Legislative & Policy Corner


Budget Update FY 2014

Last weekend, the U.S. Senate adopted a FY 2014 budget resolution (S.Con Res 8). This non-binding resolution will guide spending decisions for the upcoming fiscal year. Importantly, this resolution calls for long-term reductions in spending and sets the overall funding level for discretionary spending. The House resolution is considerably different from the Senate version because it calls for the repeal of health reform, restructuring programs and shifts responsibility of sequestration to non defense discretionary programs.

Specifically, the House budget sets overall discretionary level, or the “cap” on appropriations, at the post-sequestration level of $966 billion – $92 billion less than the cap on funding established by the Budget Control Act of 2011 – and shifts full responsibility for sequestration cuts to non defense discretionary programs. As a reminder, non defense discretionary includes the pot of money that funds the U.S. Department of Health and Human Services (HHS), Department of Interior and other non defense agencies.

House budget resolution discretionary caps:

  • Defense – $552 billion (equal to Budget Control Act cap)
  • Non defense discretionary – $414 billion ($92 billion less than Budget Control Act cap)

The Senate budget discretionary cap also is $966 billion, but the cuts are split between defense and non defense:

  • Defense – $497 billion ($55 billion less than Budget Control Act cap)
  • Non defense discretionary – $469 billion ($37 billion less than Budget Control Act cap)

The bottom line is that based on these budget resolutions the House Appropriations Committee will have $55 billion less than the Senate Appropriations Committees when developing their appropriations bills. In previous years, the House Labor, Health and Human Services and Education Appropriations bills had to absorb the majority of those cuts.

Prevention and Public Health Fund? FY 2013
Are you wondering what programs the Prevention and Public Health Fund (PPHF) will be supporting in FY 2013? If you are, you are not alone. The FY 2013 Continuing Resolution did not indicate congressional priorities for allocating PPHF dollars, which means that the administration has the authority to allocate funding for their priorities. Rumors are rampant in Washington, DC that the administration plans on using the fund to pay for some of the Affordable Care Act initiatives, like the health insurance exchanges. Many public health advocates are encouraging the administration to preserve the PPHF to pay for public health programs and to backfill the cuts at the Centers for Disease Control and Prevention (CDC). AMCHP continues to closely monitor and will keep you updated as developments progress.

Sequestration FY 2013
Our members and partners continue to express frustration about the lack of information regarding implementation of sequestration. As a result, AMCHP sent an organizational sign-on letter with the Association of State and Territorial Health Officials (ASTHO) affiliate group encouraging the administration to expedite and facilitate communication about sequestration between the department project officers and their partners in state and local government. This letter emphasizes that even if all that can be shared at this point is estimated timelines for notification that would be helpful. This letter also requests that HHS advise when additional information is expected to be available about sequestration. A copy of the letter signed by 13 national public health associations is available here.

Sequestration FY 2013 and Beyond
Last week, President Obama signed legislation solidifying sequestration for FY 2013. It is important to remember that unless Congress acts to change the current law, the automatic procedures for reducing discretionary spending will be carried out by lowering the caps on discretionary budget authority. This means that across the board spending reductions may not happen in FY 2014, however, the appropriations committee could target specific programs for elimination or deep cuts in order to meet the tight budget caps. AMCHP developed a frequently asked questions fact sheet about sequestration in FY 2013 and beyond to help you better understand this confusing topic.

Health Reform Implementation

CMS Informational Bulletin on Mental Health and EPSDT
The Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin on Prevention and Early Identification of Mental Health and Substance Use Conditions in Children on Mar. 27 “to help inform states about resources available to help them meet the needs of children under Early Periodic Screening, Diagnosis, and Treatment (EPSDT), specifically with respect to mental health and substance use disorder services.” AMCHP member Phyllis Sloyer from Florida and AMCHP staff Karen VanLandeghem participated in the National EPSDT Improvement Workgroup that contributed to this informational bulletin.

Maryland Passes Health Benefits Exchange Legislation
On Mar. 27, the Maryland General Assembly passed legislation that expands Medicaid eligibility, but also includes a unique feature; the ability for a consumer to continue previously authorized treatment on a new health insurance plan. The inclusion of this language in the law is a huge win for those concerned about continuity of care for consumers who might shift between health plans if their life situation changes. This is especially important for pregnant women who might change between a private health insurance plan and Medicaid when she becomes pregnant. For example, if a woman changes insurers, her new plan shall accept “the procedures, treatments medications, or services covered by the benefits offered by the receiving carrier or managed care organization” for 90 days or the course of the treatment, whichever is lesser.

Third Anniversary of Affordable Care Act
Mar. 23 marks the third anniversary of the Affordable Care Act. HHS provided analysis, on how many Americans are receiving preventive services coverage without co-pay (71 million), as well as other resources including a consumer education video , state-by-state fact sheets, and information on various populations and how the health care law will impact them. As always, stay tuned to AMCHP publications for the latest updates on the Affordable Care Act.

National Stakeholder Call on the Health Insurance Marketplace
On Mar. 18, CMS held a national call on the Health Insurance Marketplace (aka Health Insurance Exchange). The purpose of the call was to update stakeholders on the implementation of the marketplace and allow CMS to interact directly with stakeholders. CMS will be holding quarterly stakeholder calls beginning the last week of April 2013 for those states that will have a federally facilitated or state partnership marketplace.

CMS provided the following information and resources:

Remember there are a few places you can get more information on the Marketplace and to sign up for updates:

1.      HealthCare.gov: This site is geared toward consumers and provides general information about the Marketplace and health insurance. Consumers can sign up for e-mail and/or text message updates.

2.      Marketplace.cms.gov: This partnership page has a wide variety of tools and resources to prepare people to apply, enroll and get coverage in 2014. You will find the following information:

  • Census data on where the uninsured live – down to the PUMA level
  • Widgets and badges you can use on your own websites
  • Multimedia presentations explaining the Marketplace
  • Brochures, drop-in articles, and other information in English, Spanish, Russian, Tagalog, Chinese, Korean, and Vietnamese
  • Sign up for updates

3.      State-by-state calls: Please check the Open Door Forum page for the tentative schedule and updates on the state-by-state calls that will occur throughout 2013. Here you will find the best point of contact for your state in one of the 10 CMS regional offices nationwide.

Benchmark Health Plan Analysis
As part of the Affordable Care Act, states were required to either select or default to a benchmark health insurance plan as a reference for the essential health benefits. On Mar. 12, the Commonwealth Fund released a report analyzing the benchmark plans in 24 states and the District of Columbia. The issue brief examines how state leaders made their selection and what decisions were made given the timeline for implementation, which stakeholders were engaged and many more issues they encountered.