The Legislative Update is brought to us by Liz Powell, Esq., MPH, Founder of G2G. Liz is an attorney with 20 years government experience, including as Legislative Director on Capitol Hill. She leads a team of bipartisan professionals that has raised over $159M, run advocacy campaigns and shaped CMS reimbursement for clients.
On February 9, 2018, Congress passed a two-year budget agreement that will boost federal spending by almost $300 billion and suspend the debt ceiling for a year, ending a brief partial government shutdown that began at midnight when lawmakers missed a funding deadline. The 240-186 House vote overcame opposition from many Democrats and a faction of GOP conservatives. The Senate passed the bill earlier Friday, 71-28.
Congressional leaders are exploring the possibility of reinstating earmarks, with limits. Earmarks, provisions inserted into appropriations bills that direct spending to a specific recipient, were banned in 2011 under Speaker Boehner. Congressman Cole (R-OK) backs a proposal to let Congress direct as much as $15 billion a year to specific projects, no matter where those requests are on the priority lists of the federal agencies that run the programs. “Since the enactment of this ban, members and their constituents have grown more frustrated as federal funds have been appropriated only to be redirected to different uses via executive branch directive,” said Conference Vice Chairman Doug Collins (R-GA). The Rules Committee’s Republican leaders are seriously weighing changing the rules to allow some earmarking, perhaps beginning with the surface transportation bill they expect to write later this year. Rules Committee Chairman Pete Sessions (R-TX) said his panel would vote soon on recommendations to Speaker Paul Ryan (R-WI) and the House Republican Conference. The conference then might vote on changing party rules, Sessions said.
The budget caps deal would add four years to the Children’s Health Insurance Program, giving the public insurance program funding for the next 10 years. The agreement also allows for:
- $6 billion for the opioid epidemic
- $7 billion for community health centers
- $495 million for the National Health Services Corps, which offers loan repayment and scholarships in communities with limited access to health care
- $2 billion to boost NIH funding
The budget deal would also repeal the Independent Payment Advisory Board, a controversial program that both parties have supported repealing as it takes Medicare oversight authority away from Congress. IPAB was created under the Affordable Care Act and designed to force lawmakers to make tough funding decisions for Medicare. The 15-member panel has never been convened and has no members because Congress has never agreed to fund the panel and because Medicare cost increases so far have been less than the level called for under the law to trigger action by the payment board. Neither President Barack Obama nor President Donald Trump has nominated any IPAB members.
The chairmen of the health appropriations panels in both the House and Senate have made clear that NIH funding is a priority for FY19. They have garnered $2 billion increases for the agencies in the last two spending bills, and lawmakers have proposed anywhere from a $1.1 billion to $2 billion increase for the NIH in 2018 spending plans.
The budget measure will temporarily finance the government at current levels through March 23 while lawmakers fill in the details on longer-term spending, which includes raising the caps on defense spending by $80 billion over current law in this fiscal year and $85 billion in the one that begins Oct. 1. Non-defense spending will rise by $63 billion this year and $68 billion next year.
The budget agreement will boost federal spending by almost $300 billion and suspend the debt ceiling for a year. Republican Senator Rand Paul (R-KY) protested the huge spending increases that are central to the deal, delaying action for most of Thursday by demanding a vote on an amendment to keep existing budget limits in place. Objections to increased domestic spending were also raised by a group of Republican conservatives in the House. Representative Mark Meadows (R-NC), chairman of the House Freedom Caucus, called the deal “fiscally irresponsible.”
The nonpartisan Committee for a Responsible Federal Budget, analyzing a report from the Congressional Budget Office, said the deal would add a net $320 billion to deficits over a decade, or $418 billion counting the additional interest costs. That’s in addition to the estimated $1 trillion added to the deficit over a decade by the Republican tax cut legislation passed in December.
THE PRESIDENT’S FY19 BUDGET
Earlier this month, the President also released his budget request, with an addendum added after Congress reached the bipartisan agreement to lift spending caps. The budget lists the administration’s top priorities, which included more protections for Veterans, combatting the opioid crisis, lowering medical drug prices, expanding job opportunity and economic growth, and building a border wall with an initial $18 billion ask. Perhaps the largest section in the budget spells out the administration’s immigration proposals, including $2.5 billion in increased detention facilities and capabilities and multiple billion more dollars in other ICE increases, such as personnel and equipment. The budget proposes the following domestic cuts:
- Department of Agriculture: a $3.7 billion or 16% decrease
- Department of Education: a $7.1 billion or 10.5% decrease
- Department of Energy: a 3% decrease
- Department of Health and Human Services: a $17.9 billion or 21% decrease
- Department of Housing and Urban Development: an $8.8 billion or 18.3% decrease
- Department of the Interior: a $2.2 billion or 16% decrease
- Department of Justice: a $345 million or 1.2% decrease
- Department of Labor: a $2.6 billion or 21% decrease
- Department of State: $9 billion or 26% decrease
- Department of Transportation: $3.7 or 19% decrease
The budget requests $5 billion to be allocated over the next 5 years to HHS to combat the opioid epidemic. The budget proposes an exact breakdown of how that money should be spent:
The Budget request includes: $625 million for States; $50 million to improve first responder access to overdose-reversal drugs; $100 million for surveillance and opioid abuse prevention activities, including improving State-based Prescription Drug Monitoring Programs (PDMPs); $10 million for the Food and Drug Administration’s (FDA) regulatory science activities to develop tools to stem the misuse and abuse of opioids, to name a few.
The budget also addresses high drug prices as a main concern, suggesting a new Medicaid demonstration authority roll-out experimental programs in 5 states that will use private-sector best practices to test out a state-determined formula to protect beneficiaries from high drug prices based on local and state-wide needs. The budget also proposes changes to Medicare Part D that will give plans more negotiating power with manufacturers’ price and rebate policies and provide a more predictable annual drug cost for beneficiaries. Finally, the budget provides a more expedited way for the FDA to bring generics to market faster.
The budget also increases funding for mental health and proposes to transfer national stockpile to the HHS’ Assistant Secretary from the CDC’s authority.
STEM/Technology & Research:
The budget highlights a need for modernization across government, including better information technology, data capture and analytics, and reskilling and redeploying workers to keep up with the changing job market. Improved cybersecurity remains at the top of the Trump administration’s technology goals.
The budget highlights, once again, the administration’s desire to cut out many regulations that it believes costs American industry billions of dollars. The budget highlights a goal to cut more than $9.8 billion in lifetime regulatory costs in 2018.
The budget also proposes big changes to the SNAP program, suggesting that foods should be 100% American grown, that programs will use outcome-based employment strategies, and that the proposal will strengthen expectations for work among able-bodied Americans who receive SNAP benefits. The proposal also suggests that states and local communities should be in charge of creating Welfare to Work programs that will streamline funding from multiple programs and tailor funding to the constituents’ specific needs, coupled with a “strong accountability framework.”
As expected, the budget proposes large increases in defense spending, amounting to $716 billion total, expecting the offsets to come from $65 billion in non-defense spending. The increases are largely for “improving the joint force’s capability to take on potential great power adversaries.” It also prioritizes the modernization of vehicles and equipment across the military. No specific mention of medical R&D is made in this budget request under the defense section.
The budget also looks to increase the Veteran’s Choice program that allows veterans to seek medical attention at a hospital or clinic of their choosing.
A new Incentive Grant program has been proposed that aims to include $100 billion in grants to encourage state, local, and private infrastructure investment. It also proposes $50 billion in rural funds, $20 billion to support “bold, innovative, and transformative infrastructure projects,” a $10 billion Federal Capital Revolving fund to finance purchases, construction, or renovation, among other infrastructure programs.
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