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Title V Technical Assistance Meeting

 A View From Washington

By Amy Haddad
Director of Public Policy and Government
AMCHP

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As we closed out 2017, I think we can all agree that dysfunction had become the new normal in Washington. Congress has yet to complete its work on pressing issues such as fiscal year 2018 appropriations and reauthorizing a slew of health programs that expired in September, including the Children's Health Insurance Program (CHIP) and the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV).

Despite widespread bipartisan support for these programs, they are caught up in a frustrating political puzzle involving some seemingly unrelated issues. For example, what does tax reform have to do with children's health insurance? And why does Deferred Action for Childhood Arrivals immigration policy affect funding for public health programs?

The answer is that with such a narrow vote margin in the Senate and a strong contingent of extremely fiscally conservative members in the House of Representatives, congressional leaders must cut deals to gain every vote – making it quite easy to hold other bills hostage in order to leverage bargaining power. We've ended up with a situation where to pass tax reform in the Senate, promises have been made to address health insurance stabilization. In order to address health insurance stabilization in the House, promises have been made to increase defense spending. But back in the Senate, Democrats will insist that any increases to defense spending be matched with increases to spending for non-defense programs (like public health programs), which conservatives in the House oppose!

Is your head spinning yet?

All of this means that December was characterized by the president and congressional leadership furiously negotiating a way to ensure enough Republican votes to pass a tax reform bill, widely viewed as the marquee legislative achievement for 2017, while cutting deals on other programs without losing the necessary Democratic votes that were needed (in the Senate at least) to avoid a government shutdown. Adding to the time crunch: probably the most watched Senate race in Alabama in a long time! With Senator Doug Jones is sworn in, the make-up of the Senate shifts to 51 Republicans and 49 Democrats. Whereas most legislation requires 60 votes to move forward, certain bills, such as the tax reform bill, only needed 50 – meaning that in December, Republicans could afford to lose two votes from Republican senators, but now that margin is down to one.

Speaking of the Alabama Senate race, the outcome certainly reinforced that 2017 was anything but a predictable year for politics and policy. Because of that, I'm hesitant to make any predictions about how things will shape up, but our AMCHP policy holiday wish list would include: seeing the government stay open; important programs reauthorized such as CHIP, MIECHV, Community Health Centers, Personal Responsibility and Education Program (PREP), Family to Family Information Centers, National Health Service Corps, etc.; the Prevention and Public Health Fund to be saved; and sustained funding for the Title V Block Grant.

One thing I will confidently predict: 2018 will not be predictable, either.