POLICY BRIEFINGS


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.


THIS WEEK'S BRIEFING - JANUARY 22, 2018


Government Shutdown Begins Amidst Funding Lapse


Lawmakers have spent recent weeks debating a series of funding measures to avoid a government shutdown, but were unable to reach an agreement to keep the government open past January 19. In the absence of a spending plan, the federal government began to shut down non-essential operations at midnight on Friday.

Earlier in the week, House Republicans introduced a stopgap-spending bill (H.R. 195) that would fund the government through President’s Day. The GOP’s continuing resolution (CR) was intended to provide more time for Congress to agree upon a broader spending deal – a trillion-dollar omnibus bill that would fund the government through the end of the fiscal year (FY). H.R. 195 would have funded the Children’s Health Insurance Program (CHIP) for six years. It also would have delayed several Obamacare taxes to gain the support of some Republicans hesitant to support a fourth CR in as many months. The plan would have delayed the medical device tax and the Cadillac tax for two-years as well as the health insurance tax for one year starting in 2019. The House successfully passed the CR by a vote of 230-197 on Thursday, with 11 Republicans in opposition and six Democrats crossing the aisle to support.

The government funding debate was complicated by disagreements among party leaders and President Trump over immigration reform. Senate Democrats demanded a permanent solution to maintain protections under the Deferred Action for Childhood Arrivals (DACA) program for the 700,000 young, undocumented immigrants known as Dreamers, which the White House previously rescinded with a delayed implementation until the end of March. Majority Leader Mitch McConnell (R-Ky.), however, has stated he will not schedule a vote on any immigration compromise that does not have the support of President Trump. Since the President reportedly rejected a bipartisan immigration deal last week, DACA negotiations have been at a standstill.

At least nine Senate Democrats were needed to advance the stopgap spending measure with the required 60 votes, but the Senate lacked the necessary support to stop government funding from formally lapsing. The procedural motion on the bill failed by a vote of 50-49. Five Democrats voted to advance the bill – Sens. Joe Manchin (W.Va.), Joe Donnelly (Ind.), Heidi Heitkamp (N.D.), Claire McCaskill (Mo.), and Doug Jones (Ala.). A number of Senate Republicans also withheld support for the House-passed bill, citing the negative impact temporary funding patches have on the military and defense. Republicans Rand Paul (Ky.), Lindsey Graham (S.C.), Mike Lee (Utah), and Jeff Flake (Ariz.) voted against the bill, while Sen. McCain (R-AZ) was unable to vote due to his ongoing cancer treatment.

Both the House and the Senate were in session over the weekend, but a vote has yet to be scheduled on reopening the federal government. Republicans appear to be insisting on reopening the government before resuming negotiations on immigration, while Democratic support continues to be attached to assurances of DACA protections.

A bipartisan group of 20 Senate centrists was working Sunday on a compromise plan to get the government funded for three more weeks while the immigration debate continues. But there was no assurance that party leaders -- or the House -- would go along. The group is pulling together a proposal to extend stopgap funding for the government through February 8. The deal also would guarantee of a separate vote on legislation to put into law a program that protects from deportation some of the undocumented immigrants brought to the U.S. as children, a central demand of Democrats. If the temporary funding plan gets the assent of McConnell and Schumer, there is a good chance an immigration bill could pass the Senate. Then it would be taken up in the House, where immigration hardliners show no signs of budging. President Donald Trump, who could give Republicans political cover to vote for immigration legislation, has been giving conflicting signals. Republican Senator Lindsey Graham, who’s been one of the main negotiators on immigration, said White House staff are now demanding $33 billion for border security when Trump said last week he could make a deal for less than $18 billion.

According to the plans released by the U.S. Department of Health and Human Services (HHS), approximately half the staff at HHS will be furloughed. The Medicare and Medicaid programs will be largely unaffected by the shutdown, at least in the short term and payments will be made to eligible states from the remaining Children’s Health Insurance Program (CHIP) carryover balances. The National Institutes of Health (NIH) will continue patient care for current NIH Clinical Center patients, but will not admit new patients (unless deemed medically necessary by the NIH Director), initiate new protocols, or take any actions on grant applications or awards. The Food and Drug Administration (FDA) will stop conducting routine inspections and cease some compliance and enforcement activities. FDA will maintain critical consumer protection to handle emergencies, high-risk recalls, civil and criminal investigations, import entry review, and other critical public health issues. The Centers for Disease Control and Prevention (CDC) will have a significantly reduced capacity to respond to outbreak investigations, processing of laboratory samples, and maintaining the agency’s 24/7 emergency operations center. CDC staff will continue to support the ongoing hurricane response and World Trade Center Health Program. CDC activities that are supported by funding not impacted by the shutdown include: U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC’s Global AIDS program, the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), Vaccines for Children (VFC) program, certain asbestos exposure in Libby, Montana, Ebola response and preparedness, and Global Health Security Agenda implementation.

A new POLITICO/Morning Consult poll, conducted Thursday and Friday found more voters would blame Republicans in Congress for the government shutdown (41 percent) than would blame Democrats (36 percent). Democratic and Republican voters, by wide margins, held the other side responsible, but more independents said they would blame Republicans (34 percent) than Democrats (27 percent). Yet the shutdown is no clean political win for Democrats. Americans don’t necessarily approve of the party’s strategy to insist on a legislative solution for undocumented immigrants brought here as children before voting to reopen the government. In fact, both parties’ immigration stances — Democrats’ efforts to protect the so-called Dreamers and Trump’s insistence on funding a border wall with Mexico — are viewed by voters as less important than keeping the government open.



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