free up both President Trump, and the 115th Congress to focus on his priorities during the first 100 days of his Administration, as well as big-picture items such as a Supreme Court nomination and the debt-ceiling (which could be reached as early as March 2017).  This path would require some degree of cooperation from both the Obama Administration and the conservative element of the Republican conference.

Punting

The second scenario would be for Congress to push off all but must-do issues until after President-Elect Trump is sworn in.  Because Republicans would control both chambers of Congress and the White House, they would, in theory, have the ability to include more of their priorities in these bills before passage.  The risk in this scenario is that it bogs down the new Administration during their first days in office, at which time they will want to unveil new policy ideas, and when they have the most political capital to see those ideas to fruition.

 

Obamacare & the 115th

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Today, Senate Republican Leader Mitch McConnell (R-KY) announced the Republican leadership’s intention to repeal the Affordable Care Act, also known as Obamacare, quickly into the 115th Congress. While there is no confirmation on a legislative vehicle, the most likely means for Congress to pass something will be the Budget Reconciliation process. This process is also the vehicle that has been suggested to move any tax reform policies.

The slim majority of Republicans in the Senate, which will likely be 51-53 seats, would not be able to overcome the 60 vote cloture requirement. The Budget Reconciliation process would avoid a cloture vote, since the Budget Reconciliation requires a simple majority to pass.

Created by the Congressional Budget Act of 1974, Budget Reconciliation allows for expedited consideration of certain tax, spending, and debt limit legislation.  In the Senate, reconciliation bills are not subject to filibuster and the scope of amendments is limited, giving this process real advantages for enacting controversial budget and tax measures.  This paper addresses some frequently asked questions about reconciliation.

Off to Convention

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Congress has left town for its seven-week summer recess, having made progress on considering FY 2017 appropriations measures, but both chambers left town without a clear path forward. For the first time in many years (since FY 2010), the House and Senate Appropriations Committees have approved all 12 of their respective FY17 appropriations bills, although none has received final congressional approval.

Despite this progress, there appears to be growing support among House Conservative Republicans for enactment of a six-month continuing resolution (CR), which would last through March 2017, rather than a short-term CR through December that keeps the government funded through the election while an omnibus appropriations package is negotiated. Of note, Congress typically does kick the can on passing a full fiscal year funding in presidential election years,or has since 2002. The lame duck Congress typically leaves the fiscal completion up to the new Administration and not complete full appropriations during a lame duck session, the notable exceptions were 2004 and 2014. 

Among other issues, a long-term CR would place at risk funding increases approved by both appropriations committees for the National Institutes of Health (NIH) and the possibility of restoring the year-round Pell Grant, as approved by the Senate committee (see next item below).

The House Appropriations Committee needed two days to finish work on its FY 2017 Labor-HHS-Education appropriations bill, which it did the morning of July 14. The vote was 31 to 19. This was the first House Labor-HHS-Education bill brought to a full committee vote since 2006.

The bill’s $161.6 billion in discretionary spending is about $257 million below the Senate committee-approved level, $569 million below the FY16 enacted level, and $2.8 billion below the Administration’s FY17 request.

The measure would raise funding for the National Institutes of Health (NIH) to $33.3 billion, an increase of $1.25 billion above the FY16 level. On a party-line vote of 19-29, the committee rejected an amendment to raise NIH funding by an additional $750 million to the Senate committee-approved level of $2 billion. The increase would have been offset by declaring certain other health-related funding in the bill as emergency spending. Labor-HHS-Education Appropriations Subcommittee Chairman Tom Cole (R-OK) reiterated the statement he made in the subcommittee markup that he viewed the committee’s NIH funding level as a floor, not a ceiling.

The committee also voted down an amendment that would have restored the year-round Pell Grant. The amendment failed by a vote of 19-27, with two Republicans joining all Democrats in support of the amendment. Chairman Cole said he would welcome restoration of year-round Pell, suggesting the Senate position might prevail in the House-Senate conference on the bill.

The panel also rejected amendments to eliminate four provisions in the bill intended to block Obama administration regulatory actions. Left standing were the provisions to prohibit the Department of Labor from implementing its new overtime rule and to prohibit the Department of Education from moving ahead on regulations on teacher preparation, defining “gainful employment” and “credit hour,” and how states license institutions of higher education.

The National Institutes of Health (NIH) funding includes $165 million for the National Children’s Study, $511.5 million for Clinical and Translational Sciences Awards, and $333.3 million for Institutional Development Awards (IDeA) programs. Other details include:

  • $1.26 billion, a $350 million increase, for the Alzheimer’s disease research initiative;
  • $195 million, a $45 million increase, for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative; and
  • $300 million for the Precision Medicine Initiative.

The bill would maintain the salary cap on external NIH grants at Executive Level II of the Federal Executive pay scale.

For higher education, the bill would raise the Pell Grant maximum award to $5,935 through a combination of discretionary and mandatory funds (which is the same as the Administration’s request and the Senate bill).

The circulated report language provided the following funding levels for key higher education programs.

Supplemental Education Opportunity Grants, Federal Work-Study, and Title VI/Fulbright-Hays were flat funded at their FY16 levels of $733 million, $989.7 million, and $72.2 million, respectively. The bill would increase funding for TRIO to $960 million, an increase of $60 million above the FY16 level, and increase funding for GEAR UP to $344 million, an increase of $22 million above the FY16 level.

In contrast, the measure would reduce funding for the Institute for Education Sciences to $536 million, a cut of $81.9 million from the FY16 level. The bill also would zero out funding for the Graduate Assistance in Areas of National Need (GAANN) program-the only graduate education-specific aid program left in the Department of Education-on the basis that GAANN duplicates grant funding available through other agencies. The report also encourages using the $100 million that the Administration proposed to use in restoring the Fund for the Improvement and Support of Education (FIPSE) in FY17 to fund the First in the World program.

Meanwhile, it turns out the 10-year forecast it made just six months ago, in President Barack Obama’s fiscal 2017 budget, was way off. A revised forecast, issued Friday by the Office of Management and Budget, identified an extra $881 billion in savings over the next decade, if Obama’s budget were to become law.

House and Senate Pass Approps and then Done Until September

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After three days of amendments, the House passed yesterday the FY2017 Interior Appropriations Bill (H.R. 5538) by a vote of 231 to 196. The $32.1 billion spending bill passed the House for the first time since 2009.

The measure that takes aim at the Obama’s environment and climate change agenda would cut by $64 million the budget for the EPA, the Interior Department and other similar agencies. Funding under the bill is also $1 billion below the Administration’s request. The White House had already promised to veto the measure.

Earlier in the week, the Senate voted to clear the final version of legislation to combat prescription opioid and heroin abuse, sending the conference report to President Barack Obama, who is likely to sign it. The measure passed by a vote of 92-2. The vote followed a similarly lopsided 90-2 vote earlier Wednesday to end debate on the measure.

The measure would authorize new grant programs at the Department of Justice and Department of Health and Human Services. However, it does not include appropriations for the programs. Democrats fear funding will be short-changed when the annual spending bills are finalized later this year.

With the passage of both bills, the House and Senate, respectively, recessed until after Labor Day. Next week is the Republican National Convention and the following week the Democrats hold their convention.

 

House Approves Opioid Conference Report

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In a remarkable change of pace, the House and Senate came to a conference agreement on S.524, Comprehensive Addiction and Recovery Act this Wednesday. The agreement contains numerous provisions to combat increasing rates of opioid drug abuse, including through modifications to prescribing and pain management practices, by creating or modifying programs to expand access to treatment, particularly access to opioid overdose reversal drugs or medication-assisted treatment that eases withdrawal symptoms, and by establishing or strengthening specific programs for vulnerable groups such as drug-addicted infants. It also requires the Veterans Affairs Department (VA) to take several actions to better manage and track the use of opioids by veterans.

In both chambers and in the conference committee process, Democrats sought to add hundreds of millions of dollars in appropriations to ensure that individuals suffering from opioid addiction would have access to treatment; however, those efforts were blocked. Because of the lack of funding, the Administration has expressed opposition to the agreement — but has not issued a formal veto threat.

Today, the House almost unanimously approved legislation, by a vote of 407-5, to combat opioid overdoses after Democrats dropped their opposition to the bill at the last minute. The vote all but assures that the bill will sail through the Senate and head to President Obama’s desk next week. The legislation, a top priority for GOP leaders, is expected to be one of Congress’s biggest achievements this year.