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February 6, 2018

Inside Congress' effort to keep the government open—and what it means for the ACA, CHCs, Medicare, and more

Daily Briefing

    The House on Tuesday is expected to vote on yet another short-term spending bill (H.J. Res. 128) that would keep the federal government open through March 23 and fund community health centers for two years.

    Medicare 101: Download our cheat sheets for Parts A through D

    Unless Congress acts by Thursday, the government will shut down for the second time in less than a month. According to Vox, lawmakers have yet to reach agreements on a long-term funding deal or an immigration bill—two key issues that contributed to last month's shutdown. 

    And while Democratic and Republican congressional staffers on Monday said another government shutdown is unlikely, the House's current short-term spending bill contains a provision that is unlikely to pass the Senate.  

    Inside the latest short-term spending bill

    The bill, which House Appropriations Committee Chair Rodney Frelinghuysen introduced Monday night, would fund most of the federal government through March 23, while funding the Department of Defense for an entire year—an approach that the Senate's 44 Democrats have rejected in the past.

    The bill also includes two years of funding for community health centers, which provide health care services to about 26 million uninsured and low-income U.S. residents at more than 10,000 locations throughout the country. Federal funding for CHCs expired at the end of fiscal year 2017, on Sept. 30. Congress has not yet passed legislation to reauthorize funding for the Community Health Centers Fund.

    The short-term spending bill also includes a package of Medicare provisions that would extend Medicare programs that expired on Sept. 30 and delays scheduled cuts to disproportionate share hospital (DSH) payments for fiscal years 2018 and 2019.

    The spending bill also includes several other health care reforms, including the CHRONIC Care Act, which aims to give Medicare Advantage plans additional flexibility and expand access to telemedicine.

    According to Modern Healthcare, the spending bill contains several funding offsets to pay for the program extensions. A one-pager circulated among GOP lawmakers Monday show the bill would reduce the Affordable Care Act's Prevention and Public Health Fund levels and rescind unspent funds in the Medicare and Medicaid Improvement Funds, and modify long-term hospital payments, among other changes.

    According to Axios' "Vitals," insurers had pushed for Congress to include a reinsurance provision for the ACA's exchanges in the short-term measure. However, the House's bill does not contain any funding to create a reinsurance program. 

    Bill's prospects in Senate unclear

    House Republican leaders said the full-year DOD funding provision was needed to secure the votes of conservative Republicans and ensure the bill's passage in the House.

    However, the bill would require Democratic support to reach the 60 vote threshold to pass in the Senate, and Senate Minority Leader Chuck Schumer (D-N.Y.) on Monday warned that Senate Democrats would not support the DOD funding provision. Industry observers say the Senate could strip the DOD funding provision from the bill and send it back to the House for consideration.

    According to the New York Times, congressional lawmakers also are nearing a deal on new military and domestic spending caps that have delayed progress on a long-term spending bill. Some lawmakers and congressional aides say there is a chance a final deal could be reached this week, but CNN reports that it's not certain the bill will be finalized before the current continuing resolution expires.

    White House deputy press secretary Raj Shah on Monday said President Trump is committed to a long-term budget deal. He said, "Moving from stopgap measure to stopgap measure is no way to govern," adding, "We're disappointed in Congress that we're potentially facing something like that" (Bresnahan/Ferris, Politico, 2/5; Mattingly, CNN, 2/5; Golshan, Vox, 2/5; Mattingly/Walsh, CNN, 2/6; CQ HealthBeat News, 2/2 [subscription required]; Baker, "Vitals," Axios, 2/6; Luthi, Modern Healthcare, 2/5).

    Medicare 101: Cheat sheets for Parts A through D

    Through the years Medicare has grown more complicated, including private supplemental insurance and prescription drug coverage. Download our cheat sheets to learn how each of the four parts of Medicare works, and why they’re so important for provider organizations:

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