|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|
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New additions to the following chronologies are in bold type.
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.
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
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 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:
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).
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.
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:
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:
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.
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:
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):
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"
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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.
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 Summary12. 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
America's Priorities (new edition to be released by the Concord Coalition in fall 2009)