Appropriations

Lawmakers are starting to look to an additional continuing resolution (CR) to keep the government running—potentially through the holiday season and into the new year.  There has been little progress on FY18 spending levels and Republicans focusing on the tax overhaul, Congress is likely to need an additional CR to avoid a government shutdown when the current CR expires on December 8.  Senate appropriators have yet to finish their work in committee and it is unclear when, and if, they may resume panel markups.  A CR at current levels into January 2018 (or later) would trigger across the board cuts because the current levels exceed the sequestered spending caps for FY18 unless Congress enacts a bipartisan deal to raise the caps before then.

ACA

The Trump Administration is proposing a series of changes to the health insurance exchanges that would transfer more responsibility to the states in 2019.  The proposed rule would place more authority in the hands of state regulators on key aspects, such as essential health benefits, how much insurers spend on medical claims, and the certification of health plans. It would allow states to select a new benchmark plan, which establishes the state’s 10 essential health benefits. Under the current plan, states were asked to model benefits after those in a plan already operating in a state and defaulted to the largest small group plan if the state did not choose one each year. There is possibility of implementing a federal default list of benefits in the future. The proposed rule would also give states more flexibility over the small business exchange.  Additionally, it is proposing to push a mandatory review of premium increases from a 10 percent threshold to 15 percent—the rate review system was designed to ensure premium hikes were “reasonable.”  Finally, CMS is proposing to changes to the navigator system—removing requirements that each exchange have at least two organizations, known as navigators, that help consumers enroll in coverage and ending a requirement that the navigator be located in the exchange’s geographic area

CHAMPION Act

This morning, the House passed HR 3922, the Championing Health Kids Act, by a vote of 242-174 (15 Democrats voted in favor, three Republicans voted against).  The bill funds Children’s Health Insurance Plan (CHIP) for five years and Community Health Centers and several other health programs for two years.  It also provides for up to $1 billion in additional Medicaid funding to Puerto Rico and eliminates scheduled cuts in Medicaid funding to hospitals that serve large numbers of uninsured and low-income patients for two years.

To offset the measure’s spending, the bill would cut the Prevention and Public Health Fund by $6.35 billion (back to the committee-approved level).  The Prevention Fund makes up roughly 12 percent of the CDC’s budget and losses in the Fund will have ripple effects throughout HHS.

Tax Plan

The House released its’ tax reform plan, The Tax Cuts and Jobs Act, on Thursday.  GOP leaders look to get the plan on the House floor the week of November 13.  There is no mention of the $1.5 trillion deficit that the plan would produce, or how they would ensure domestic programs would not bear the brunt of the plan.