Source: Modern Healthcare
Republicans are weighing another partisan budget bill as a way to advance President Donald Trump’s stalled priorities — and that means more cuts to healthcare programs are likely to be on the menu.
Trump and GOP leaders have not been able to win the support of enough Senate Democrats to end a partial shutdown of the Homeland Security Department or pass the president’s current top priority, the SAVE America Act, which would tighten voting rules and restrict transgender healthcare. They are also facing Democratic resistance to a $200 billion Iran war funding proposal.
Since the Senate requires 60 votes to end filibusters and there are only 53 Republicans in the Senate, these measures are stuck.
The lack movement has Republican leaders proposing to utilize the same “budget reconciliation” process they employed to pass Trump’s tax law last year. A reconciliation bill uses expedited procedures, isn’t subject to filibusters and can clear the Senate with a 51-vote majority.
“There’s a lot of support for a budget reconciliation bill,” Senate Majority Leader John Thune (R-S.D.) said Tuesday. “If that’s what it takes to get some of these things across the finish line, and we can do it with simple majorities, we’ll take a hard look at that.”
Leaders have not indicated how extensive any such legislation might be, but a key restriction on a budget reconciliation bill is it must contain provisions that impact spending or tax revenue. Funding the Iran war or the Homeland Security Department could qualify. But some conservatives worry the SAVE America Act would be deemed out of bounds by the Senate parliamentarian as a policy measure.
What Senate leaders and Trump decide to focus on and how tightly focused they want to keep it will have large implications for whether there will be significant healthcare provisions.
If they want to use reconciliation to raise hundreds of billions of dollars to fund the war, Congress would likely look for ways to offset those expenses to ensure conservatives stay on board. Healthcare cuts are one way to save money.
Indeed, the conservative House Republican Study Committee declared in January its members want to pursue “Reconciliation 2.0” and offered a menu of items that could be considered. That includes policies that fell out of the tax law and trillions in cuts that had been proposed before and after during debates over extending enhanced subsidies for health insurance exchange plans last year.
In the context of saving money, their options included:
-
Implementing broad site-neutrality payment rules in Medicaid, which the Republican Study Committee estimated would save $172 billion over a decade.
-
Funding cost-sharing reductions for health insurance exchange plans to save $37 billion.
-
Cutting the federal matching rate for the District of Columbia’s Medicaid program from 70% to 50% to save $9.5 billion.
-
Prohibiting funding for migrants temporarily on Medicaid before immigration verification or enrolled via the Hospital Presumptive Eligibility program, saving $14 billion.
-
Expanding language in the tax law to make all non-citizens ineligible for Medicaid and other programs to save $231 billion.
-
Ending the Affordable Care Act of 2010’s Prevention and Public Health Fund to save $11 billion.
-
Easing Food and Drug Administration approvals for biosimilar versions of biologic pharmaceuticals to save $6 billion.
-
Permanently barring reimbursements to the Planned Parenthood Federation of America.
-
Barring spending for transgender transition healthcare.
Options could also include ideas Republicans have floated as counterarguments to the Democratic mantra that healthcare cuts are harming Americans, or to advance Trump’s “Great Healthcare Plan.” Many of those would not save money or would require new spending. They include:
-
Expanding Individual Coverage Health Reimbursement Agreements, and granting small employers two-year and per-employee tax credits.
-
Creating health insurance options that do not have to comply with the ACA’s benefit and coverage rules.
-
Replacing exchange subsidies with deposits into health savings accounts, likely with less money.
-
Codifying association health plans.
-
Requiring greater price transparency from health insurance companies and providers.
-
Codifying the TrumpRx program.
Whether any new reconciliation effort can emerge or succeed is far from clear.
Conservative Republican senators such as Mike Lee (Utah) and Rick Scott (Fla.) have cast doubt. Lee has warned the SAVE America Act would be ruled out of order. Scott said he thought it would be hard to find 50 Republican supporters without tax cuts as a carrot.
Influential House Republicans such as Ways and Means Committee Chair Jason Smith (Mo.), whose panel has authority over taxation and Medicare, have also been cool to the idea.
House Speaker Mike Johnson (R-La.) has endorsed the notion, however. Trump, who had been reluctant to go this route, came aboard on Tuesday, said Sen. John Kennedy (R-La.).
“It’s taken a while for the president to get comfortable with this reconciliation,” Kennedy said. “But my information is — based on what Sen. Thune says — he is comfortable and enthusiastic. So we’ve got to saddle up and ride and get this done.”
