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February 1, 2015

Posts in "Budget/Appropriations"

January 27, 2015

CBO Cuts Health Law Cost Estimate

The Congressional Budget Office on Monday set the stage for the start of the congressional budgeting season with its annual long-term economic outlook report. The budget analysis agency estimates that the long-term cost 2010 Affordable Care Act is about $101 billion lower than an earlier estimate. The total net cost of the law over the next 10 years is $1, 350 billion, which is a 7 percent reduction from previous estimates and substantially lower than original estimates. Aiding the reduced cost is a $68 billion reduction in the cost of subsidizing insurance purchased on state and federal insurance exchanges. However, the lower costs are partially offset by increased Medicaid spending. The CBO also reports that 42 million people in the United States were uninsured in 2014, a number that would have been 12 million larger without the health law. In 2015, the number of uninsured will be about 36 million.

Additionally, the report notes that federal spending on the Medicare program will grow by nearly 7 percent a year over the next 10 years. The CBO estimates that the number of people enrolled in Medicare will rise to about 73 million in 2025, from 54 million last year.  Overall, the federal annual deficit is projected to fall to $468 billion in fiscal 2015, and again in fiscal 2016, before topping $1 trillion again in 2025.

January 26, 2015

Poll Finds Support for Global Health Spending

More Americans support spending on global health needs instead of foreign aid in general, according to a new poll by the nonpartisan Kaiser Family Foundation – in part because the public thinks medical aid abroad protects them at home.

About 36 percent of 1,505 adults who were polled in early December said that the United States spends “the right amount” on health services overseas, 26 percent said “too much” and 27 percent saying it was “too little.” That’s compared to 24 percent who said the country spends the right amount on the broader category of foreign aid, 56 percent who said the nation spends too much on general foreign aid and 11 percent who said it was too little.

But people’s attitudes on overall foreign aid change when they learn how little the federal government actually spends on foreign assistance as measured by a percentage of the budget, the poll found. When told that all foreign aid spending is about 1 percent of the federal budget, the number of people saying it is too much fell from 56 percent of respondents to 28 percent of those polled. The number of people saying it was the right amount grew to 34 percent and the number saying it was too little grew to 26 percent of people surveyed.

People may more supportive of global health spending than foreign aid because they see a benefit for Americans. About 69 percent said that improving health in developing countries protects the health of Americans by preventing the spread of diseases like SARS, bird flu, swine flu, and Ebola.

January 21, 2015

Keeping Up on Unauthorized Appropriations

Every January, the Congressional Budget Office provides congressional committee’s with a sort-of advance warning notice. The CBO report lists the various unauthorized appropriations and expiring authorizations which may need some legislative attention. Most legislation that streams through Congress largely updates, revises and renews various existing laws. Often, for budgetary reasons, program spending is given a discrete time frame and a specific expiration date. As a result programs are often face authorization renewals.

The CBO report, sorted by House committee jurisdictions, can be a useful guide on possible legislative action this year. Included in the mix of expired programs is a wide range of very prominent health programs and laws, including the National Institutes of Health and the Affordable Care Act. A Senate committee on Tuesday already scheduled early action on a re-authorization bill for senior citizen nutrition programs.


January 16, 2015

Push For Two-Year Spending Bills, Especially for the Indian Health Service

A bipartisan group of senators led by New Hampshire Democrat Jeanne Shaheen and Georgia Republican Johnny Isakson this week proposed a measure (S 150) seeking to overhaul the entire budget and appropriations process by shifting spending bills into a two-year cycle. Such a change, which has been suggested by lawmakers in the past, would significantly alter the legislative timetable. Currently lawmakers scramble each year in April and May to pass a budget resolution and often are deadlocked on spending priorities at the Oct. 1 start of the new fiscal year.

The chairman of the Senate Health, Education, Labor and Pensions Committee,  Republican Lamar Alexander of Tennessee, also supports the idea, noting that the longer budget cycle also would give committees more time to review and consider ending unnecessary programs.

Separately, Alaska Republican Rep. Don Young and New Mexico Democrat Ben Ray Lujan this week introduced a measure (HR 395) that would authorize the Indian Health Service (HIS) through a 2-year appropriations process. The IHS doesn’t have automatically approved spending for  health care services like the Medicare and Medicaid programs. The agency is regularly plagued by mid-year shortfalls and would likely benefit from a longer-term spending plan. The concept of two-year funding is already used for selected portions of the veterans’ health care program.


December 12, 2014

Health Care Agency Funding Bill Races Toward Finish Line

Week in Review

The Senate today is the last stop before final passage of an omnibus year-end spending bill. The House on Thursday — in contentious voting — approved the package, along with a stopgap spending resolution keeping federal agencies open over the next few days as senators deliberate on the larger spending bill.

The measure has been in negotiations for several weeks, but added spending is limited due to previously established budgetary caps, which left lawmakers little room to add money for discretionary health programs. Overall, funding for the agencies within the Department of Health and Human Services remain largely at last year’s levels or receive modest increases. However, separate mandatory spending for the Medicare and Medicaid programs jumps by more than $60 billion compared to 2014 levels, spurred by a huge increase in Medicaid funding to the states due to the Affordable Care Act.

Additional funding to respond to the Ebola crisis, particularly focused on assistance to West African countries and FDA and NIH drug and vaccine development, reduced any wiggle room for new spending. The original $6.2 billion White House Ebola response request was reduced in the spending package to $5.4 billion and is spread out between HHS agencies, the State Department and the Defense Department. Also, Republicans claimed no new health care overhaul law funding but omitted any major health law program cuts, except for a continued hold on money for a dormant health law provider payment advisory board. Separately, the measure continued a long-standing federal abortion ban and calls for administration action to clarify health plan abortion coverage requirements.

Congress this week completed action on a bill reauthorizing newborn screening programs (HR 1281), offering education, information tools and research on inheritable disorders in newborns and children. Also, the House passed bills updating veterans’ suicide prevention efforts (HR 5059) and renewing breast health education programs (HR 5185). The Senate could quickly complete action on the two measures today or this weekend prior to ending the term of the 113th Congress. The House has already retired for the year.

Planning on Reading the Spending Bill? Try the Explanatory Report First

The Senate today is racing toward completing votes on a spending bill package  that includes money for health care programs through the end of fiscal 2015.  The 1600+ page bill details spending levels for most federal agencies, except for temporary stopgap funding provided for the Department of Homeland Security. However, the main bill text itself offers very dense reading material. A separate accompanying explanatory statement on the bulk of the bill’s health care agencies provides useful background and commentary on many health care issues that have recently attracted lawmaker attention. At 110 pages, the document — complete with copy-editor notations — describes congressional views and suggestions for health programs and regulatory activities.

CQ HealthBeat’s (@CQHealthTweet) KerryYoung reported (subscription) on several elements included in the explanatory statement. The Centers for Disease Control and Prevention is ordered to direct funding for fighting prescription drug overdoses to states hit hardest by the drug abuse (see explanatory statement page 30). The report also urges the Centers for Medicare and Medicaid Services to reconsider a decision on Medicare coverage for a high-tech heart pump, with an eye toward expanding eligibility for the device (see bottom of page 75).

Items noted in the explanatory statement may not be included in the actual bill text. Often a provision is too contentious for the bill, but a compromise can land some commentary in the accompanying report. Such a compromise in this year’s bill led to explanatory instructions clarifying coverage requirements for health plans purchased through health insurance exchanges, with an eye toward a dispute over plan coverage of abortion services. The report instructs HHS to take heed of a recent federal audit of health plan abortion coverage and orders quick responses to complaints on violations of “conscience protection” provisions on abortion services coverage (view health plan transparency and provider complaint comments beginning on page 81).


December 5, 2014

Congress Presses Toward a Spending Bill; Agencies Try To Tackle Circumcision & Blood Donation Guidance

Weekly Review

Congressional appropriators toil today to craft a year-end spending package. The objective is to assemble the full-year spending bills for most federal agencies, including contentious health care agency funding and policy riders, plus a stopgap temporary funding resolution for more controversial immigration provisions.

Meanwhile, the Senate is preparing for votes next week on a Pentagon re-authorization bill, which includes a hike in prescription co-payments for service members and blocks a ban on military sales of tobacco products. Senators are also seeking to avoid any amendments on a tax extension bill due to worries that someone will seek an amendment repealing a medical device excise tax.

Earlier this week, the House completed legislative action on bills calling for improved reporting on sudden infant deaths and adds Ebola drugs to an existing FDA rapid drug development program. Also, the House overwhelmingly approved a bill creating a tax-exempt accounts for persons with disabilities. The measure is largely funded through Medicare payment ban on vacuum systems to treat erectile dysfunction and other Medicare provider payment adjustments.

Meanwhile, the Centers for Disease Control staked out guidance on awkward health care provider conversations with patients on the benefits of male circumcision but a FDA panel avoided offering guidance on overturning a controversial ban on blood donations from gay men.

December 4, 2014

DeLauro Hopes Third Chair’s the Charm for Labor-HHS

Rosa DeLauro of Connecticut, a fiery liberal Democrat with a clear passion for medical issues, is hoping that her new partner on the House Labor-Health and Human Services-Education Appropriations subcommittee will get the once influential panel back on track. Tom Cole, R-Okla., will take the Labor-HHS gavel in the 114th session.

This subcommittee oversees the spending and operations of some of the most highly regarded federal agencies, including the National Institutes of Health and Centers for Disease Control and Prevention. Yet, the Labor-HHS panel has not advanced an annual spending bill as far as a full committee markup, let alone the House floor, since Republicans took control of the chamber in 2011. During that time,  DeLauro has served as ranking Democrat to two GOP subcommittee chairmen, Denny Rehberg of Montana and Jack Kingston of Georgia. Both ended their House careers to make failed Senate bids, Rehberg’s in 2012 and Kingston’s in 2014.

“I hope that 2015 will be the year we finally manage to debate a Labor-HHS appropriations bill,” DeLauro told CQ Roll Call.

DeLauro also said that she is looking forward to working with Cole, with whom she has collaborated in the past on legislation regarding the needs of children in foster care who have behavioral needs and disabilities.

While Rehberg and Kingston had to commit time to their Senate races, Cole appears to have no immediate ambition beyond the House. His choice to lead the Labor-HHS panel could auger well for the neglected panel. Cole is a member of the House GOP whip team and an ally of Speaker John A. Boehner. Cole has said that he is looking forward to the chance to “craft legislation,” despite the challenges of “complex and at times even controversial” matters covered by the Labor-HHS bill.

Cole’s soon-to-be counterpart on the House Energy and Commerce Committee also indicated that he expects the Labor-HHS panel to be busy in the 114th session. The House Energy and Commerce Committee is planning to introduce broad legislation affecting the regulation of medical products in the next session. Joe Pitts, the Pennsylvania Republican who leads Energy and Commerce’s health panel, has congratulated Cole on his selection to lead the “critical” Labor-HHS panel.

“I am looking forward to working with him closely on health issues in the coming Congress,” Pitts said. “There’s a lot of work that will require close cooperation between the authorizing and appropriating committees.”

November 24, 2014

CBO Offers Some Uncomfortable Deficit Reduction Options

Congressional anxiety over the federal debt level and consistent annual budget deficits has recently taken a back seat to other battles. Also, deficit worries were put on hold by last year’s bipartisan budget agreement that set 2014 and 2015 spending levels. However, the budget battle will resume again next year and will be spurred by required action on raising the ceiling on the federal debt limit. Republican control over both chambers, plus the development of the annual congressional budget plan, will likely shift the focus back onto efforts to reduce deficit spending.

Health care program spending figures prominently in any debate on budgetary and deficit matters. The Congressional Budget Office last week compiled a summary of policy choices available to manage deficit and debt levels. Many of the items have been debated in Congress in the past and are highly contentious. The budgetary advisory agency estimated 10-year savings from several policy options including:

  • Limiting funding for the National Institutes of Health (savings: $11.5 – $34.7 billion)
  • Increasing the excise tax on cigarettes (added revenue $34.7 billion)
  • Limiting medical malpractice awards (savings: $60.4 billion)
  • Change Medicare cost-sharing rules and restricting Medigap policies (savings: $111 billion)
  • Increasing premiums for Medicare Parts B and D (savings $ 314 billion)
  • Requiring drug manufacturers to pay minimum rebates on Medicare Part D drugs (savings $103 billion)
  • Requiring minimum out-of-pocket fees for military retirees (savings: $27 billion)
  • Raising military retiree health plan enrollment fees and restrict coverage options (savings: $19 – $73 billion)




November 17, 2014

Examining the Impact Stopgap Spending and a Federal Shutdown

Congress will have to pass some form of a spending bill by Dec. 11, which is when congressional authority for temporary continuing spending expires. Appropriators are keen on a complete omnibus bill, which will fund the federal government, including health agencies and programs, through the end of fiscal year 2015. However, an omnibus bill is vexed by the complexities of agreeing on all the spending program details and funding levels, plus anxiety over looming administration action on immigration policy.

A likely alternative is a new stopgap spending bill, or continuing resolution, which would fund the government at largely current levels into the first few months of 2015. The short-term spending bill could include added funding elements for Ebola response efforts.

Budget chiefs at federal agencies likely wince at the idea of another continuing resolution (CR) because it greatly complicates federal budgeting and spending. A 2012 Congressional Research Service report explained that a CR not only adds to paperwork but agencies could also delay hiring, issuing grant awards and cut back on travel expenses. However, the alternative to a CR is a federal government shutdown, which poses much more severe headaches and federal employee furloughs. A Government Accountability Office report issued last week examined the impact of last year’s federal shutdown on HHS agencies.



November 14, 2014

Weekly Roundup: Emergency Ebola Funding Seeks a Spending Bill Home

Congress this week returned from the longest election recess break since 1960 and immediately began posturing on an upcoming spending bill and other possible available options for the lame duck session. A temporary extension of fiscal 2015 spending expires on Dec. 11. Congressional appropriators spent the week urging passage of a complete full-year spending package, which would include funding for health agencies and programs. Alternatively, some Republicans suggest a further spending bill extension, which would shift spending decisions into January.

The U.S. had no Ebola patients for only a few days this week. Following the release of a NY physician on Tuesday, a new patient from Sierra Leone arrives in Nebraska on Saturday. The administration’s emergency funding request for Ebola response activities, both in West Africa and domestic preparedness was examined on Wednesday in a Senate hearing (view Roll Call video). Separately, a House committee hearing on Thursday largely supported emergency funding to help the State Department respond to the Ebola outbreak in West Africa.

The biggest threat to the Ebola funding request appears to be if Congress resorts to a further extension of stopgap spending instead of a complete omnibus measure due to political pressures. In that case, a portion of the extra Ebola funding would likely be tacked onto a stopgap continuing resolution. However, the entire spending bill package is also threatened by possible Republican reaction to any White House action on immigration policies.

Meanwhile, a Senate committee this week set up a pathway for action on a measure (S 2917) adding Ebola drug research to an existing FDA drug development program. Action over the next few weeks is also possible on a bill (HR 5059) seeking to reduce veterans’ suicide rates. Also, the House on Thursday completed voting — and sent to the President — a bill renewing traumatic brain injury research programs (S 2539) and a measure urging the FDA to expedite the approval of sunscreen ingredients (S 2141).


November 10, 2014

Week Ahead: Committees Examine New Ebola Response Funding; Allows Exchange Plan Viewing Today

House and Senate committees this week return to examination of the U.S response to the Ebola virus outbreak in West Africa and a review of domestic public health preparedness plans. Senate appropriators on Wednesday afternoon seek details from Health and Human Services Secretary Sylvia Mathews Burwell and the HHS Ebola response duo of FDA Director Thomas Frieden and Anthony Fauci the director of National Institute of Allergy and Infectious Diseases, plus State and Homeland Security department officials. On Thursday the House Foreign Affairs Committee also examines international Ebola response efforts in West Africa.

The White House last week requested $6.18 billion in additional funding. The formal request includes $2.4 billion for Department of Health and Human Services agencies, with the bulk of funding directing toward Centers for Disease Control and Prevention efforts to respond to the outbreak and other infectious disease threats. The White House also seeks $2.1 billion for the U.S. Agency for International Development for humanitarian assistance; $157 million for the Biomedical Advanced Research and Development Agency to manufacture vaccines for clinical trials; and $112 million for the Defense Advanced Research Projects Agency research on the virus. Other funding will be held in a contingency fund pending further developments of the epidemic (view White House fact sheet). The funding is in addition to $88 million in CDC and drug development funds approved by Congress earlier this year and $750 million in reprogrammed Pentagon spending for a West African relief mission.

Also this week, the House Veterans Affairs Committee honors Veterans’ Day sentiments in a hearing on recently enacted legislation expanding veterans’ health care treatment options.

Separately, a new enrollment period for health insurance exchanges begins on Nov. 15 but you can see plan data online starting today. The Centers for Medicare and Medicaid Services says that early look at plan details will assist consumers prior to beginning the formal enrollment process.


November 7, 2014

Weekly Review: Election Shock and New Health Law Battles; Additional Ebola Response Funding Requested

The 2014 congressional mid-term elections this week vaulted Republicans into control of the Senate and bolstered GOP majorities in the House. The new Congress, which convenes in January, will press the White House on changes – including a possible an outright repeal — of the Affordable Care Act.

CQ Roll Call followed the election as results came in on Tuesday evening (view Roll Call election maps) and wrapped up the election in an election impact conference on Thursday (view C-SPAN video of election commentary and reporter roundtable discussion).

The newly reconfigured Congress will likely also pressure the administration on federal agency and health program spending priorities and policies. Additionally, a new Congress requires a restructuring of committees that can address health care issues. Separately, election results for state governorships signaled a likely delay in any further action on expanding the Medicaid program.

However, the old Congress returns starting next week to wrap-up remaining topics, primarily an extension of federal spending beyond the scheduled Dec. 11 expiration of funding for federal agencies. The White House requested that the spending bill, which likely will extend fiscal 2015 funding into the new year, include new emergency funding to bolster the U.S. response to the Ebola outbreak in West Africa and precautionary efforts to support domestic preparedness programs.

Meanwhile, the Supreme Court this week passed up on an opportunity to accept a legal challenge to health insurance subsidies offered to policies purchased on the federally operated insurance exchanges. Justices meet again today in a private conference and have another opportunity to consider accepting pending cases. Official notice of the decision – or no decision – will be officially posted on Monday morning. [Update: CQ Roll Call’s Todd Ruger reports (subscription) that the court on Friday agreed to hear the health law subsidy challenge case. The White House said it is confident the court will agree that the intent of the law was to include subsidies in all states].


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.



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