Congress is back and the list of priorities have grown due to Hurricane Harvey. That list may have become easier or more difficult because of the need for more disaster relief. That all remains to be seen. There are currently 12 working days when both houses are in session before the end of September and the end of the fiscal year hits. Eyes will be on Washington on Wednesday when the President and congressional leaders from both parties meet to discuss priorities. Here is a listing of some of the pending issues and how they may have been adjusted since the end of July. Several could blow up into the major issue for the fall and that does not consider any foreign affairs conflicts:
Appropriations for FY 2018
There is speculation that one of the first acts for the returning Congress is to provide a short-term continuing resolution or CR for FY 2018. This speculation may have gotten a boost due to Hurricane Harvey.
Congress needs to provide a down-payment on disaster relief for Houston and attaching that emergency spending to a CR might be the quickest way forward. Speculation is that a CR would extend federal funding until early December. If it’s a “clean” CR and not complicated by the President’s demands for a boarder wall appropriation, that would provide 2017 level funding for eight or ten weeks it might be the easiest way to provide the disaster funds and avoid a shutdown in September.
Estimates for a Texas disaster relief package range from $150 billion to $200 billion. In the past many conservatives, especially in the House, have demanded offsets or cuts to pay for disaster relief. There may be less opposition this time since some of the most conservative members in the House and Senate are in the sizable Texas delegation of 36 House members and the two senators. In 2013, 20 of the current House Republicans from Texas opposed the Hurricane Sandy relief. They were supported by the then-House Budget Chairman Paul Ryan (R-WS). The relief will come in several parts and phases as assessment of needs are made and grow over time. The President is proposing around $7 billion in an initial request.
For the rest of the appropriations, the House Appropriations Committee adopted a Labor-HHS bill but the Senate had not yet acted before they left in August. For more specifics, the CWLA Budget Chart can be viewed on the LEGISLATIVE INDEX. The Senate is expected to address a Labor-HHS bill this week and they may attempt to do it on a bipartisan basis. That always remains a challenge.
The August House-passed “security measure” included funds for the Defense Department, Military Construction, Veterans Affairs and the Legislative Branch budget. The House is assuming a $5 billion cut to non-defense discretionary spending below what was established under the Budget Control Act (BCA). Non-defense spending is at $511 billion while the Defense Department is expected to get $621 billion.
The Senate Appropriations Committee has approved funding ceilings that will allow for $518 billion for non-defense spending and that is on par with the 2017 appropriations and slightly above the BCA. The approval by Republican leadership sends a message that they are not in line with what the House is proposing.
The President has called for a government shutdown if the appropriations doesn’t include funding for a wall with Mexico. Speculation and theories suggest a shutdown would come in December after the CR expires but that could always be altered by the President’s reaction. On top of this is how the disaster package will impact on these considerations.
Debt Ceiling Increase
Raising the debt ceiling could easily become the most dominant issue of September but again it too could be tied with hurricane relief.
Much of the Congressional Republican leadership would like to simply pass what is called a clean debt ceiling increase. That means no attachments, bills or proposals. This has been the position of Secretary of the Treasury Steve Mnuchin.
Conservative House Republicans are sure to demand cuts in programs especially entitlements as part of their agreement to provide the increase. They have also warned against using the debt ceiling increase to fund disaster relief but that could again get swept away if some of the most conservative members from Texas see a debt ceiling increase as an important vehicle. In all likelihood, Republican leadership will have to rely on a significant number of Democrats to approve a debt ceiling increase. It is unclear what Democrats will ask in return. They could propose, as some have suggested, some form of guarantee that any tax package be revenue neutral as opposed to deficit neutral meaning programs could not get cut to pay for tax cuts. There are also other suggestions that they might bundle some inclusion of other programs such as a re-authorization of the CHIP-Children’s Health Insurance Program.
Home Visiting Extension
Two House bills have been introduced to extend the Maternal Infant Early Childhood Home Visiting (MIECHV) program which runs out on September 30. The Republican bill (The Increasing Opportunity through Evidence-Based Home Visiting Act) extends it for five years with some alterations and maintaining funding at the current $400 million a year. The Democratic bill (The Home Visiting Works Act of 2017) extends it for five year and increases it to $800 million by year five. There are no Senate bills yet. While there is bipartisan support for the home visiting program in the Senate it is unclear if there is support for a five year extension and with more funding. The split in the House bills could be a concern. The Republican bill includes an additional state match in funding and new directives on research, changes the advocacy community is not happy about.
One way for CWLA members to show your support is to go to the CWLA ACTION CENTER and send a letter of support to your members of the House and Senate.
Next Steps in Health Care
Health care not to be forgotten in the fall.
The Senate HELP Committee is holding two hearings this week on the ACA. They are focused on the exchanges. On the first day, the Committee will hear from state insurance commissioners and on the second day they will hear from governors.
Governors John Hickenlooper (D-CO) and John Kasich (R-OH) are working together on a bipartisan fix to strengthen the ACA.
The HELP hearings are a follow up to an earlier announcement by Chairman Senator Lamar Alexander (R-TN) and Ranking Senator Patty Murray (D-WA). They have succeeded in recent years at passing bipartisan packages that found some common ground, if not always the funding, including the reauthorization of the Elementary and Secondary Education Act (ESEA or ESSA), the reauthorization of the Child Care and Development Block Grant (CCDBG), last year’s CARA drug legislation and an FDA bill.
Since Congress departed in the summer, the President permitted the latest installment of insurance cost-sharing subsidies through the ACA. At about the same time the Congressional Budget Office (CBO) determined there would be significant problems in insurance coverage and significant costs to the federal government if the President pursues his threat to cut off funding.
CBO indicated in The Effects of Terminating Payments for Cost-Sharing Reductions, that
“insurers in some states would withdraw from or not enter the nongroup market because of substantial uncertainty about the effects of the policy on average health care costs for people purchasing plans. In the agencies’ estimation, under the policy, about 5 percent of people live in areas that would have no insurers in the nongroup market in 2018.”
CBO also indicated that cutting the subsidies would increase the federal deficit. Deficits would increase, “on net, by $194 billion from 2017 through 2026” Total federal subsidies for health insurance in the nongroup market—in particular, the sum of the premium tax credits and the
“ CSR payments—would increase for two reasons: The average amount of subsidy per person would be greater, and more people would receive subsidies in most years.”
While the President and some House leaders continue their call for another Senate attempt at repeal, Majority Leader McConnell is ready to move on to tax cuts.
While the subsidies went through, the Administration is also seeking to undercut sign ups by cutting the open enrollment advertising and navigator programs that assist people in signing up through the exchanges.
In addition to the HELP Committee hearings the Senate Finance Committee has also raised the possibility of hearings where much of the oversight and funding is controlled.
CWLA will be advocating for a technical fix of the ACA provision that Medicaid coverage be available to age 26 for youth formerly in foster care. The ACA mandated this coverage but due to the inability to adopt technical fixes to the ACA, this guarantee does not extend to a young person if s/he moves to a different state. Senator Robert Casey (D-PA) is expected to introduce a bill this week to fix this problem. CWLA has endorsed the bill.
Tax Cuts or Tax Reform
Mr. Trump gave his most extensive remarks on tax cuts on Wednesday, August 30 in a speech in Missouri. But those remarks provided little specifics on what changes might happen.
The first tough question is whether this is a package of tax “reform” versus a package of tax “cuts.” A tax cut package is much easier politically because it simply reduces someone’s taxes without dealing with which current tax deductions and breaks should be eliminated. A reform package similar to the bipartisan bill of 1986 under President Reagan, would likely be revenue neutral meaning no overall increase or decrease in taxes although some taxes could go down while others go up.
Another point of debate is whether this is deficit neutral or deficit increasing. The Trump Administration has argued that a large tax cut will generate enough economic activity and growth that deficits will go down. Based on the 1981 President Reagan tax package and the 2001 President George W Bush tax package that made the same arguments on how they would affect the deficit, those across-the-board cuts did not result in deficit reduction.
A tax cut package that cuts taxes without the offsetting tax increases could only be deficit neutral if it pays for tax decreases with program cuts. This could include block granting entitlements and other cuts to mandatory programs.
Congressional discussions have been taking place since the break started but it’s not clear what has resulted. The President and key Republican tax writers will meet today to further discuss their strategy. The White House is also set to announce a website to promote the tax bill. The last join statement by the White House and Congressional Republicans in late July argued for making taxes simpler, fairer, and lower for hard-working American families. One significant point was that they were dropping Speaker Paul Ryan’s desire to have a border tax. The Senate left with mixed messages with Finance Committee Chair Orrin Hatch (R-UT) saying he wants a full committee and bipartisan process but Leader McConnell seemed to throw cold water on the idea saying that a Senate Democratic letter with 45 signatures meant they may be too far apart and reconciliation will be used again.
CHIP-Children’s Health Insurance Program
Funding for CHIP is set to expire at the end of this month and fiscal year on September 30. CHIP was a Hatch-Kennedy bipartisan program created under the Clinton Administration and it has helped to provide health insurance coverage to millions of children by providing states with grants to fund policies for children. Combined with Medicaid, 45 million children receive health care coverage with CHIP covering nearly nine million of that total. Approximately 95 percent of children have health insurance coverage and CHIP has been a big part of that success. CHIP reauthorization is part of the CWLA legislative agenda for this year.
The Senate Finance Committee has scheduled a hearing for Thursday, September 7.
The legislation was last extended in 2015 and as was a concern back then, states are budgeting now for next year and it is important that they have the certainty of a CHIP reauthorization in planning those budgets. If Congress fails to extend funding for CHIP, millions of children who rely on the program will face coverage disruptions or lose coverage altogether.
It should be near the top of the list of must do items. Senator Orrin Hatch indicated that he was being pressed on attaching any number of must pass bills with the CHIP reauthorization. This could play out in several ways being bundled under a debt deal, a home visiting deal or combined with undesirable cuts.
A House budget resolution reported from Committee has not been approved by the House. The resolution would direct some $203 billion in entitlement and mandatory spending cuts. The House Ways and Means Committee would be directed to find $52 billion in cuts. That means programs such as Supplemental Security Income (SSI), TANF, possibly child welfare services, and most certainly the Social Services Block Grant would all be targeted for cuts and in the case of SSBG total illumination.
For Congressional leaders, the prime need for this budget resolution is that it would create a reconciliation instruction that not only would direct the $200 billion in entitlement/mandatory cuts but would allow for the tax cut-tax reform to be passed under the reconciliation/non-filibuster process.
Moderate Republicans have objected and there may be as many as 20 who will vote against the House budget resolution because it goes too far in cuts in both the annual appropriations levels as well as the cuts to mandatory/entitlement programs. On the other side of the philosophical divide are some conservative members who don’t feel it cuts enough in entitlement and mandatory programs and that seems to be a condition for the significant increases in defense spending.
It is unclear at this point what the Senate intends to do. Both Houses want the tool of a new reconciliation instruction to fast-track tax cuts and there may be a way to do that and not deal with the other complexities of settling on spending levels and mandatory cuts.
Commission on Opioids
On July 31, the Commission, Chaired by Governor Chris Christie (R-NJ) released an interim report of recommendations which can be found on the CWLA Legislative index under substance use.
The report is more of a summary with recommendations to be expanded upon. Commissioners said, “In 2015, 27 million people reported current use of illegal drugs or abuse of prescription drugs…only 10 percent of the nearly 21 million citizens with a substance use disorder (SUD) receive any type of specialty treatment…
Overall the report offers proposals targeted more toward treatment than law enforcement measures which is a significant political turn from the law and order approach to crack-cocaine in the 1980s.
The full report is due in October but the report and issue may give an opening to child welfare advocates to highlight the need for greater access to substance use and mental health services—issues many members of Congress haven’t connected on yet.
CWLA is preparing a set of recommendations to the Commission.
The possible shift to bipartisan fixes to the ACA, may be an opportunity to educate Members of Congress, especially members of various Senate and House child welfare-related caucuses that voting to cap and block grant Medicaid and by extension cuts to behavioral health services cannot be fixed with small-bore child welfare bills that mandate more services by states without the added resources.
Key recommendations by the commission include:
- Rapidly increase treatment capacity…by waiver eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion;
- Mandate prescriber education initiatives;
- Fund a federal incentive to enhance access to Medication Assisted Treatment (MAT);
- Model legislation for states to allow naloxone dispensing via standing orders; quickly develop fentanyl detection sensors and disseminate them to federal, state, local, and tribal law enforcement agencies;
- Enhance interstate data sharing among state-based prescription drug monitoring programs;
- Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA);
- Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool.
In addition, the report states that the commission is examining 11 other areas that will be more fully explained in the final report.
The Commission was established to develop final recommendations by October 1. Other members include Governor Charlie Baker (R-MA), Governor Ray Cooper (D-NC), former-Congressman Patrick Kennedy (R-RI), Bertha Madras, Harvard Medical School. Members also include the Secretaries of Health and Human Services, Defense and Attorney General.
The Juvenile Justice and Delinquency Prevention Act Reauthorization (JJDPA)
Just before the Senate left last week, they gave a voice vote approval to a reauthorization of S. 860, The Juvenile Justice & Delinquency Reauthorization Act of 2017. That bill now joins H.R. 1809, the House version.
There are differences in the two bills with Senator Tom Cotton (R-AR) the main roadblock last year, winning some concessions on juvenile status offenders. Arkansas has a high percentage of incarcerated status offenders.
After the Senate sent the bill over, Congresswoman Virginia Foxx (R-NC), Chairwoman of the House Committee on Education and the Workforce, and Congressman Bobby Scott (D-VA), Ranking Member of the Committee issued a joint release congratulating the senate and sounding optimistic about a future deal.
The JJDPA was created in 1974 and it was last reauthorized in 2002 and is now nearly a decade overdue for reauthorization. The law remains the only federal statute that sets out national standards for the custody and care of youth in the juvenile justice system and provides direction and support for state juvenile justice system improvements. The House bill passed in May.
860 is sponsored Senator Charles Grassley (R-IA) and Senator Sheldon Whitehouse (D-RI).
Mandatory and Entitlement Cuts, SSBG Prime Target
The House Budget resolution proposes $203 billion in cuts to mandatory and entitlement programs and some House members were pushing for closer to $500 billion. There were a host of cuts in the President’s budget that come from cuts and the elimination of mandatory and entitlement spending. Both SSBG and TANF are targeted as major revenue raisers through the elimination of SSBG and a cut of $1.7 billion to TANF. Other key budget cutting targets are converting Medicaid to a block grant, cuts in the SNAP program, changes to the Pell grants and Supplemental Security Income/SSI program.
SSBG may get an unattended boost through disaster relief. SSBG has been a key tool to provide disaster relief. After Hurricane Katrina, some disaster relief funding flowed through SSBG not just to the state of Louisiana but several other surrounding states that had taken in survivors of that hurricane.
The protection of SSBG continues to be a top priority for CWLA and a host of state and local groups. An updated letter in support of SSBG now includes more than 80 national organizations and state and local groups from each of the 50 states. State Fact Sheets on SSBG are on the Advocacy page on the SSBG State Fact Sheet Tab.