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October 31, 2014

Posts in "Budget/Appropriations"

October 23, 2014

Health Programs Factor in Upcoming House Committee Leadership Changes

The focus on upcoming November congressional elections understandably centers on possible election results and which party will control the Senate. However, the election of a new Congress, which convenes in January, also starts the process for reconfiguring the leadership of pivotal House committees. Roll Call’s Emma Dumain and Matt Fuller today examine possible GOP leadership changes in 11 different committees.

Health care program funding authority, particularly for the Medicare program, falls under the jurisdiction of the House Ways and Means Committee. The committee’s current chairman, Michigan Republican Rep. Dave Camp is retiring and Wisconsin Republican Rep. Paul D. Ryan has the inside track — but has some competition — to take over the gavel of the powerful tax committee.

Ryan has led a long-running campaign to overhaul the Medicare program as the chief of the House Budget Committee. His annual budget proposals (view the 2015 budget plan) have suggested ideas on overhauling the Medicare program allowing Medicare beneficiaries to choose between competing private coverage programs with the federal government offering premium support payments. In 2011, a liberal advocacy group attacked an earlier Ryan Medicare proposal with a video featuring a Ryan look-alike actor pushing an elderly woman in a wheelchair off a cliff.  At the helm of the Ways and Means Committee, Ryan would have the opportunity to craft a Medicare overhaul measure instead of offering budgetary suggestions.

If Ryan departs from the budget panel, the heir apparent is the committee’s current Vice Chairman, Rep. Tom Price, a conservative physician from Georgia. Price is a staunch opponent of the 2010 health care overhaul law and has authored his own proposal on overhauling health insurance coverage options. Price’s plan relies on offering tax breaks to give people the means to buy health insurance instead of the current health insurance exchange plan subsidies.

October 22, 2014

Annual Spending Waste Report Mocks State Medicaid Provider Taxes and Assorted NIH Grants

Oklahoma Republican Sen. Tom Coburn today unveiled an annual report listing examples of possibly dubious spending on various government programs. The report always offers interesting and sometimes humorous reading and illustrates the often-unusual nature of federal program and grant spending. Sen. Coburn usually highlights examples of unusual health program spending.

This year’s report mocks National Institutes of Health research on human interaction with dogs, the impact of meditating through reading Buddhist texts, and funding for a smart-phone application that helps parents manage the eating habits of fussy children. The eccentric nature of  some NIH grants is a regular target for the annual report. Last year’s waste report blasted a study on marital conflict between husbands and wives.

The 2014 report includes a critique of state Medicaid provider taxes, particularly on nursing homes, which inflates federal Medicaid payments to the state. States collect both the additional tax and the additional Medicaid funding.  In July, Healthopolis highlighted a report that indicates states are increasing relying on Medicaid provider taxes to fund the program.

Other items in this year’s report blast the weighting of sleep apnea as grounds for veterans’ disability benefits and the random assignment of Medicare Part D prescription drug plans to beneficiaries who do not indicate a preference. Roll Call’s Niels Lesniewski reports that this year’s report is presumably the last of the senator’s annual compilation of unusual federal spending. Sen. Coburn is retiring from the Senate at the end of the year.

 

 

October 17, 2014

This Week: Congress Focuses on a Travel Ban and Ebola Response Funding

Lawmakers this week escalated calls for a travel ban for people coming from Ebola-ravaged West African countries. The pleas for travel restrictions culminated at a special recess House subcommittee hearing on Thursday (view C-SPAN video), where lawmakers grilled federal health and border control officials about their recent actions and missteps in managing the response to the first U.S. Ebola case. Republican members are leading the charge for a travel ban – or imposing restrictions on visas –but some Democrats have also endorsed the idea.

However, Centers for Disease Control and Prevention Director Thomas Frieden continued to insist this week that restrictions would only encourage people to avoid regular travel channels and limit governments’ ability to track those who have been exposed to the virus. The Economist, in an opinion that coincided with its cover article on Ebola published today, echoed the same reasoning for avoiding travel restrictions. President Obama told reporters at the White House on Thursday that he does not have a “philosophical objection” to a travel ban but is relying on advice from infectious disease experts, who say the current screening process is the best approach to managing potentially infected travelers.

Meanwhile, a separate congressional battle is brewing over added Ebola response funding for the CDC and the National Institutes of Health. Roll Call’s David Eldridge reported that Democrats are pressing for a separate hearing on Ebola response funding prior to the end of the recess break and claim the CDC cannot do its job adequately without more congressional appropriations. Roll Call’s Emma Dumain wrote that Republicans countered by noting that the CDC has not yet asked for additional funding. Also, CQ HealthBeat’s John Reichard reported (subscription) that hospital executives are scrambling for grant funding for technical assistance in managing Ebola cases, and CQ Roll Call’s Melanie Zanona noted (subscription) that health provider groups have ramped up calls for a boost in funding for a federal hospital preparedness program.

Other related Healthopolis reports on Ebola this week:

October 9, 2014

CBO: Annual Deficit is Lower But Health Program Spending Is Up

The federal government ended the 2014 fiscal year with an estimated $486 billion annual deficit, which is the lowest deficit level since 2008. The Congressional Budget Office monthly budget report pegs the lower deficit estimate largely on increased receipts from taxpayers.

However, overall federal spending — measured as outlays — increased and Medicaid and health insurance subsidy payments increased by 19 percent over 2013 levels. The CBO identifies the 2014 start of subsidized insurance plans and expanded state Medicaid coverage as a main reason for overall spending increase. Federal outlays on Medicaid and insurance premium subsidies increased in 2014 by $49 billion.

In September, the final month of the fiscal year, defense spending and reduced unemployment benefit outlays were down by $2 billion but spending for Medicaid increased 10 percent and Medicare increased 5 percent.

 

 

 

 

October 1, 2014

GAO Opinion Bolsters GOP Case on Insurer Risk Payments

A group of Republican lawmakers on Tuesday obtained a legal opinion on legislative instructions for funding a key factor enticing health insurance participation in the state and federal exchanges. Exchange health plans can be obtained without restrictions due to preexisting health conditions and eliminating insurance limitations on preexisting conditions is a primary objective of the Affordable Care Act.

However, to avoid a catastrophic insurance market breakdown, the law instituted an individual coverage mandate, which broadens the coverage pool.  Also, the law added a temporary premium stabilization program for insurers to re-balance the coverage risk. The federal government subsidizes plans that have losses above a set amount and recovers money from plans that have gains.

CQ Health Beat’s (@CQHealthTweet) Rebecca Adams reported that the Centers for Medicare and Medicaid Services, in insurance exchange rules issued in May, tweaked the amounts this year given to insurers to cover losses and offset the cost of caring for high-cost patients. CMS expects the insurer subsidies and recouped payments to offset each other, but the final rule text notes:

In the unlikely event of a shortfall for the 2015 program year, HHS recognizes that the Affordable Care Act requires the Secretary to make full payments to issuers. In that event, HHS will use other sources of funding for the risk corridors payments, subject to the availability of appropriations.

On Tuesday, the Government Accountability Office provided Alabama Sen. Jeff Sessions and Michigan Rep. Fred Upton with an opinion noting that legislation covering fiscal year 2015 spending, which begins today and is funded through a stopgap spending resolution through Dec. 11, should also include special funding instructions for risk payments.

 

September 29, 2014

Ebola Patient Arrives at NIH; Congress Slowly Releases Ebola Response Funds

On Sunday afternoon, the National Institutes of Health received its first Ebola patient. An American physician who was volunteering services in an Ebola treatment unit in Sierra Leone and was exposed to the virus was admitted to the NIH Clinical Center’s high-level isolation unit.

Meanwhile, congressional appropriators are slowly releasing the requested transfer of funding for the U.S. Ebola response effort in West Africa. Roll Call’s Humberto Sanchez and Niels Lesniewski reported on Friday that the approval of the transfer of the entire $1 billion request is held up pending further details on Pentagon plans to keep soldiers from contracting the illness.

Appropriations and defense committee leaders have released only portions of the request. The partial release of funding, which would have expired at the end of the last week, allows the Pentagon to spend $100 million of the funds while lawmakers await details of how the funds will be used.

 

 

 

 

September 26, 2014

Weekly Spotlight: Ebola Crisis Entices a Global Health Focus

President Barack Obama today address a summit of international health leaders at the White Hosue. The president and cabinet officials will tout the administration’s global health agenda, which is shadowed by the ongoing Ebola crisis in West Africa. On Thursday, the assembled health leaders met (view broadcast) to encourage non-governmental organizations to join in on an effort to create a worldwide system to get ahead of threats like Ebola. In a Thursday speech at the UN, Obama exhorted world leaders to ramp up their response efforts on Ebola.

However, an expanded international health crisis response program will require Congress to appropriate funds beyond the $1 billion the administration is seeking to establish treatment units and train and equip health care workers in West Africa. This week, a quirky funding transfer approval process inched toward final approval of shifting Pentagon funds toward the U.S. Ebola response plan.

Committee chiefs from congressional defense and appropriations panels must sign off on the transfer requests. CQ Roll Call’s Megan Scully reported on Wednesday that House appropriators have approved the request subject to additional details on goals and a mission timeline. A separate Associated Press report on Wednesday noted that a Senate defense committee transfer request sign off is still pending.

Meanwhile, CDC Director Tom Frieden this week spoke to congressional staffers at a seminar on the Ebola outbreak (view C-Span broadcast) and Roll Call’s Hannah Hess reported on the reaction to a display of Ebola containment devices on display in a House office building.

 

 

 

 

 

 

 

September 19, 2014

Pentagon Transfers $1 Billion to Ebola Relief Effort

Prior to leaving for a seven-week recess break, the Senate on Thursday completed action on a stopgap spending bill funding federal health agencies until Dec. 11. Included in the bill is additional Health and Human Services agency funding and transfers to respond to the Ebola crisis in West Africa.

However, the $88 million in revised funding pales in comparison to escalating levels of Pentagon funding transfers for Ebola relief efforts. On Monday, the Department of Defense announced a transfer request for $500 million to support the introduction of U.S. troops into region to assist in logistical operations and training of health care workers. The additional funding coincides with President Barack Obama’s revised U.S. Ebola response plan. On Wednesday, the Pentagon upped its funding request to $1 billion.

Funding transfers within Pentagon spending accounts are not uncommon but they require the approval of the leaders of congressional defense committees. Here are the first and second reprogramming requests submitted to congressional committees for Ebola response activity funding.

 

September 17, 2014

Democrats Offer an Alternative Health Spending Bill

The House today is poised to pass a stopgap spending bill that funds the federal government – including health agencies and programs – through Dec. 11. The short-term measure is necessary because congressional appropriators this year have yet to gain an agreement on the regular annual spending bills. The annual measure funding the bulk of health agencies – the Labor-HHS-Education bill – is the most contentious bill due to conflicting views on funding the health care overhaul law plus a range of spending restrictions and the prospect of added controversial amendments.

House Democratic appropriators this week decided to unveil their own Labor-HHS-Education spending bill, even though it has no chance of garnering a House vote. The effort offers a glimpse into Democratic spending priorities. The draft measure offers a slight increase in funding for the National Institutes of Health and the Centers for Disease Control and Prevention. However, CQ HealthBeat’s (@CQHealthTweet) Kerry Young noted some differences between the House Democrats’ draft and a languishing separate measure spearheaded by Senate Democratic appropriators. The two bills diverge slightly on funding for the Substance Abuse and Mental Health Services Administration and specific funding for HIV/AIDS programs and cancer research.

 

 

 

September 10, 2014

Mapping the Impact of NIH Funding

The largest discretionary spending component of the budget of the Department of Health and Human Services funds the National Institutes of Health, the primary federal medical research agency. The sprawling NIH campus in Bethesda, Md., belies the fact that 85 percent of the agency’s $31 billion annual budget goes to fund medical research off campus in all 50 states.

A medical research advocacy group, United for Medical Research, this week updated its state-by-state map of NIH research funding flowing to each state and supporting an estimated 400,000 jobs. California and Massachusetts lead in receipt of NIH research grants and the larger states dwarf the totals for Idaho, Wyoming and Alaska. NIH has established an award program that seeks to ship research dollars to 23 states with a poor track record of competing for NIH grant money. However, parsing out medical research outside of the NIH also amplifies the nationwide impact of any reductions in the NIH budget.

 

 

 

 

Congress Offers Ebola Response Funding; Health Care Volunteers Are Needed in Africa

House appropriators on Tuesday evening unveiled details of a fiscal 2015 continuing resolution to fund the government into the new fiscal year. The measure stretches funding through Dec. 11 and provides an extra $88 million to fight the Ebola outbreak in West Africa. The added funding matches the administration’s request to support medical specialists on the ground in Africa and speed the development and manufacturing of Ebola drugs.

Congress’ role in addressing the threat of the Ebola virus focuses on providing funding for medical supplies and drug and vaccine research. However, halting the spread of the disease will hinge on finding enough health professionals willing to volunteer. HealthBeat’s (@CQHealthTweet) Rebecca Adams (@RebeccaAdamsDC) reported Tuesday on the profound challenge of enticing health professionals to volunteer to go to Africa to directly assist in efforts to combat the spread of the virus.

The World Health Organization estimates that 760 foreign volunteers will be needed at any one time over the next six months to monitor infected people, test lab samples, run logistical offices and disinfect thousands of corpses. The global WHO appeal so far has generated only a handful of responses and the agency estimates that as many as three health care workers are needed for each patient. The gruesome impact of the virus on the human body and the paucity of proven drugs and a viable vaccine hinders the task of recruiting volunteer health workers.

 

September 8, 2014

Spotlight: White House Suggests Additional Ebola Response Funding

Congress returns this week with the primary objective of forging a stopgap spending bill extending existing federal spending in order to avoid a federal agency shutdown at the end of the month. On Friday, the administration added additional Ebola response funding to a list of requested immediate spending adjustments and transfers — called “anomalies,” to address additional critical funding requirements. CQ HealthBeat reported that the administration’s spending adjustment request includes the transfer $10 million from existing accounts into a new fund to respond to the crisis and $58 million in new funding for Department of Health and Human Services drug research to accelerate the development of Ebola drugs and vaccines. Separately, the U.S. Agency for International development has allocated $75 million from current funds to respond to the outbreak.

White House budget planners want congressional appropriators to add the additional funding to a continuing resolution, which would fund the federal government beyond the Oct. 1 start of the new federal fiscal year. The continuing resolution is expected to provide stopgap funding from October until mid-December. Separately, a group of House Democrats last week pressed Republican leaders to schedule a hearing prior to the end of the month on U.S. efforts to fight the spread of the Ebola virus in West Africa.

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September 4, 2014

Waiting for Ebola Response Funding

The Ebola crisis in West Africa might complicate congressional action on a stopgap spending bill to keep the government operating beyond the Oct. 1 start of the new fiscal year.

Several lawmakers at a hearing on the Ebola crisis during last month’s recess urged Centers for Disease Control and Prevention Director Thomas Frieden to request more money. However, in an interview with CQ HealthBeat on Wednesday, Frieden noted that spending is already authorized for global disease detection and response, and he avoided detailing additional funding needs specifically in response to the Ebola crisis. The administration’s proposed budget submitted before the virus outbreak requested $42.5 million in added spending for global health programs.

The continuing resolution might include additional money to support the international medical response to Ebola, but CQ Roll Call’s Tamar Hallerman reported today that congressional Republican leaders are seeking to avoid too many new spending provisions in a stopgap bill, which would extend current spending levels and policy directives through Dec. 11 or 12.

 

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August 20, 2014

IRS Struggles to Collect the Medical Device Excise Tax

Funding for the 2010 Affordable Care Act hinges, in part, on a 2.3 percent excise tax on medical device sales. The tax applies to cardiac defibrillators, imaging equipment and a variety of other equipment sold to hospitals, doctors and other providers. Congressional efforts to eliminate the tax enjoy significant bipartisan support in Congress from Republicans and Democrats, particularly from states that are home to a concentration of medical device manufacturers.

Internal Revenue Service collection of the tax began in 2013. A Treasury Department’s Inspector General report released on Tuesday indicates that taxpayer reporting on the IRS excise tax form does not account for all applicable medical device sales. Also, the tax agency is struggling to reconcile data provided by taxpayers and cannot accurately identify all of the medical device makers that are required to file the form and pay the tax. Through the first half of 2013, Treasury auditors estimate that the tax levy should have collected $1.2 billion in excise taxes, but the IRS has received $913 million.

August 8, 2014

Ebola Crisis Prompts CDC Funding Questions (Video)

A House Foreign Affairs subcommittee hearing Thursday on the Ebola outbreak in West Africa prompted a discussion on Department of Health and Human Services (HHS) funding levels. The lead agency responding to the Ebola crisis is the Centers for Disease Control and Prevention (CDC), which is funded through the HHS budget. The chairman of the House panel questioned whether enough money was available for CDC programs designed to prepare for a pandemic health crisis. CQ HealthBeat’s Kerry Young reported that a senior GOP appropriator, also attending the hearing, inquired about the need to shift current HHS funding toward toward addressing the CDC response to the Ebola crisis.

However, the HHS budget is already subject to separate transfers to cover new expenses from an influx of migrant children at the border with Mexico. A HHS agency, the Administration for Children and Families, is responsible for housing and care for the migrant children. The administration requested emergency program funding for HHS border relief efforts, but Congress was unable to reach an agreement on supplemental spending prior to the August congressional recess.

Neither the House nor Senate has passed a fiscal 2015 spending bill for HHS, whose appropriations are frequently stymied by disputes over additional spending for the implementation of the 2010 health care law. When Congress returns in September, appropriators could offer additional HHS pandemic response funding in separate planned action on a stopgap continuing spending resolution which would extend funding for all federal agencies past the Oct. 1 start of the new federal fiscal year.

 

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