Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Congress has a busy agenda to accomplish in the coming weeks if lawmakers hope to be home for the holidays.

On page 3, we discuss the state of negotiations to avoid a government shutdown. The current continuing resolution (CR) expires on December 8. Another short-term spending bill will likely be necessary, with current reports indicating that the next CR will fund the government through December 22. One key health-related question is how much additional funding will be included to address the opioid crisis.

A long-term appropriations agreement will need to address the 2018 caps set by the Budget Control Act (BCA), which will automatically trigger across the board spending cuts in the absence of congressional action to raise the caps. Congressional leaders are currently negotiating a deal to raise the budgetary caps by as much as $200 billion over two years. The National Defense Authorization Act (NDAA) included funding $77.4 billion above the caps for defense, and Democrats are pushing for a similar amount for non-defense spending.

As noted on page 3, Democrats and Republicans are currently at odds over the inclusion of a Deferred Action for Childhood Arrivals (DACA) provision that would allow Dreamers to avoid deportation. President Trump ended the DACA program effective mid-March 2018.

Lawmakers are also debating the inclusion of an individual insurance market stabilization package [to extend cost-sharing reduction (CSR) payments and fund reinsurance programs] in the long-term omnibus spending bill. This provision is discussed in more detail on page 2.

Congress has yet to reauthorize the Children’s Health Insurance Program (CHIP), community health centers, and other expiring health care programs. Once an agreement is reached on offsets for such a package, it could also be attached to a year-end spending bill. For more details on the state of negotiations, please see page 3.

Finally, the Administration is seeking to extend sequestration under the BCA from fiscal year (FY) 2025 to FY 2027 in order to pay for a $44 billion disaster-relief package they want attached to the FY 2018 spending bill.

While the House and Senate have successfully passed tax reform legislation, each chamber’s proposals now head to conference committee to be reconciled, with hopes to get a final bill to the President’s desk by the end of the year. Because of the bill’s impact on the federal deficit, lawmakers will also have to grapple with a waiver to Senate PAYGO rules, in order to avoid a Medicare sequester. We provide more details on this subject below. Finally, the House and Senate also need to pass a Medicare extenders package, which will likely be included in the end of the year spending package.

December 4, 2017: | Page 1 Page 2 Page 3 Page 4



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