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Category: Health/Medical

House Committee Passes FY16 Labor-H

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The House Appropriations Committee passed it’s FY16 Labor-H bill by a vote of 30-21. The passage came after hours of debate during which Democrats bitterly criticized funding levels for domestic discretionary accounts and saw a series of their amendments defeated. The bill is $3.7 billion below fiscal 2015 enacted levels and $14.6 billion below President Barack Obama’s budget request. It contains increased funding for the National Institutes of Health but would block new discretionary spending to implement the Affordable Care Act. Additionally, the Administration has issued a letter of concern about the legislation. It is speculated that an official veto threat will not be far behind.

The legislation is expected to be considered on the House Floor after the Fourth of July Recess.

 

White House Issues Veto Threat on House’s FY16 House Interior and OMB Letter on FY16 Labor-H Appropriations Bill

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As discussed yesterday, the House’s FY16 Interior appropriations bill contained significant cuts and policy riders which would be of serious concern to the White House. Accordingly, the White House has issued a Statement of Administrative Policy (SAP) about the House’s draft bill, which includes a veto threat. Additionally, the OMB Director Donovan wrote a letter on the House’s FY16 Labor-H appropriations bill outlining the Administration’s concerns.

This not the first veto threat offered by the administration this year (see here and here). Both SAPs for the House’s FY16 Interior and FY16 Labor-H measures cite the conformance to Sequestration levels of funding as an overarching reason to veto the measures, which has been a reoccurring theme all year.

The SAP on the FY16 Interior bill cites the drastically underfunded core Department of the Interior programs as well as the Environmental Protection Agency’s operating budget. Additionally, the SAP states concerns with “the numerous highly problematic ideological provisions that have no place in funding legislation. These provisions threaten to undermine the ability of States and communities to address climate change and protect a resource that is essential to America’s health—clean water, as well as the most basic protections for America’s special places and the people and wildlife that rely on them.

Additionally, the Administration raises concerns with the numerous policy riders including: blocking the Department of the Interior’s proposed fracking regulations; preventing the implementation of the National Ocean Policy; prohibit funding for the EPA to impose new Green House Gas standards; prevent the EPA from continuing work to implement the 2008 Lead Renovating and Repairing rule until the EPA develops a commercially available “improved” lead paint test kit; and allow the use of lead ammunition in the hunting of migratory waterfowl on public lands.

Finally, the SAP raise separation of powers concerns with the bill due to the policy provisions.

The OMB letter on the FY16 Labor-H bill cites the cuts and restrictions to the Affordable Care Act, the cuts to programs like Head Start, the $6.7 billion cut to the Department of Ed (from the PBR’s proposal), and the effective $370 million cut to Pell. The SAP says in part:

“Through a combination of funding cuts and ideologically-motivated restrictions, the Subcommittee bill would obstruct the functioning of the Health Insurance Marketplaces, jeopardizing or disrupting coverage for the more than 10 million people currently enrolled in health insurance plans through the Marketplaces. It would also deny assistance to States expanding their Medicaid programs under the ACA, jeopardizing coverage for many millions more.

– and –

“This bill includes a $370 million cut to the Pell Grant program, which will make it more difficult to help students pay for college over the next decade. It also cuts funding for administering and overseeing the student aid programs by $136 million, or roughly 9 percent, below the President’s request, hurting the Department of Education’s ability to hold the approximately 6,500 colleges and universities that receive Federal dollars accountable to students and taxpayers and ensure that all students have access to high­ quality loan servicing.”

Additionally the letter cites concerns about the elimination of Title X family planning funds, cuts to the Social Security Administration, and cuts to the Biomedical Advanced Research and Development Authority (BARDA) which procures new medical countermeasures to protect against potential chemical; biological, radiological and nuclear attacks. Finally, the Administration is concerned about the numerous policy riders including the prevention of the ED from implementing the Gainful Employment regulations as well as the host of riders designed to defund and effectively kill the ACA.

 

 

Senate Subcommittee Passes FY16 Labor-H

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The Senate Appropriations Labor, Health, Human Services, Education and Labor Subcommittee considered and passed their FY16 Labor-H bill today. While the Senate version has a higher discretionary amount than the House version, which will need to be worked out in conference.

Education Funding

The Committee bill provides funding to increase the maximum Pell Grant award from $5,775 in the 2015-16 school year to an estimated $5,915 for the 2016-17 school year. While the bill maintains $22.5 billion in discretionary spending for Pell Grants in fiscal year 2016, it would rescind $300 million in funds that the Congressional Budget Office estimates will be needed to support the program next year.  The bill also cuts $29 million from Supplemental Education Opportunity Grants and $40 million from Federal Work Study.  All three programs help low- and moderate-income college students and their families cover the many costs of higher education.

Similarly to the House version, the Senate includes several policy riders to address and curtail administrative actions taken by the Department of Education (ED).  The bill includes a new provision prohibiting the ED from moving forward with several new regulations expanding the Federal government’s role in higher education, until Congress has an opportunity to weigh in through the authorization process, as appropriate. Specifically, the bill prohibits the Department from moving forward with regulations or policies to develop or implement a college ratings system, define gainful employment, establish requirements for the State authorization of higher education programs, define credit hour, and establish a new accountability framework for teacher preparation programs.

Health Funding

The bill funds the Department of Health and Human Services at $70.4 billion, a $646 million decrease from FY2015. Further, the bill eliminates Affordable Care Act (ACA) funding and includes several provisions prohibiting any funds from being transferred to specific ACA activities that were never intended to be supported with discretionary funds prevent the administration from diverting funds away from core CMS activities.  In addition, several oversight provisions are included in the bill:

  • Risk Corridor – Bill language is included requiring the administration to operate the Risk Corridor program in a budget neutral manner by prohibiting any funds from the Labor-HHS-Education appropriations bill from being used as payments for the Risk Corridor program.
  • State-Based Exchanges – With the increasing number of State-Based Exchanges failing due to lack of revenue, the bill includes new language preventing the administration from using discretionary funds to pay for operational costs for these Exchanges.
  • Health Exchange Transparency – Bill language is included requiring the administration to publish ACA-related spending by category since the Act’s inception.
  • ACA Personnel – Bill language is included requiring the administration to publish information on the number of employees, contractors, and activities involved in implementing, administering, or enforcing provisions of the ACA.

National Institutes of Health (NIH) – $32 billion, an increase of $2 billion above FY2015.  This is the largest increase the NIH has received since its doubling ended in 2013.

  • $200 million for Precision Medicine;
  • $350 million increase for the National Institute on Aging, the lead Institute researching Alzheimer’s disease;
  • $135 million, an increase of $70 million, for the BRAIN Initiative to map the human brain;
  • $461 million, an increase of $100 million, to Combat Antibiotic Resistance;
  • $300 million, an increase of $26.7 million, for the Institutional Development Award;
  • and increases to every Institute and Center to continue investments in innovative research that will advance fundamental knowledge and speed the development of new therapies, diagnostics, and preventive measures to improve the health of all Americans.

Other Provisions

Corporation for Public Broadcasting (CPB).  The bill fails to provide a requested increase of $40 million for fiscal year 2016 to support the costs associated with replacing CPB’s interconnections system.  To cover these costs, the bill would allow CPB to make cuts to its support for local television and radio stations.

Social Security Administration (SSA).  The bill cuts SSA by $185 million, or roughly two percent, affecting the 50 million Americans who currently receive retirement and survivor benefits from Social Security, as well as the millions more who become eligible this year.  On an average work day in fiscal year 2016, SSA predicts it will process about 22,000 applications for retirement and survivor benefits, a 29 percent increase since fiscal year 2008.  At this bill’s funding level, SSA would need to reduce staff, office hours, planned information technology investments and curtail planned improvements to customer service and program integrity.  This reduction could result in a furlough of up to two weeks for SSA staff.

Federal Relations will continue to track the legislation and provide updates as text and report become available.

More Details on House FY16 Labor-H

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The House Appropriations Committee posted the committee report to their FY16 Labor, HHS, and Education (Labor-H) appropriations bill today giving additional insight to the legislation passed earlier last week.

The bill provides a new maximum Pell award of $5,915 but discretionary funding is down $370 million. They take this money from the current surplus. The committee report states (page 133):

The Committee recommendation uses this surplus along with the funds appropriated in this bill to maintain the maximum Pell Grant award in the 2016–17 academic year. However, the Committee notes with concern that the Pell Grant program will again face a significant fiscal shortfall in future years without further reforms to make the program more efficient and targeted to the students and families that are most in need.

Additionally,

  • Federal Supplementary Education Opportunity Grant (SEOG) is level funded at $733 million
  • Federal Work Study is level funded at $989 million
  • Federal Student Loans (Title VI programs) are level funded ($65 million for the domestic program and $7million for the overseas programs)
  • Graduate Assistance in Areas of National Need (GAANN) program is funded at $25 million (a cut of $4.2 million)
  • Institute for Education Studies (IES) is funded at $409 million (a cut of $163 million)

 

House Appropriators Releases FY16 Labor-H

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House Appropriations Committee Republicans released their draft FY16 Labor, Health and Human Services, Education, and Labor (Labor-H) spending plan earlier today, and Democrats are already protesting the proposal and calling for an end to the budget caps. The House Appropriations Labor-H Subcommittee is expected to consider and pass the measure tomorrow.

The Labor-H bill may be the one of the most delicate and contentious appropriations bills considered by the House and the Senate this year because of the hot-button, politically-contentious policies, and well-known agencies funded through the bill. For context, the bill funds a diverse amount of well-known agencies, including :

  • National Institutes of Health
  • Centers for Disease Control
  • Centers for Medicare and Medicaid
  • Department of Education
  • National Labor Relations Board
  • Corporation for Public Broadcasting

Despite the Congressional Republicans’ goal of moving all 12 appropriations measures this year, there are strong doubts that even GOP control of both chambers can get Congress back in the habit of considering it beyond an omnibus spending package. To wit, neither the House or Senate released a draft Labor-H bill in FY2015, and only the Senate acted in FY2014. The bill contains programs on health spending, including Obamacare policy riders, education spending, including student loan provisions and riders, Department of Labor programs and the Corporation for Public Broadcasting.

Overall

The draft bill would provide a total of $153 billion in new discretionary funding, $3.7 billion less than the current level and $14.6 billion less than the President’s Budget Request. It would provide $31.2 billion for the National Institutes of Health (NIH), an increase of $1.1 billion from the current level and $100 million more than the President sought. Lawmakers in both parties have expressed a desire to boost funding for NIH, but they are limited by laws that keep overall FY16 discretionary funding at 2015 enacted levels.

Health-Related Funding

Within the NIH funding, the legislation includes $165 million to support activities for the National Children’s Study, $480.6 million for Clinical and Translational Sciences Awards, and $311.8 million for Institutional Development Awards (IDeA) programs.  

The bill also provides increases for several targeted research initiatives, including $886 million, a $300 million increase, for an Alzheimer’s disease research initiative; $461 million, a $100 million increase, for an antibiotic resistance initiative; $150 million, a $95 million increase, for the Brain Research through Application of Innovative Neuro-technologies (BRAIN) initiative; and the full $200 million requested for the Precision Medicine Initiative (PMI).

The Centers for Disease Control (CDC), which has been at the forefront of efforts to contain the Ebola virus in Africa and keep Americans from abusing narcotics including painkillers, would get $7 billion. That’s a $140 million increase from the current year and equal to the President’s Budget Request. This includes $70 million to combat prescription drug abuse, an increase of $50 million from the current level. While we do not yet know how much funding is included for specific programs – like the Education Research Centers, Agriculture and Fishery Centers, and Health Prevention Research Centers – the House bill does include $341.1 million for NIOSH, which is about $6.2 million more than was included in the FY2015 omnibus.

Beyond the bipartisan increases for CDC and NIH, the draft bill contains provisions that are sure to induce partisan debates. The Labor Department would get $11.7 billion, $206 million less than current funding and $1.4 billion less than Obama requested. The Education Department would get $64.4 billion, $2.8 billion less than current funding and $6.4 billion less than requested.

Also on the ‘bad news’ front, the proposal would terminate the Agency for Healthcare Research and Quality (AHRQ). The bill also includes several policy provisions, including prohibitions on the Department of Education from moving forward with regulations to establish a college ratings system, place new requirements on teacher preparation, define “gainful employment” and “credit hour,” and dictate how states must license institutions of higher education.

Policy riders include a provision ensuring any new HHS Dietary Guidelines focus only on food and nutrients and have a sound scientific evidence base and several provisions to protect life, including continuations of all longstanding restrictions on abortion funding that have been included in the legislation in prior years. The legislation also includes the text of Congresswoman Diane Black’s (R-TN) HR 940, the Health Care Conscience Rights Act.

Education-Related Funding 

House Approriators allocated $64.4 billion in discretionary funds for the Education Department, about $6.4 billion below the Administration’s request.The bill eliminates 19 duplicative, ineffective or unauthorized education programs and cuts several other “lower-priority” programs.

For elementary education, the measure would fund grants for states to support children with special needs, known as the Individuals with Disabilities Education Act (IDEA), at $12 billion, about $500 million more than the 2015 level and $1 billion greater than the President’s request. Funding for Head Start would increase by roughly $300 million to $8.8 billion. The President requested an additional $1.5 billion for Head Start programs to lengthen both the school day and school year. The program currently receives $8.5 billion, which appropriators boosted significantly after they took heat because of slots lost in the program during the sequester, forcing some facilities to shut their doors during the Fall 2013 government shutdown.

In the higher education realm, appropriators proposed raising the maximum Pell Grant award by $85 to $5,915 though a combination of mandatory ($1,055) and discretionary funds ($4,860). Perkins was provided $1.7 billion total, an increase of $600 million, the program has remained at $1.117 billion since FY 2014.

funding. Most interestingly for higher education, there are a number of potentially contentions policy riders which prevent the Education Department from moving forward with regulations to establish the Administration’s college rating system (Postsecondary Institution Ratings System), place new requirements on teacher preparation, change the definitions of gainful employment and credit hour, and tell states how to license institutions of higher education.

Other Provisions

The bill provides an advance appropriation of $445 million for Corporation for Public Broadcasting for fiscal year 2018, which is the same level of advance funding provided in the fiscal year 2015 enacted level and the budget request.

The bill includes $200 million for the National Labor Relations Board – a decrease of $74.2 million (27 percent) below last year’s level and $78 million (28 percent) below the President’s budget request.

Going Forward

The House Appropriations on has not yet scheduled a full committee markup on this proposal nor is it clear when the measure will be considered on the House floor, but that should happen sometime in the next week or two. There are sure to be a lot of amendments debated during the process. We will continue to update this information as the bill advances – but we are still a long way from the finish line on this one.

Read the press release here. 

Read the text of the bill here.