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On the Hill: Appropriations Debate, Tax Extenders, Medicare DSH

With temporary federal funding set to expire Dec. 11, Congress faces a government shutdown if it does not pass the omnibus appropriations package in the next two days.

Work on details of the package has caused intense debate among lawmakers about which policy riders they can attach without hurting their chances of passing the package. Congressional leaders have suggested that, if negotiations are not completed this week, lawmakers might pass a short-term extension until they can agree on a long-term package. Some conservative Republicans have called on leaders to pass a six-week continuing resolution.

Congress also is trying to pass a tax-extenders package that may include a delay of the Affordable Care Act (ACA) “Cadillac tax” on high-value health insurance plans, along with a delay of the ACA’s medical device tax. Instead of tackling a larger package, Congress likely will vote on a two-year deal developed by the House Committee on Ways and Means.

Last week, the Senate passed its reconciliation bill, which would repeal significant parts of the ACA, including Medicaid expansion. Although the Senate bill went further than its House counterpart in trying to repeal the ACA, the House is expected to quickly approve the Senate-passed measure. Although President Obama’s veto of the measure is all but certain, Republicans believe it has value as a trial balloon for future ACA repeal efforts that might fare better under a Republican president.

Last week, America’s Essential Hospitals wrote letters of support to sponsors of companion legislation (H.R. 3024/S.2228) in the House and Senate that would permit judicial and administrative review of Medicare payment determinations for disproportionate share hospitals (DSH).  Under current law, hospitals receiving Medicare DSH payments may not appeal decisions made by the Centers for Medicare & Medicaid Services (CMS) on DSH payment reductions.

In committee business, the Senate Committee on Health, Education, Labor, and Pensions held a hearing Dec. 8 on the nation’s opioid epidemic. Also Tuesday, the House Committee on Energy and Commerce held the second of a two-part hearing on state insurance marketplaces with CMS Acting Administrator Andy Slavitt. On Dec. 9, Energy and Commerce scheduled a hearing on six pieces of legislation focused on improving health care and treatment.

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About the Author

Walsh is the senior manager of legislative affairs for America's Essential Hospitals.