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 Must Pass Spending Deal Before Friday Midnight

Congressional leadership from both chambers have been negotiating to settle on terms for a federal spending deal to keep the government running past the March 23 deadline. Their goal is to pass an omnibus appropriations package to fully fund the remainder of fiscal year (FY) 2018, that ends on September 30. House Majority Leader Kevin McCarthy (R-Calif.) signaled late last week that his caucus would like to see the package released to the public Sunday evening. The House could vote on the potential spending deal as early as Tuesday. The Rules Committee scheduled a meeting for Monday evening to consider a rule on the bill. This would give the Senate little or no time to make any amendments before the March 23 deadline. Early last week, Sen. Rand Paul (R-Ky.) signaled his opposition to the potential deal, expressing frustrations with the budget deal from earlier this year that raised government spending caps. With Sen. Paul’s opposition and the absence of Sen. John McCain (R-Ariz.) from the Senate due to his ongoing cancer treatment, the Senate would need to rely on support from Democrats to pass the legislation.

Issues holding up the negotiations include the $13 billion Gateway Project tunnel to link New Jersey and New York under the Hudson River, language differences around funding for groups that provide abortion services, and the ongoing dispute regarding protections for millions of so called “Dreamers” that arrived in the country as minors and could lose temporary protective status under the Deferred Action for Childhood Arrivals (DACA) immigration policy. Republicans also decided in recent weeks to limit an accounting gimmick known as CHIMPS (Changes in Mandatory Program Spending) to $14 billion that could be used to pay for spending elsewhere. This could result in $5 billion in cuts for programs within the Departments of Labor and Health and Human Services.

Key health items still being discussed include the allocation of the funds for opioids, given that the budget agreement included up to $6 billion for FY18 and FY19, as well as inclusion of the cost-sharing reduction (CSR) payments sought to stabilize the health insurance market. The CSR payments face concerns on both sides. Some Republicans have voiced concerns with the current provisions given that it does not explicitly apply the Hyde amendment that prohibits taxpayer funds from being used for most abortions, while some Democrats have voiced concerns that the CSR payments would not be sufficient to stabilize the market and, as such, would prefer a broader package. Last Monday, renewed opposition was brought forward in a letter to congress from 15 conservative organizations, including Heritage Action, the Club for Growth, and Americans for Prosperity. The groups claim that any funding of CSRs would equate to a bailout for private health insurance companies and claim that the payments and reinsurance programs are costly and unnecessary.

National Match Day Celebrates Biggest Numbers in History

On Friday, the National Resident Matching Program (NRMP) released results to applicants seeking medical residency and fellowship training positions. 37,103 applicants applied for 37,162 available positions, signifying the largest ever number of slots offered on match day. Of the available positions, 96.2% were filled, up 0.2% from 2017. Specialties that filled 100% of their available slots include Neurological Surgery, Physical Medicine and Rehabilitation, Integrated Interventional Radiology, and Thoracic Surgery. According to the Association of American Medical Colleges (AAMC) the U.S. faces a current shortage of up to 104,900 doctors by 2030. A bill to provide increases to graduate medical education (GME) slots, the Resident Physician Shortage Reduction Act (H.R. 2267/S. 1301), was reintroduced in 2017 by Reps. Joseph Crowley (D-N.Y.), and Ryan Costello (R-Pa.), and Sens. Bill Nelson (D-Fla.) and Dean Heller (R-Nev.).

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