Congress has a lengthy to-do list before the end of the year. NHF is closely monitoring numerous issues affecting the bleeding disorders community including:
The House and Senate have started conference proceedings to negotiate a final tax reform bill. The House and Senate bills differ on a number issues related to healthcare such as the individual mandate, deduction for medical expenses, and Orphan Drug Tax Credit. These key differences will need to be resolved. There are likely to be further revisions to the tax bill as House and Senate leaders seek to reconcile differences between the bills. Once agreement is reached on a final version of the bill, the House and Senate will each need to pass it again before legislation is sent to President Trump to be signed into law. The goal is for this entire process to be wrapped up before Christmas.
Children’s Health Insurance Program (CHIP) Reauthorization
Authorization for the Children’s Health Insurance Program (CHIP) lapsed on October 1st, 2017, which jeopardizes coverage for about 9 million low-income children and 370,000 pregnant women across the US who are currently covered through CHIP. Since October, states and the federal government have used various reserve funds and measures to allow for insurance coverage to be maintained. This factsheet from the Kaiser Family Foundation discusses how individual states are responding to this situation. While members of Congress from both parties have expressed support for CHIP, Congressional leaders have not yet reached a final agreement on how long to reauthorize the program, nor how to pay for it. Most experts expect at least a short-term reauthorization of CHIP to be added to the final funding bill.
Congress just passed a short-term funding bill that extends government funding at current levels (called a continuing resolution or CR) until December 22nd, 2017. Congressional leaders are currently negotiating final spending bills for the remainder of the fiscal year. However, this requires Congress to also agree to a deal to raise budget caps allowing for increases for defense and non-defense programs. Once bill language is finalized by Congressional leaders, it will need bipartisan support in the Senate. dding policies to gain support of Democrats in the Senate may complicate support of some conservative members in the House. All of this uncertainty means that a government shutdown is still possible before the end of December.
ACA Market Stabilization
Finally, some in Congress want additional policies to stabilize health insurance markets to be included in the end-of-the year package. This will be particularly important if the final tax reform bill does include a repeal of the individual mandate. While there appears to be sufficient support in the Senate to add the Alexander-Murray (market stabilization) and Collins-Nelson (short-term reinsurance) proposals to the end-of-year package, there may not be enough support in the House to pass them. NHF will be closely monitoring the discussion over market stabilization and will notify the community if there are opportunities to engage on this issue.
There are a number of additional policy issues that may be included in the final end-of-year bill or bills, including the reauthorization of the community health center program; provision of funding to help states and territories rebuild after natural disasters; and an immigration reform policy to respond to Dreamers. NHF is monitoring the situation in Washington and will notify the community as the situation becomes clearer.