June 25, 2017


Health Reform: State of Play President's Health Plan May Limit Scope of Medicare Commission Health Spending: Bending the Curve Health Reform Side-by-Side Appropriations Tracker


Quick Read

You can jump down to any of this week's articles by clicking on the headlines above.  


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Budget Process: Step-by-Step

Quick Read

New additions to the following chronologies are in bold type.    

1. Economic Stimulus 

  • January:  Congress allowed release of the second half of TARP's $700 billion 
  • Feb 17: American Recovery and Reinvestment Act (ARRA) signed into law by the President (Concord Summary)
  • June 18: Congress enacted $1 billion "cash for clunkers" program in FY 2009 Supplemental
  • August 7: President signed (HR 3435) to extend "cash for clunkers" program w/ an additional $2 billion 
  • Current: Track expenditures at www.recovery.gov   

2. Completion of '09 Appropriations

3. FY 2010 Budget 

  • February 26: President Obama transmitted a budget outline.
  • March 20: CBO released its Preliminary Analysis of the President's FY 2010 budget (using CBO economic projections)
  • March 25-26: House Budget Comm. and Senate Budget Comm. marked-up their respective versions of the FY 2010 Congressional Budget Resolution.
  • April 29: House and Senate adopted Budget Resolution Conference Report (S.Con.Res. 13).
  • May 11:  Administration released detailed FY 2010 Budget 
  • May-Sept: Action on the 12 regular FY 2010 appropriations bills beginning with the House and Senate Appropriations Committees dividing their budget resolution allocations among their 12 respective subcommittees (known as 302(b) allocations).  See "Appropriations Tracker" below for detailed appropriations actions.
  • August 25: CBO and OMB Release Updated Economic and Budget Projections
  • October 15: Budget Resolution deadline for committees to report budget reconciliation legislation (health care reform and student loan reform), although congressional leaders will initially try to move a free-standing health reform bill without budget reconciliation's filibuster-proof protections. 

4. Stabilizing the Financial, Housing, and Auto Sectors

5. Health Care Reform 

  • March 5: White House Summit on Health Reform
  • May 11: White House meeting with Key Stakeholder Groups
  • July 15: Senate HELP Committee completed mark-up of health care reform bill.
  • July 17: Ed & Labor Committee marked up and passed its portion of the House Tri-Committee health reform bill
  • July 17: Ways & Means Committee marked up and passed its portion of the House Tri-Committee health reform bill
  • July 17: CBO released cost estimate on House Tri-committee bill estimating a deficit increase of $239 billion.
  • July 31: Energy and Commerce passed modified version of Tri-Committee health reform
  • Sept. 9: President speaking to Congress says he won't sign a bill that increases deficits "either now or in the future"
  • Oct. 15: Budget Resolution deadline for committees to report budget reconciliation legislation including health care reform (although congressional committees are first attempting to move free-standing health reform legislation without budget reconciliation's filibuster-proof protections.) The advantage of Reconciliation is its immunity from filibuster; the disadvantage is that bill opponents could use the "Byrd Rule" to strip out all "non-budgetary" policy provisions.

6. Climate Change - Energy    

  • May 21:  House Energy & Commerce Committee passed the Waxman-Markey climate change bill, approving the measure on a nearly party-line vote (33-25). The bill would mandate a 17% reduction in greenhouse gas emissions by 2020 and 83% by 2050.  To accomplish this, the government would set a cap on the amount of carbon dioxide that could be emitted and would issue allowances to polluting sectors that could buy and sell those rights ("cap-and-trade").
  • June 6: CBO says Waxman-Markey climate bill (HR 2454) would reduce the federal deficit $24 billion over 2010-2019. CBO Report
  • June 17: Senate Energy & Committee Committee passed 15-8 a controversial energy bill opposed by many environmental groups    Press Release    Bill Summary   Opposition from Environmental Groups
  • June 26: CBO estimates that the revised Waxman-Markey climate bill (HR 2998) would reduce the federal deficit $9 billion over 2010-2019 (increasing revenues from "cap-and-trade" by $873 billion and increasing direct (mandatory) spending $864 billion).  CBO Report
  • June 26: House narrowly passed Waxman-Markey climate change bill 219-212
  • Senate EPW Chairman Barbara Boxer (D-CA) is aiming for a September mark-up of legislation.
  • The Administration wants a bill passed before U.N. climate change talks in Denmark in December.

7. Highway Bill (FY 2010-15)

  • September 2008: Due to a shortfall in Highway Trust Fund revenues, Congress passed PL 110-318, providing an $8.017 billion transfer from the Treasury's general fund to the HTF.
  • Highway Bill.--Leaders of key congressional committees have been negotiating the parameters of the next multiyear highway bill for fiscal years 2010-2015.  However, the Obama Administration has signaled an interest in putting off consideration of a multiyear highway bill due to cost issues -- opting instead for an 18-month extension of current law--but even that will require finding $20 billion in revenues, since the federal gas tax is generating insufficient revenues to fund highway programs.
  • February 2009: Sweeping reforms proposed by the National Surface Transportation Infrastructure Financing Commission
  • August 7, 2009: President signed legislation (HR 3357) to transfer $7 billion from the general fund to the Highway Trust Fund to keep it solvent through September 30, when the current Highway Bill expires.
  • Background.--For the period covered by the budget resolution (2010-2014), Congress allocated $259 billion to the relevant House and Senate Committees for highway and transit spending. This amount reflects a $67 billion increase above the "baseline" level--which is tied to current highway spending. 

8. Statutory PAYGO

  9. Higher Education Reform

  • July 15: House Education and Labor Chairman George Miller (D-CA) introduced legislation (HR 3221) to convert Federal Family Education Loans (otherwise known as guaranteed student loans) to direct government loans. The budget savings from the student loan reforms would be used to convert Pell Grants into an entitlement program with automatic inflation adjustments.
  • July 21: House Education & Labor Committee voted to report HR 3221 to convert all federally subsidized student loans into direct government loans; the bill can move forward either as a free-standing bill or as a filibuster-proof reconciliation bill -- although Senate leaders appear likely to utilize reconciliation to avoid a filibuster
  • July 24: CBO Cost Estimate for HR 3221
  • CBO, July 2009: Analysis of the Subsidy Costs of Direct and Guaranteed Student Loans
  • Sept 11: CBO says a proposal favored by the student loan industry would save less money than an administration proposal to convert all student loans to direct government lending   CBO Cost Estimate
  • Oct. 15: Budget Resolution deadline for committees to report budget reconciliation legislation including student loan and Pell Grant reforms

10. Long-Term Deficit Reduction

  • February 23: White House Fiscal Responsibility Summit 
  •   March 17: Rep. Jim Cooper (D-TN) introduced legislation to establish a commission to reform tax policy and entitlement programs (HR 1557) 
  •  May 14: Sen. George Voinovich (R-OH) introduced legislation to establish a commission to reform tax policy and entitlement programs (S 1056) 
  •  July 22: In an interview with the Washington Post President Obama said he would support creation of a "commission or mechanism" to develop recommendations on which Congress would have to act and that "everything is going to have to be on the table." He said after health reform is enacted "then I think we're in a position to be able to, either at the end of this year or early next year, start laying out a broader picture about how we are going to handle entitlements in a serious way."

11. Tax Legislation

  • Unsustainable Deficits and Tax Reform: Under the President's Budget, average revenues during 2010-2019 are 18.5% of GDP, with average spending amounting to 23.7% of GDP.  Tax reform proposals are often mentioned as one way to close the gap.  See Congressional Research Service:  An overview of tax reform proposals in the 111th Congress. 
  • Estate Tax:  Under current law, the estate tax is repealed for tax year 2010 and will return to pre-2001 levels in 2011.  The Senate Finance Committee is likely to move legislation before the end of 2009 to retain the estate tax at 2009 levels for future years.


Health Reform: State of Play


Finance Chairman Max Baucus released a health plan on Tuesday of last week.  On Wednesday, the President's speech to Congress clarified his position and rallied Democrats, but did not change the strategic situation. Senate Democrats (who have 59 votes including Independent Joe Lieberman (CT) and the ailing Robert C. Byrd (WV)) need to secure the support of at least one Republican (most likely, Senator Olympia Snowe of Maine) to move health reform in the Senate with the 60 votes needed to overcome a Republican filibuster. However, if they lack 60 votes, Democrats will be ready with a fallback "budget reconciliation bill."  A reconciliation bill would require only 50 votes (because it is filibuster-proof); the downside is that a reconciliation bill is restricted to "budgetary" provisions--which significantly limits the scope of the bill.    See Health Reform Side-by-Side below.

Baucus Outlines Plan, Schedules Mark-up

Senate Finance Committee Chairman Max Baucus (D-MT), after months of closed door negotiations with a bipartisan "Gang of Six" committee members, sought to move the process forward last week, releasing an outline of a forthcoming health plan.  Baucus plans to release a more detailed "chairman's mark" this week, and begin a committee mark-up next week (the week of September 21).  In general, the Baucus plan would: require individuals to have health insurance (or pay a penalty); require employers--except for small businesses--to offer insurance (or pay a fee per worker); prohibit insurers from denying coverage due to pre-existing conditions or dropping coverage due to illness; expand Medicaid coverage for people at or near the poverty level; provide tax credits (to people with incomes up to 400% of poverty level) to help the uninsured obtain insurance; set up state-based exchanges to promote access and establish non-profit co-ops to spur competition; cost $900 billion over 10 years and offset costs by taxing high cost insurance plans, imposing a series of fees on providers, and implementing Medicare and Medicaid reforms.  For more details, see the health reform side-by-side below.   Full text of Baucus health reform outline

Snowe Says Public Plan is Effectively "Off the Table"

Sen. Olympia Snowe (R-ME), the Republican Senate Finance Committee member most likely to provide Democrats with the "60th vote" they need to overcome a filibuster of health reform legislation said on Sunday's "Face the Nation" that the President's health reform public option is "universally opposed by all Republicans in the Senate."   Snowe said that discarding the public option "could give real momentum to building consensus on other issues."  However, Snowe left open the possibility of supporting a provision that would trigger-in a public option in the event that other measures are unable to slow the growth of private insurance premiums.

President Outlines Plan

 President Obama outlined in a September 9th address to a joint session of Congress the key elements he would like to see in included in health reform legislation:

  • Make it illegal for insurance companies to deny coverage based on pre-existing conditions, or limit coverage through annual or lifetime caps.
  • Limit out-of-pocket expenses.
  • Require insurance companies to cover routine checkups and preventive care.
  • Create insurance exchanges to expand coverage, provide tax credits to make insurance affordable, and offer a public plan as one of the choices to spur competition
  • Individual mandate (individuals required to have health insurance)
  • Employer mandate (cover employees or pay into the system, often know as "pay or play")
  • Deficit Neutral: "I will not sign a plan that adds one dime to our deficits -- either now or in the future." 
  • But the President goes on to say, "not a dollar of the Medicare trust fund will be used to pay for this plan," asserting that sufficient savings can be found in Medicare "waste and fraud" and Medicare Advantage (private insurance) subsidies. 
  • Fill the Medicare Part D (prescription drug coverage) doughnut hole.
  • Excise taxes on high cost insurance policies.
  • Demonstration projects on capping medical malpractice awards to deter defensive medicine.

Full Text of President's Address

President's Health Care Plan

House to Combine Three Bills

While keeping a close eye on developments in the Senate, House Democrats are working to reconcile differences among the three versions of the "tri-committee" health reform bill passed by the Ways & Means, Education & Labor, and Energy & Commerce Committees.

The House Rules Committee will have to meld the three committee bills together, along with any further amendments adopted by the Energy and Commerce Committee.  The House committees may also have to develop a reconciliation bill by October 15 if the Senate goes that route (see above). 

Outyear Deficits Pose Major Hurdle; CBO to Score Finance Bill Over 20 Years

President Obama, in his speech to Congress, said: "I will not sign a plan that adds one dime to our deficits -- either now or in the future."  Fulfilling this vital commitment poses a major challenge to White House, Senate, and House negotiators.  For example, in July, Senate Budget Committee minority staff released an estimate for the House Tri-Committee health reform bill (HR 3200) projecting $1.2 trillion in additional deficits for the second 10 years (2020-2029).  This follows a CBO letter on July 26 stating that "relative to current law, the (House Tri-Committee health reform bill) would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window." Senate Budget Committee Republican staff projections   In general, negotiators are likely to find it more difficult to pay for the second 10-year period than the initial 10-year period due to the phase-in of benefits during the first 10 years and the growth of costs in the second 10 years.  Article about additional estimates of the House bill by the Lewin group.   Full text of the Lewin study

In a related and important development, Congressional Quarterly reports that the Congressional Budget Office will likely provide a cost for the Finance Committee's health reform plan over 20 years -- not just the usual 10 years.  From a fiscal responsibility perspective, this is quite significant since the costs of health reform are likely to ramp up when it is fully phased in, i.e., beyond the intial 10 years.

President's Health Plan May Limit Scope of Medicare Commission

Following the President's health care speech to a joint session of Congress last week (discussed above), the White House posted the President's health reform plan on the White House website.

Among the bullet points setting forth the plan is the following:

  • "Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system.  The President's plan will create an independent Commission, made up of doctors and medical experts, to make recommendations to Congress each year on how to promote greater efficiency and higher quality in Medicare. The Commission will not be authorized to propose or implement Medicare changes that ration care or affect benefits, eligibility or beneficiary access to care. It will ensure that your tax dollars go directly to caring for seniors."

Medicare is one of the fastest growing programs in the Federal budget due to the rapid rise in health care costs, the retirement of the baby boom generation, and longer life spans.  There is a broad consensus that bringing Medicare growth under control is central to reversing the unsustainable growth in federal deficits. 

Consequently, there has been considerable debate this year about transforming Congress' Medicare Payment Advisory Commission (MedPAC) into an executive branch commission with authority to propose and implement, subject to congressional disapproval, policy changes to rein in the growth of Medicare spending.  For example, the Baucus health reform plan includes the following: 

  • "Medicare Commission. This provision would establish an independent Medicare Commission (MC) that would submit proposals to Congress to extend Medicare solvency and improve quality in the Medicare program. Congress would have an opportunity to amend the proposal or pass an alternative proposal with an equivalent amount of budgetary savings. Should Congress not pass an alternative measure, the Secretary of HHS would be required to implement the provisions included in the original MC proposal."

The President's proposal could be interpreted as contradicting the Senate proposal with regards to the scope of the commission, depending on how the Administration defines the terms "benefits, eligibility...(and) beneficiary access."   It is important that ongoing negotiations clarify this issue and allow the Commission to find savings in the Medicare program to improve its long-term solvency and contribute to paying for health care reform.

Concord Coalition issue brief on the importance of an independent Medicare Commission

Health Spending: Bending the Curve

One of the most common phrases heard during the current health care reform debate has been "bending the curve," which refers to slowing the projected rate of growth in health care costs.  The current fast pace of health care cost growth -- much faster than projected economic growth -- has led to projections of unsustainable deficits in the public sector and crushing costs on the private sector and individuals.

A new report funded by the Robert Wood Johnson foundation lays out a 4-part strategy for health care cost containment:

  1. Invest in better health information technology.
  2. Reform payment systems that reward providers for delivering lower-cost, high-quality care.
  3. Establish health insurance exchanges that pool risk and promote competition.
  4. Support and encourage better individual choices.

Full Text of the Report

Health Reform Side-by-Side

Currently pending are three major health reform measures at various stages of development, as well as a set of principles laid out by the President in addressing Congress last week (9/09/09):

  1. A tri-committee House plan (Ways & Means/Rangel, Energy & Commerce/Waxman, and Education and Labor/Miller).  
  2. A Senate HELP Committee Democratic plan (Kennedy-Dodd-Harkin) was voted out of committee on July 15, 2009.  HELP Committee Summary

  3. A plan released by Senate Finance Committee Chairman Max Baucus (D-MT) based on bipartisan negotiations among the "Gang of Six," also including ranking Republican Chuck Grassley (IA), Senator Kent Conrad (D-ND), who also chairs the Budget Committee and Senator Jeff Bingaman (D-NM); and Republican Senator Olympia Snowe (R-ME) and Senator Mike Enzi (R-WY), who is ranking Republican on the HELP Committee. 

Click here for a Concord Coalition side-by-side comparison of the four plans


Appropriations Tracker


With the new fiscal year beginning October 1, 2009, it appears that few appropriations bills will make their way through House-Senate conference and to the President's desk on time.  (The four bills that have passed both chambers and await conference action are: Agriculture; Energy-Water; Homeland Security; and Legislative Branch.)  In order to keep the federal government operating, Congress will need to pass a "continuing resolution" that keeps agencies funded into October (usually at the lower of House-passed, Senate-passed, or last year's spending levels).

Limited agreement with President's proposed program reductions/terminations:  According to Congressional Quarterly analysis, "excluding proposed Pentagon spending, both the House and Senate bills have cut less than half of the roughly $2.4 billion Obama sought to wring out of the fiscal 2010 budget."

REVISED House Subcommittee (302(b) Allocations (among the 12 appropriations subcommittees)

Senate Subcommittee (302(b) Allocations (among the 12 appropriations subcommittees)

Click on the dates below for links to bill summaries.  If you have trouble with the Senate links go to http://appropriations.senate.gov/ and click on "Subcommittees"
















6/11 6/18 7/9 * 7/7  8/4






6/18 6/24 6/25





7/22 7/30
9/09 9/10





7/17 7/8









6/8 6/12


6/17 6/18 7/9




6/10 6/18 6/26





7/10 7/17 7/24
7/28 7/30





6/9 6/12 6/19


6/18 7/6



Mil Con-VA

6/16 6/23
7/6  7/7




State-For Ops


















*polled out (no formal subcommittee vote)

Earmark Disclosure

Earmark lists are available on the House Appropriations subcommittee websites and Senate earmark requests are linked to on the Senate Appropriations website.

Important Note

Following are links to the latest congressional action, plus a sampling of issues facing the appropriators as reported by Congressional Quarterly and Congress Daily. The numbers in parentheses are the FY 2009 regular appropriations level in billions (not including stimulus funds); the President's FY 2010 request; the House FY 2010 level; and the Senate FY 2010 level.


Statements of Administration Policy (SAPS) on the Appropriations Bills are available by clicking here.

Appropriations Bills


1. AGRICULTURE ($21.4 / P-$23.6 / H-$22.9 / S-$24.0) -- Major issues include increasing FDA funding; overhaul of the food safety system; whether to continue a ban on importation of Chinese poultry; a controversial animal identification system that grew out of concerns about mad cow disease; and the President's proposal to end direct payments to farmers with more than $500,000 in annual sales revenue.  Summary Table  House Bill Summary   Senate Bill Summary

2. COMMERCE-JUSTICE-SCIENCE ($57.7 / P-$64.6 / H-64.4 / S-$64.9) --  Major issues include the President's proposed 7% increase over the current year; funds to close Gitmo; a major Southwest Border Initiative; readiness of the Census Bureau for the upcoming census; NASA's post-space shuttle priorities; and a program to help states defray the costs of jailing illegal immigrants convicted of crimes. Summary Table    House Bill Summary   Senate Bill Summary

3. DEFENSE ($631.9 / P-$640.1 / H-636.3 / S-636.3) not including military construction and housing which are funded in the Mil Con-VA bill -- Major issues include terminating the F-22 fighter program which has been plagued with operational problems and cost over-runs; funding for a 2d engine for the F-35 Joint Strike Figher program; funding for the C-17 transport plane, the VH-71 presidential helicopter and the Missile Defense Agency's Kinetic Energy Interceptor--all of which the Administration wants to end; proposed cuts in the Army's Future Combat Systems; and rising personnel costs.  (Note: the Administration has threatened to veto the Defense Authorization bills if they authorize further funds for the F-22 or disrupt the F-35 program.)   House Bill Summary   Senate Bill Summary

4. ENERGY-WATER ($33.2 / P-$34.4 / H-$33.3 / S-$34.3) --  Major issues include how to fund the backlog of Army Corps water infrastructure projects; Defense environmental clean-up; funding for the Administration's "Re-Energyse" proposal (energy innovation centers); how to continue the big boost in renewable energy research after the stimulus bill's funds run out; funds to dispose of weapons grade plutonium under a new agreement with Russia; streamlining approval of new nuclear reactors; and the President's proposal to cut funding for the proposed nuclear waste facility at Yucca Mountain.  House Bill Summary  Senate Bill Summary

5. FINANCIAL SERVICES-GENERAL GOVT ($22.6 / P-$24.2 / H-$24.15 / S-$24.4) -- Major issues include U.S. policy toward Cuba; education vouchers in the District of Columbia; IRS funding; funding for states to upgrade voting equipment; and a provision requiring GM and Chrysler to reinstitute agreements with certain auto dealerships. Summary Table   House Bill Summary  Senate Bill Summary

6. HOMELAND SECURITY ($40.0 / P-$42.8 / H-$42.6 / S-$42.9) -- Major issues include funding efforts to find and deport illegal immigrants; whether to further fortify the fence being built along 700 miles of the U.S.-Mexico border; whether to bar release of photos of terrorism detainees; allowing Gitmo detainees into the U.S.; whether the proposal to cut the DHS budget starting in 2012 is realistic; the system for providing federal disaster relief; reorganizing the Federal Protective Service; continuing an "antiquated" Coast Guard navigation system; and increased funding for road and rail security. House Bill Summary   Senate Bill Summary

7. INTERIOR-ENVIRONMENT ($27.6 / P-$32.3 / H-$32.3 / S-$32.1) --  Major issues include boosting EPA funding; earmarks for water projects; eliminating a program to clean up diesel engines in California; adequacy of wildfire funding; drilling in federal lands and waters; and new taxes and fees on the oil and gas industry. House Summary Table   House Bill Summary   Senate Bill Summary

8. LABOR-HHS-EDUCATION ($155 / P-$160.7 / H-$160.6 / S-$163.1) --  Major issues include rejecting the Administration's request to target NIH money at specific diseases; modifications and funding increases for the Pell Grant program; funding for school construction; increased funding for OSHA and LIHEAP; lifting a prohibition on federal funds for needle exchange; and eliminating abstinence-only sex education programs. Summary Table  House Bill Summary  Senate Bill Summary

9. LEGISLATIVE BRANCH ($4.3 / H-$4.9 / S-$4.5) -- Major issues include creating a fund to pay for renovation of the Capitol and House and Senate office building; and requests for more staffing at CBO and GAO.  House Bill Summary   Senate Bill Summary

10. MILITARY CONSTRUCTION - VA ($72.9 / P-$77.7 / $H-77.9 / S-$76.7) -- Major issues include advance appropriating FY 2011 funds for VA health care; BRAC funding; housing for trainees; more funds for VA health care for treatment that is not service-connected; and funding for Guard and Reserve initiatives. (Since Jan. 2007, Congress will have increased the baseline for the VA by $20 b, a 58% increase.)  House Bill Summary   House Summary Table   Senate Bill Summary

11. STATE-FOREIGN OPERATIONS ($50.0 / P-$52.0 / H-$48.8 / S-$48.7) -- Major issues include the President's proposed 9% increase for the State Dept. and foreign aid programs; conditions attached to funds for the World Bank and IMF; dropping the "Mexico City" policy that prohibited use of international family planning funds for abortion; funding for Millennium Challenge Corporation (aimed at countries that adopt democratic and free-market policies); and funding for the U.N. Population Fund (which is strongly opposed by anti-abortion groups). House Bill Summary   Senate Bill Summary

12. TRANSPORTATION-HUD ($55.0 / P-$68.9 / H-$68.8 / S-$67.7) -- Major issues include how to make up the shortfall in gasoline tax revenues flowing into the highway trust fund; funding for high speed passenger rail and a national infrastructure bank; funding for a new air traffic control system; additional funding for low-income housing rental vouchers; increasing loan guarantees through the FHA; and capital and safety improvements to Washington's metrorail system.   House Bill Summary    Senate Bill Summary