This Week in Washington: House appropriations talks continue, Senate vote to advance mini omnibus fails; Lower Costs, More Transparency Act pulled from House consideration; House Budget Committee marks up budget resolution
Appropriations Talks Continue As Shutdown Nears
Both the House and Senate return Tuesday to consider appropriations. In the Senate, they are prepping a Continuing Resolution (CR) to go to sometime in December. Both Republicans and Democrats are involved in crafting it. However, because Sen. Rand Paul (R-KY) objects to the inclusion of funding for Ukraine, the Senate cannot speed up consideration of the legislation. Thus, the Senate legislation is unlikely to be sent to the House until the end of the week or Saturday at the earliest.
In the House, Speaker McCarthy has been discussing a CR only through early or mid-November. He has been told by several Republicans that if he gets a bill done with Democrats, they will trigger consideration of his removal.
The House leaders have lined up 4 appropriations bills to be considered this week – Defense, Ag, State-Foreign Ops and Homeland Security. However, there is a complicated rule to allow this to happen. Leadership is now trying to determine if they have enough votes for the rule. If the rule fails, they cannot move forward. On Saturday, McCarthy floated to his caucus a 30 day CR or a 45 day CR. He may try to attach a CR to the border security bill and possibly include a debt commission, after the four appropriations bills are considered. By then the Senate may be wrapping up their CR.
Lower Costs, More Transparency Act Pulled from House Consideration
On Sept. 18, the House was expected to hold a floor vote on the Lower Costs, More Transparency Act but the bill was unexpectedly pulled from consideration. The bill is a large healthcare package that includes provisions to increase hospital and other provider price transparency, implement site-neutral payments for off-campus hospital outpatient departments, ban pharmacy benefit manager (PBM) spread pricing and extend funding for health programs.
House Energy and Commerce Committee Chairman Cathy McMorris Rodgers (R-WA) has announced that she remains committed to getting the bill passed by year’s end.
House Budget Committee Marks Up Budget Resolution for FYs 2024-2033
On Sept. 20, the House Budget Committee reported out of committee the Concurrent Resolution on the Budget for fiscal years (FYs) 2024-2033. The budget resolution outlines House Republican spending priorities over the next 10 years. It seeks to balance the budget and reduce the deficit by a projected $16.3 trillion by 2033, resulting in an estimated $130 billion budget surplus in FY 2033. It would:
- Cap FY 2024 discretionary spending at $1.47 trillion and limit spending growth at 1 percent per year;
- Cut total discretionary spending by $4.6 trillion by FY 2033;
- Cut mandatory spending by $8.7 by FY 2033;
- Lower interest payments on the national debt by $3 trillion;
- Repeal Inflation Reduction Act and Green New Deal provisions; and
- Create a bipartisan commission to recommend changes and oversee the solvency of Social Security and Medicare.
In addition, the resolution contains several policy statements, including one that urges Congress to enact legislation implementing Medicaid work requirements and decreasing the share of federal funds supporting state healthcare services. It is doubtful that the budget resolution will be considered by the full House.
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House Energy and Commerce Committee Chairmen Send Letter to CDC and USDA Regarding Federal Select Agent Program
On Sept. 15, House Energy and Commerce Committee Chairman Cathy McMorris Rodgers (R-WA), Subcommittee on Oversight and Investigations Chairman Morgan Griffith (R-VA) and Subcommittee on Health Chairman Brett Guthrie (R-KY) sent a letter to Centers for Disease Control and Prevention Director Mandy Cohen and Department of Agriculture Secretary Tom Vilsack requesting information on the federal select agent program (FSAP).
The FSAP oversees the possession, use and transfer of potentially dangerous biological agents and toxins. The chairmen are interested in the program because the committee is investigating the safety and security of federal high-containment laboratories.
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Vote Planned for SUPPORT Act Reauthorization and Maternal Health Legislation
The House plans to vote this week on legislation to reauthorize the SUPPORT Act, and vote on maternal health legislation that was reported out of the Senate Health Education Labor and Pensions (HELP) Committee on Sept. 21.
The Preventing Maternal Deaths Reauthorization Act of 2023 reauthorizes the Center for Disease Control and Prevention’s support for state-based mortality review committees through fiscal year 2028. The legislation also includes a new provision directing CDC, in consultation with the Health Resources and Services Administration, to disseminate best practices on maternal mortality prevention to hospitals, state-based professional societies and perinatal quality collaboratives.
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act would advance the requirement that state Medicaid plans provide medication-assisted treatment and continued support for Naloxone for first responders.
Senate Vote to Move Forward “Mini Omnibus” Fails
On Sept. 20, the Senate failed to move forward a package of three appropriations bills known as a “mini omnibus” that combines the Agriculture-FDA, Military Construction-VA and Transportation-HUD appropriations bills. Republican senators continue holding out on supporting the bill, notably Sen. Rand Paul (R-KY) who announced that he will not support any bill that includes military aid to Ukraine.
Senate HELP Committee Marks Up Bipartisan Primary Care and Health Workforce Act
On Sept. 21, the Senate Health, Education, Labor and Pensions (HELP) Committee marked up and moved out of committee the Bipartisan Primary Care and Health Workforce Act. The legislation, which was introduced by Chairman Bernie Sanders (I-VT) and Sen. Marshall (R-KS), aims to address primary care challenges and health workforce shortages and would reauthorize community health and medical education programs. It would:
- Reauthorize $5.8 billion per year in funding for the Community Health Center Fund through fiscal year (FY) 2026;
- Reauthorize $1.5 billion in funding for the Teaching Health Center Graduate Medical Education Program through FY 2028;
- Reauthorize $950 million per year in funding for the National Health Service Corps through FY 2026;
- Provide $1.2 billion in grants to community colleges and universities to increase nursing program enrollment;
- Provide $300 million to primary care doctor residency programs and invest in dental training and workforce programs; and
- Implement provisions aimed at prohibiting anticompetitive practices by hospitals and insurance companies, including banning certain facility fees.
Ranking Member Bill Cassidy (R-LA) opposed the legislation, announcing that it is rushed and fails to specify how funding increases will be paid for. During the mark up, he submitted 67 amendments but withdrew the majority of them, citing a lack of support.
The Ranking Member and a number of HELP committee senators are concerned about cost offsets included in the bill that would draw funds from the Prevention and Public Health Fund. The Chairman has announced that he was continuing to look for other funding sources, including drawing funds from bills related to pharmacy benefit managers (PBMs) and generic drug access. He is also in discussions with the Chair of the Senate Finance Committee, Sen. Ron Wyden (D-OR), concerning potential pay for mechanisms.
In addition, the committee reported out of committee bills related to maternity and pediatric healthcare programs.
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Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.