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  • Washington Highlights

    House Introduces New CR, CHIP Package While Senate Signals Different Approach

    Tannaz Rasouli, Sr. Director, Public Policy & Strategic Outreach

    House Republicans Dec. 13 unveiled legislation (H.J.Res. 124) to continue federal funding through Jan. 19, fund the Department of Defense (DoD) through the end of FY 2018, and extend a number of health care programs, including the Children’s Health Insurance Program (CHIP). Upon its release, however, senators in both parties expressed skepticism that the package would secure Senate passage, and suggested that the bill would be restructured before enactment.

    The continuing resolution (CR) in the measure would extend the current stopgap (P.L. 115-90) beyond its current expiration of Dec. 22, with some adjustments to specific accounts within the Department of Health and Human Services. House lawmakers also attached, however, a full-year FY 2018 defense spending bill to the package, funding DoD at levels higher than the existing spending caps for defense programs.

    To prevent the higher defense spending in the package from triggering automatic cuts to the Pentagon, the bill also would effectively suspend the sequestration order for “security spending” in FY 2018, but would only delay the sequestration order for non-security spending until after Jan. 19.

    Under such a scenario, congressional leaders would not need to proceed with their ongoing efforts to achieve a budget deal to address the defense spending cap [see Washington Highlights, Dec. 7], leaving advocates in the health care community concerned that lawmakers also would abandon concurrent efforts to address the non-defense discretionary spending cap. The AAMC-convened Ad Hoc Group for Medical Research issued a Dec. 14 statement urging leaders to remove the provision and “renew their commitment to negotiate a bipartisan, bicameral budget deal that raises the discretionary spending caps for both defense and non-defense programs” and would enable increased investment in the National Institutes of Health and other programs.

    In addition to the CR, the legislation also includes text from the CHAMPIONING Healthy Kids Act (H.R. 3922), which the House passed in early November [see Washington Highlights, Nov. 3]. The bill would extend funding for CHIP for five years through FY 2022 and would maintain the 23 percent increase in the federal matching rate to states from the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) only for FYs 2018 and 2019. It also would extend funding for Federally Qualified Health Centers (FQHCs), the National Health Service Corps, and Teaching Health Center Graduate Medical Education (THCGME) through FY 2019. Additionally, the bill would delay the Medicaid disproportionate share hospital (DSH) payment cuts by two years.

    When the House originally considered H.R. 3922, Democrats opposed the measure due to its pay-fors, which include changes to Medicaid’s third party liability requirements, increased Medicare premiums for high-income beneficiaries, and cuts to the Prevention and Public Health Fund.

    Advocates have been urging Congress to complete its CHIP reauthorization, because the program expired Sept. 30. Governors John Kasich (R-Ohio) and John Hickenlooper (D-Colo.) sent a Dec. 12 letter urging House and Senate leadership to “make it a priority to reauthorize the Children’s Health Insurance Program (CHIP) as quickly as possible.”

    A total of 10 governors joined Govs. Kasich and Hickenlooper on the letter, which notes, “In the absence of Congressional action, we have worked to protect coverage for children and pregnant women in each of our states, but we will need federal support to continue the program. Resources are nearly exhausted and some states already have begun to inform families that their children’s coverage may end of January 31.”

    Prospects for the package, however, remain unclear. Press reports quoted Senate Minority Leader Chuck Schumer (D-N.Y.) characterizing the legislation as “a partisan spending bill that could never pass the Senate” and “an unfortunate waste of precious time.”

    Senate Appropriations Labor-HHS-Education Subcommittee Chair Roy Blunt (R-Mo.) also acknowledged to reporters that the bill is likely to change substantially if it reaches the Senate. He suggested that congressional leaders would likely reach agreement on topline discretionary spending levels after Congress finishes its work on the pending tax bill. Congress would then need to pass another stopgap that could extend into early January or as late as mid-February, to allow lawmakers to complete other outstanding issues.