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 Legislative & Policy Corner

Health Reform Implementation

Federal Budget Update
Welcome to March fiscal madness when legislation, amendments and resolutions are being introduced and debated at lightning speed. AMCHP staff is closely monitoring and analyzing various proposals as they are introduced and the below synopsis is our analysis of where things stand today.

FY 2013 Mar. 1, 2013 Sequestration
The Office of Management and Budget (OMB) issued a sequestration order two weeks ago. A couple of days following that announcement, the Health Resources and Services Administration (HRSA) sent an email to formula grantees indicating the percentage cut would be 5 percent, which, according to our best guess, equates to an approximate $32 million reduction from the Title V Maternal and Child Health (MCH) Services block grant bringing the FY 2013 baseline to $606 million. Unfortunately, it appears most agencies have not yet contacted states and partners to delineate the percentage cut and when the cuts will be administered. AMCHP will be working in close partnership with the Association of State and Territorial Health Officials (ASTHO) and other affiliates to request that the U.S. Department of Health and Human Services (HHS) communicate with the field regarding sequestration so that state and local public health departments can plan their budgets accordingly.

FY 2013 Mar. 27, 2013 Funding for the Federal Government Expires
Congress is currently debating legislation to fund the federal government for the remainder of the fiscal year (Mar. 27-Sept.30). Despite our best efforts, this legislation DOES NOT UNDO sequestration. Sequestration is still scheduled to occur and this legislation would lock it in for FY 2013. The House approved their version of the bill last week and the Senate is currently amending that legislation. As of today, there are differences between the two bills and the amendment process is still taking place.

  • House Continuing Resolution (H.R. 933): Late last week the U.S. House of Representatives approved their version of a resolution funding the federal government for the reminder of the fiscal year. Included in this bill is small across the board cut to all programs. This legislation is currently being debated in the U.S. Senate.

  • Senate Continuing Resolution: On Mar. 11, Senate Appropriations Chairwoman Barbara Mikulski (D-MD) unveiled her version of a continuing resolution (CR) intended to fund the government through the rest of the fiscal year while helping many federal agencies better manage spending cuts under sequester. The Senate bill expands on the stopgap funding plan (H.R. 933) passed by the House last week but maintains the same overall spending level. The Senate version includes three more bills — Agriculture, Commerce-Justice-Science and Homeland Security, along with the new Military Construction-Veterans Affairs and Defense bills the House included in its version. This includes $6.9 billion for the U.S. Department of Agriculture (USDA) Women, Infants and Children nutrition program, which is above the FY 2012 funding of $6.6 billion. While the remaining seven spending bills, including the Labor, Health and Human Services and Education, are funded at FY 2012 levels funding for those agencies will be further reduced by a small across the board cut and the 5 percent as stipulated by the sequester. Under this bill, however, the National Institutes of Health (NIH) will receive a $71 million increase but, that increase will be washed away with the 5 percent or $1.5 billion sequestration reduction. The CR is expected to pass next week.

Senators are offering amendments to this resolution, which would increase or decrease funding for key programs. Below is a summary of key amendments and their status:

  • Sen. Harkin (D-IA): This amendment to the CR that would increase funding the Title V Maternal and Child Health Services Block Grant (+$1.4 million), NIH (+$140 million), Ryan White AIDS Drug Assistance Program (+$29 million), the Preventive Health Block Grant (+$25 million), among other programs. The amendment did not pass.
  • Sen. Cruz (R-TX): This amendment would have blocked the use of federal funding to implement the Affordable Care Act. This amendment did not pass.
  • Sen. Coburn (R-OK): Introduced an amendment that would limit the involvement of federal employees in association conferences to 25 individuals per conference. This would have an impact on the involvement of Health Resources and Services Administration, Centers for Disease Control and Prevention staff and other federal government staff in conferences and meetings. AMCHP is currently reviewing the amendment and analyzing its impact on the AMCHP annual conference.

As of today, more than 100 amendments are pending for consideration to the Senate continuing resolution. It is expected that the continuing resolution will be approved by the Senate early next week. After that, the legislation would return to the House for an additional vote. AMCHP will keep you updated as this process moves forward.

FY 2014 Apr. 15, 2013 Budget Resolution
Last week, the Chairs of the House and Senate Budget Committees unveiled their budget resolutions providing a blueprint for funding in fiscal year 2014 and beyond. The two proposals could not be more different in their approach to reduce the deficit and set spending priorities for the next year. Below is a summary:

  • House Resolution – Chairman Ryan (R-MN): This resolution proposes to balance the budget in ten years. Some of the initiatives included in this resolution are the following: repeal the Affordable Care Act, combine the Children’s Health Insurance Program and Medicaid into one block grant program that would be indexed for growth based on population increases and inflation, creates a premium support program for Medicare, freezes maximum Pell Grants for 10 years, and cuts food assistance programs. According to an analysis by the Center on Budget and Policy Priorities this legislation cancels sequestration for defense while further lowering the caps or overall amount of funding available for non defense discretionary programs for FY 2014-FY 2023. Specifically, this proposal would provide $700 million BELOW sequestration levels or $1.1 trillion BELOW the caps established by the Budget Control Act of 2011. According to the Coalition for Health Funding, this proposal essentially shifts responsibility for sequestration entirely on non defense discretionary programs.

  • Senate Resolution – Chairwoman Murray (D-WA): First, this plan cancels sequestration. This resolution reduces the size of the deficit to 2.2 percent of GDP by reducing the deficit by $1.85 trillion over the next decade through $975 billion in spending cuts and $975 billion in new revenue, $275 billion dollars in cuts would come from Medicare and Medicaid, $76 billion from other mandatory, $240 billion from cuts to defense spending. This resolution lowers the caps or overall amount of spending available for non defense discretionary programs established by the Budget Control Act by $142 billion.

Since these plans are so dissimilar, it is unclear how Congress will resolve the differences between the two in the near future. It is important to note that budget resolutions do not get signed into law, but are important proposals setting the course for spending for the next fiscal year. The Senate will be considering the budget resolution in the next week.

FY 2014 Oct. 1, 2013 Testimony
In case you missed it, last week, AMCHP member Dr. Christopher Kus testified before the House Labor, Health and Human Services and Education Appropriations Subcommittee about the need for sustained funding for the Title V Maternal and Child Health Services block grant. Chairman Kingston (R-GA), Ranking Member DeLauro (D-CT), and Rep. Roybal Allard (D—CA) heard his oral remarks. Click here to view the written testimony.

What’s Next?
AMCHP will continue to keep you updated as these budgetary issues unfold. We expect the continuing resolution funding the federal government for the remainder of the fiscal year will be finalized by the end of next week. The House and Senate will vote on their respective budget resolutions. Finally, it is expected that President Obama will release his budget for FY 2014 by Apr. 8.

If you have any questions please contact Brent Ewig or Carolyn Mullen.  

AMCHP Submits Comments on Title V Data Reporting
On Mar. 7, AMCHP provided comments to HRSA on the Federal Register notice that was released by OMB on Jan. 7 requesting comments on the burden on states to report data on the amount of federal funding from the Title V MCH Services Block Grant that states spend on direct services. Request for comment was given in order to "Analyze Title V Programs in the Context of the Affordable Care Act." States also provided comments specific to their programs.

More States Approved to Partially or Fully Run Marketplaces
On Mar. 7, HHS conditionally approved four additional states to run their health insurance marketplaces. With the approval of Iowa, Michigan, New Hampshire and West Virginia, 24 states and the District of Columbia are conditionally approved to partially or fully run their marketplace with the doors opening for enrollment on Oct. 1, 2013. HHS is also working with several other states in dividing the labor of plan management.

Navigator and In-Person Assister Funding
HHS announced on Mar. 8 that the funding announcement for the navigator and in-person assister programs has been delayed. There were no details included in the announcement about when it is expected, but a follow-up webinar will be scheduled to discuss the funding announcement and answer questions. Stay tuned for more information!