Search Results for: cliff

Why is NACHC Pushing for a Fix for the Primary Care Funding Cliff in the Lame Duck Session?

Since the Policy and Issues forum in March, NACHC and health center advocates have been diligently working on all fronts to educate Congress on – and push for a solution to – the looming expiration, at the end of FY2015, of dedicated funding streams supporting the operations of Community Health Centers, scholarships and loan repayments through the National Health Service Corps, and primary care training in Teaching Health Centers. The potential expiration of funding for these programs to the future of Health Centers and those we serve.

Together we have undertaken many different efforts to eventually lead us to what we hope will be a successful resolution to this threat to the stability of the program. NACHC staff and advocates have held hundreds of meetings with Members of Congress at home and in Washington, DC to discuss the funding cliff. As part of the Access is the Answer Campaign, advocates have gathered petitions and support letters from local elected officials to send to their Members of Congress. Congressional Champions in both the House and Senate have led letters with bipartisan majorities to leadership requesting Congress work together in a bipartisan manner to fix the funding cliff. NACHC is now leading a sign on letter for national groups urging Congress to fix the cliff when members return after the election – to date, more than 70 groups have signed on. These efforts have helped us “raise the drumbeat” and demonstrate we have the support to the Leadership of Congress to fix the cliff.

As many of you have heard, we are now entering the next phase in this effort: we are advocating that Congress fix the cliff during the lame duck session of when members return after the elections. The timing of this push is based on what is happening in Congress. While many things depend on the upcoming election, we are hearing that the lame duck has the potential to be an opportunity to resolve some lingering issues Congress wants to get off of their docket before the new Congress comes into session. If the opportunity presents itself, we want a cliff fix to be one of the items on the list of priorities for Congress to resolve, especially since there are a limited number of opportunities next year.

However, in order to be on the list of priorities, we need to make a bigger, louder push that starts now. There is a limited opportunity to weigh in when members return as the session could move very quickly and the agenda is being set as we speak. We don’t want to miss this key time now when staff is taking into consideration potential issues for the lame duck. Over these next few weeks, it will be incredibly important to demonstrate the importance of getting this done.

We’ve heard from Members of Congress that despite our efforts, they have not felt the sense of urgency from back home. To that end, we will also be facilitating a massive email push – ahead of the elections – for our entire advocacy network to send emails to their Members of Congress requesting they fix the cliff. The goal of this effort will be to flood their mail reports so that staff, as well as the members, take notice. In tandem with that effort, we will be asking some of our advocates to hold targeted meetings with key Member of Congress back home over the next few weeks to reinforce the message to fix the cliff. There is also a sign-on letter for national organizations to join to show their support – to date, more than 70 have signed on. The lame duck session will be the final opportunity this year for us to fix the cliff. We do not want this issue to go down to the wire and we will need all of your support to help us achieve our goal. Please join us as we make this push to fix the cliff in the lame duck session of Congress.

The Fiscal Cliff Deal – What it Means for Entitlement Programs

by Heather Foster, MPH

While we blogged last week about what the fiscal cliff deal means for Health Center grant funding and the sequester, it’s also worth noting what changed in regards to entitlement programs such as Medicaid and Medicare…and what that means for the next round of deal-making.

“Savings” were found by making a number of cuts – largely to the Medicare program, none of which will have a major direct impact on health centers.  The major items of note in this portion of the package were the full repeal of the “CLASS Act,” a voluntary long-term care fund established as part of health reform, and rebasing of the Medicaid Disproportionate Share Hospital (DSH) payments.  The DSH changes will mainly impact the public hospitals, also part of the safety net, so there could be some trickle down impact onto the rest of the safety net.

Of note, the much-talked about provider tax cuts were NOT in the mix, nor was the blended FMAP proposal put forward by the Administration last year.  In fact, the Administration recently withdrew its support for the blended-FMAP, as it would act as a disincentive to states to take up the new Medicaid expansions.  This means, however, that eliminating or reducing provider taxes will almost definitely be on the table as part of the next round of discussions.  President Obama recently stated that the next proposal to offset the sequester (which was postponed, and as of now will take effect in less than two months), will be much more focused on health care cuts than the current one.  While the lion’s share of the cuts will likely come from Medicare there will also be continuing pressure to find savings in the Medicaid program.  We will continue to monitor all of these discussions and work to prevent both arbitrary cuts to the Medicaid program writ-large as well as any specific impact on health centers’ Medicaid PPS.

The package also included a slew of miscellaneous items that are typically renewed around Christmastime every year—known as “extenders.”  These included the so-called “doc fix” or payments for non-health center physicians billing Medicare, along with an extension of Medicare therapy caps, extension of Transitional Medical Assistance for low-income families transitioning from welfare to work, and expansion of Medicaid and CHIP Express Lane eligibility (which relies on data from other state offices, such as school lunch programs) to make Medicaid eligibility determinations for children.

Stay tuned for continued updates on the status of deficit reduction discussions and further deals to forestall the sequester!

Fiscal Cliff Averted and Sequestration Delayed For Now

by Abby Pinkele

Late last night and at the very last minute, the House passed HR 8, the American Taxpayer Relief Act of 2012, to avert the fiscal cliff and delay the sequester for two months. A more detailed explanation of HR 8 can be seen here in the Washington Post.

In the long term, HR 8 largely focuses on tax and revenue provisions. In the short term, this legislation pushes the pause button for two months on the sequester. The delay in the sequester required a reduction in spending, which in this case involves a reduction in the Budget Control Act spending caps for the FY13 and FY14 budgets. The legislation reduced the cap on discretionary funding for non- defense discretionary programs for FY13 from $361 billion to $359 billion. As outlined in a previous blog, Congress is currently operating under a temporary Continuing Resolution (CR) for FY13 that will expire on March 27, 2013.  Appropriations provided thus far in FY13 for non- defense discretionary programs under the CR totals $356.163 billion; thus, reducing the cap to $359 billion would not have any impact on the current level of funding, and it actually leaves $3 billion in additional cap room for increased non-defense spending in a full-year CR.

Though we can breathe a small sigh of relief for now, the road ahead will not be any easier as Congress will be tackling what will very likely prove to be contentious issues. The debt ceiling will need to be increased sometime in February, the sequester will go into effect on March 1 unless it is averted again, and the CR will expire March 27th throwing a potential government shutdown into the mix. This legislative super storm will need to be resolved in relatively early in March and we should anticipate that these negotiations will be just as difficult as the showdown we just witnessed.

For health centers, the playing field has not changed with the delay of the sequester. We will still be working to ensure our 2% funding cap is in place for all health center funding should the sequester eventually go through.  We also want to ensure the Administration would use the $300 million increase provided within the Health Center Trust Fund for FY13 to offset any sequester funding cut to health centers in lieu of cutting existing health center operations. Additionally, we will want to ensure that Medicaid is not undermined in any deal to avert the sequester.

We will also be closely monitoring action on the CR and raising the debt limit to ensure that funding for health centers is protected. Many members on Capitol Hill are already stating their displeasure at the lack of funding reductions and entitlement reform included in HR 8.  We can expect a lot more discussion around ways to reduce spending in the coming months, along with increased calls for funding reductions as well as entitlement reform as necessary components for passing any new spending bills.

It is important for our grassroots advocates to continue their outreach to House and Senate members. Advocates should also be on the lookout for action alerts to contact Members of the House and Senate on this issue in the months to come. We wish you a Happy New Year and we will provide any new information and updates as soon as we receive them.

Fiscal Cliff Discussions: How Medicaid is in the Mix

by Alex Sange, MPP

As Congress and the White House continue to hammer out a deal to avert the so-called “fiscal cliff,” members of the House, Senate, and the Administration are voicing their ideas and opinions about changes to programs including Medicare and Medicaid.

The “fiscal cliff” refers to the combined impact of a myriad of tax and spending policy changes that will occur around January of next year:  we will again reach our debt ceiling and (again) require an increase, several broad-based tax cuts will expire, the annual decrease in the Medicare physician payment rates is set to take effect, and the “sequester” – the automatic across the board cuts included as a part of the deal to raise the debt ceiling last year – will take effect.   Congress and the President are working hard to come to a deal that includes enough revenue and savings to offset the impending policy changes, tax increases, and spending cuts.  As you would expect, efforts to find savings and cut programs have been far-reaching and have included discussion around entitlement programs.  What is not being talked about right now is a massive cut to the Medicaid program.

This is no accident – this is a deliberate and consistent choice made by Medicaid supporters to protect it from across-the-board cuts.  When the debt ceiling was under discussion last year, Congress designed a solution (the sequester) that was meant to impose automatic cuts to reach specified targets for spending and deficit reduction if Congress could not find a way to meet the mutually agreed upon targets.  The so-called Super Committee eventually failed to find a way to cut spending, and the sequester is now scheduled to happen January 2, 2013.  Fortunately, the Budget Control Act did recognize the critical role Medicaid plays in providing health care to the underserved and Medicaid is fully exempt from any automatic cut or reduction.  The force of this protection, and the rationale behind it, makes the most plausible cuts to the Medicaid program smaller changes around the edges – rather than the massive overhaul to the structure of the Medicaid program (such as block grants, for example).

This article from Politico provides a good outline of the Medicaid changes that may be under discussion.

While major changes to Medicaid appear to be off the table for now, we will continue to watch discussions very closely on behalf of health centers and their patients.  Stay tuned to the Health Centers on the Hill blog for updates on the fiscal cliff negotiation and any policy changes that impact health centers.

Avoiding a Shutdown, Resurrecting AHCA, and Closing Out the Wicker-Stabenow Health Center Funding Letter

By: Oliver Spurgeon, Deputy Director, NACHC Federal Affairs

The halls of Capitol Hill are buzzing this week as Congress returns from the two week Easter Recess, President Trump and Congressional Democrats continue negotiations to keep the federal government open beyond Friday, April 28, the Wicker-Stabenow Health Center funding letter closes, and House Republicans consider bringing the American Health Care Act back from the dead.

We here at Health Centers on the Hill want advocates to be up to date on all the latest developments. To that end, you can get a more in-depth look at these and other policy issues impacting health centers by joining our April Policy and Advocacy Webinar, this Wednesday at 3:30 PM eastern. Click here to register.

Shutdown Fight

With just three days left to negotiate a deal before the federal government shuts its doors and temporarily suspends nonessential services on Friday at midnight, Democrats on Capitol Hill and the Trump administration have yet to find agreement on the remainder of the FY17 spending package. At issue for the Trump administration and Congressional Democrats, respectively, are a $1.5 billion down payment to begin construction of the southern border wall, and $7 billion to fund cost sharing reduction (CSR) payments for participants in the federal healthcare exchanges with incomes below 250% of the poverty level. For more on CSR payments and their role in marketplace coverage, see a recent post here on our sister blog, The Policy Shop.

Until the inclusion of recent demands to fund the border wall and continue CSR subsidies for health exchange enrollees, Congressional leaders were able to iron out roughly 200 controversial provisions in the FY17 continuing resolution. Congressional leaders in both parties were able to put partisan affiliations aside to avoid the traditional political stumbling blocks of Planned Parenthood funding and budget cuts at various federal agencies, including the Environmental Protection Agency and State Department, which have held up previous negotiations. However, the recent addition of border wall funding and CSR payments have left Congressional Democrats and the Trump administration at loggerheads.

Most recently, Mick Mulvaney, the Director of the Office of Management and Budget OMB and President Trump’s chief negotiator on the FY17 spending package, proposed a dollar-for-dollar exchange to fund both the border wall and CSR subsidies; however, that offer has drawn sharp rebuke from Congressional Democrats who support a permanent extension of the CSR payments. We’ll continue to send out updates this week negotiations between the Trump administration and Congressional Democrats progress. Please keep an eye on NACHC’s social media accounts and blog for up-to-the-minute news about the FY17 spending package.

****Editor’s Note****


Negotiations between the Trump administration and Congressional Democrats are still ongoing, showing glimmers of a possible breakthrough to avert a government shutdown before Friday’s midnight deadline. President Trump’s $1.5 billion request for border wall funding has been rescinded ‒ removing one of the largest obstacles leaders in Washington faced to strike an agreement that keeps the federal government open.

However, a deal isn’t guaranteed. As of Wednesday afternoon, Republicans and Democrats are still wrestling with several issues including $7 billion for CSR subsidies, at least a $15 billion increase in defense funding, $500 million to alleviate Puerto Rico’s looming Medicaid crisis, and $1.3 billion for coal miners’ health benefits. At Wednesday’s morning press briefing, Speaker of the House Paul Ryan suggested that the $7 billion for CSR subsidies have no place in Congress’ annual spending bills ‒ implying that the Trump administration, and not Congress, is responsible for funding them. As we move closer to Friday’s midnight deadline, it looks increasingly likely that Congress will pass a week-long extension in order to reach a deal next week.


****End Note****

Wicker-Stabenow Health Center Funding Letter

If Friday’s shutdown drama doesn’t provide enough excitement for you, there’s also another deadline on the horizon: the Wicker-Stabenow Health Center Funding Letter closes out Thursday, April 27. Currently, 46 Senators have signed on board to support health center funding in FY18; but that’s still well short of the 62 who joined last year. (Click here to see if your Senator has signed, or if he/she signed last year but not yet this year) We need your help to make sure Congress knows the importance of ending the health center funding cliff well before September 30, and why providing robust funding for health centers in FY18 is important. Click here to send a note to your U.S. Senators and ask them to add their names to the Wicker-Stabenow Health Center Funding Letter.

Reviving the American Health Care Act

House Republicans spent much of the Easter Recess discussing potential changes to their Affordable Care Act repeal bill, the American Health Care Act, which failed to receive a vote on the House several weeks ago. In a concerted effort to bring additional members of the House Freedom Caucus on board the American Health Care Act, Rep. Tom MacArthur (R- NJ) proposed an amendment to relax many of the ACA’s current consumer protections. Specifically, it would allow states to opt out of certain ACA requirements that everyone be charged the same amount for health care coverage, regardless of their health status. In exchange for waivers, states would be required to establish a new risk-sharing program to help cover the sickest and most costly patients, who could be denied coverage by insurers due to the waiver.

Lastly, a change made to the bill before Congress departed for the Easter Recess provided $15 billion for states to establish their risk-sharing programs; however, a recent analysis of Rep. MacArthur’s proposal suggests states will need between $3.3 billion and $17 billion each year in order to make the proposal viable. Long story short, Rep. MacArthur’s amendment is expensive!

House Republicans have yet to decide whether to move forward with Rep. MacArthur’s amendment, and several moderate Republican members of the House of Representatives have already expressed concerns about the potential impact, and cost, of removing health care protections for vulnerable Americans.

Wrapping Up

Although progress on the House ACA repeal effort is expected to grind to a halt this week due to Congress’ focus on the looming government shutdown, the Federal Affairs team here at NACHC will continue to publicly express the importance of immediately fixing the health center funding cliff, preserving the structure and integrity of Medicaid, and providing predictability for health centers. Click here to read NACHC’s statement on the American Health Care Act, and please continue to follow our activities on Twitter and Facebook for the latest updates on the House’s ACA repeal effort.