Congress, back from the Thanksgiving break, faces a backlog of must-pass legislation, including a health care “extenders” bill that could provide the vehicle for a top association priority: a minimum two-year delay of Medicaid disproportionate share hospital (DSH) payment cuts.

Those cuts started Oct. 1, the beginning of fiscal year (FY) 2018. America’s Essential Hospitals has advocated strongly for halting the cuts and delaying them at least two years.

In addition to the extenders bill, which would fund the Children’s Health Insurance Program, community health centers, and other priorities, Congress is expected to tackle these items:

  • A short-term Continuing Resolution (CR):  Because Congress likely won’t reach a budget agreement before the current continuing resolution ends Dec. 8, lawmakers will need to pass a two-week CR to allow more time to negotiate a final package.
  • Tax reform: Now that the Senate Committee on Finance has passed the Senate’s version of the Tax Cuts and Jobs Act, the Senate Committee on the Budget will need to certify the bill to ensure it meets reconciliation instructions. Then, the bill likely will move to the floor this week under budget reconciliation rules, with 20 hours of debate equally divided between Democrats and Republicans, followed by a “vote-a-rama.” If the Senate passes the bill, the House and the Senate will negotiate a final version of the bill in a conference. After those negotiations, each of the two chambers will vote on the negotiated bill before sending it to the president for his signature. It is likely that a vote-a-rama will occur by the end of this week. The tax bill will need 51 votes to pass.
  • Raising the budget caps: The Congressional Budget Office reports that the current version of the tax bill would increase the federal deficit by $1.4 trillion over the next decade. Congress will need to raise budget caps to offset the deficit increases if the deficit remains in the final bill. Congress will need a 60-vote majority to approve increasing the caps.
  • A long-term funding bill: Congressional leaders hope to finalize the other outstanding legislation before the short-term CR expires late in December. If successful, Congress is expected to pass a long-term CR or omnibus appropriations bill funding the government through the rest of FY 2018 before recessing for the holidays.

Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) hope the year-end funding package includes their bipartisan proposal to stabilize the Affordable Care Act (ACA) marketplace. Their bill would fund cost-sharing reduction payments for two years in exchange for increased state flexibility on ACA waiver requirements. Democrats say they would oppose the Alexander-Murray bill if Republicans keep a repeal of the ACA individual mandate in the tax reform package. Moderate Republicans hope that passing the Alexander-Murray bill alongside the tax bill will offset the effects of repealing the individual mandate.

Bill to Stop 340B Cuts Gains Cosponsors

Last week, Reps. David McKinley (R-WV) and Mike Thompson (D-CA) introduced H.R. 4392, a bipartisan bill that would place a permanent moratorium on a new Centers for Medicare & Medicaid Services policy, in the 2018 Outpatient Prospective Payment System rule, that cuts by 27 percent Medicare Part B payments for drugs purchased through the 340B Drug Pricing Program. The bill’s sponsors this week said the legislation has 56 cosponsors.

America’s Essential Hospitals released a statement in support of the legislation and an Action Alert encouraging members to urge their House delegations to cosponsor the bill.

Committee Activity

The Senate Committee on Health, Education, Labor, and Pensions (HELP) will hold a hearing Nov. 29 on Alex Azar’s nomination as Secretary of Health and Human Services.

The HELP Committee also will hear states’ and providers’ perspectives on the opioid crisis at a Nov. 30 hearing.

The House Committee on Energy and Commerce will hold a Nov. 30 hearing on 21st Century Cures Act updates from the Food and Drug Administration and the National Institutes of Health.