December 8, 2017

Trump signs short-term spending bill with temporary CHIP fix

Daily Briefing

    President Trump on Friday signed a two week stopgap spending bill (H.J. Res. 123) that includes a temporary fix to allocate CHIP funding to states running low on money for the program—but the bill does not authorize new federal CHIP funding.

    Medicare 101: Cheat sheets for Parts A through D

    Congress passed the measure on Thursday. The House voted 235 to 193, with 18 Republicans voting against the continuing resolution and 14 Democrats supporting the legislation, while the Senate voted 81 to 14, with seven Republicans and eight Democratic senators voting against the measure.

    Continuing resolution details

    The continuing resolution will maintain current spending levels through Dec. 22—essentially establishing a new deadline by which Congress must pass a spending bill to avoid a federal shutdown.

    The bill also includes a provision that would temporarily lift a restriction on the amount of money states can receive from CMS' reserve of unused CHIP funds. Federal funding for the program expired Sept. 30, and without new funds several states are at risk of depleting their reserves by the end of the year.

    Some observers say the provision could help states continue implementing their programs while Congress works to reauthorize federal funding for CHIP. However, the provision does not authorize any new appropriations; rather, it makes it easier for states to receive money from CMS' reserve, which Axios' "Vitals" reports likely contains enough funds to last a few months. Some states have already requested additional funds from CMS' reserve.

    At least one state, Colorado, has begun notifying CHIP enrollees that they could face coverage disruptions if Congress does not soon reauthorize federal funding for the program.

    CHIP could be sticking point in spending bill negotiations

    Top Republican and Democratic congressional leaders met with Trump on Thursday to begin negotiations on a final spending bill, which will require Democratic support to pass Congress, Vox reports.  

    Attendees appeared optimistic about future discussions after the meeting, but according to Vox, Democrats may seek to use their votes as leverage to push legislative priorities that are likely to be tough sells for Republicans. For instance, Democrats are reportedly seeking to include protections for undocumented immigrants covered under the Deferred Action for Childhood Arrivals (DACA) program, which the Trump administration is phasing out.

    House Minority Leader Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.) after the meeting outlined other legislative priorities they are pursuing, including funding to fight opioid misuse, support veterans, and address funding lapses for CHIP and community health centers.

    Several Republicans also have raised concerns about the lack of action on CHIP and said it is likely to be a priority for the spending bill, CQ News reports. For instance, Sen. Shelley Moore Capito (R-W. Va.) said she has received "very positive feedback" from the Senate Finance Committee and Senate leaders on CHIP reauthorization. "I've talked to [Senate Majority Leader Mitch] McConnell [R-Ky.] about this several times and I think it's going to be in the year-end package," she said.

    Sen. Orrin Hatch (R-Utah), who chairs the Senate Finance Committee, said, "We're going to do CHIP—there's no question about it in my mind," adding, "But we've got to do it the right way. But the reason CHIP's having trouble is because we don't have any money anymore."

    Tax reform caught up in spending bill negotiations

    At the same time, Republican congressional leaders are hoping to use the extra time provided by the continuing resolution to reconcile the House- and Senate-passed tax reform bills.

    Both measures include their own changes to the tax code that could affect the health care industry, as well as individuals' ability to deduct medical expenses. However, a key difference is that the Senate bill contains a provision that would eliminate the Affordable Care Act's individual mandate penalty, while the House bill contains no such provision.    

    The House and Senate this week began work on a compromise bill, but it remains unclear whether the individual mandate provision will be included.

    Sen. Susan Collins (R-Maine) has tied her support for eliminating the mandate penalty via Republicans' tax reform measure to the passage of two health bills. One, a bipartisan health bill crafted by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), would fund cost-sharing reduction (CSR) payments to insurers called for under the ACA. The second would fund reinsurance programs for exchange insurers.

    Collins on Thursday said she received assurances from McConnell that the health care bills would be passed in both chambers before a final tax bill is brought for a vote. According to Vox, Collins views the new spending deadline as an opportunity for the House and Senate to vote on the bills.

    However, Republican Study Committee Chair Mark Walker (N.C.) said Thursday that House conservatives received assurances that the ACA would not be part of negotiations surrounding a final spending bill. He said, "The three things we were told are not gonna happen as part of our agreement: no CSRs, no DACA, no debt limit" (Golshan, Vox, 12/7; Levy, U.S. News & World Report, 12/7; Carney, The Hill, 12/7; Bresnahan et al., Politico, 12/7; Cancryn, Politico, 12/8; Raman, CQ News, 12/7 [subscription required]; Baker, "Vitals," Axios, 12/8; Wilkie, CNBC, 12/8).

    Medicare 101: Cheat sheets for Parts A through D

    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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