By Lyle Dennis, Cavarocchi – Ruscio – Dennis Associates, Consultants to AASLD
When Congress returns to work after Labor Day, lawmakers will face a confluence of high-stakes, complex issues that include a deadline for raising the federal government’s debt ceiling, funding the upcoming year’s budget, tax reform, infrastructure spending and perhaps taking another run at repealing, replacing or repairing the Affordable Care Act (ACA).
While some of this may sound like it does not relate to AASLD, in the inter-connected world of public policy these days, it seems that every issue is linked to every other issue. And that makes life even more complicated than it would be otherwise.
The most immediate question is how—or if—Congress will stabilize the ACA marketplace. After the Senate’s high-profile failure (discussed in last month’s column) to agree on repeal legislation, the Senate Health, Education, Labor and Pensions (HELP) Committee has announced plans to hold hearings on September 6 and 7 to examine ways to stabilize the marketplace. Unless Congress acts by September 27—when the law requires that insurers must sign contracts with the federal government to sell on the federal exchange in the following year—as many as nine million Americans in the individual market may see their premiums skyrocket by an estimated average of about 20 percent.
Among other things, the Senate committee hopes to develop a legislative package that lends stability to the ACA’s cost-sharing reduction (CSR) payments. (The Trump administration announced it will decide whether to continue ACA subsidies on a month-to-month basis.) Hard-line conservatives in the House, however, vow to continue to push for repeal-only legislation and a discharge petition, which would force the House leadership to bring the bill up for a vote, is circulating among conservative House members.
September also promises to create some high drama over government funding for key public health, research and multiple other programs.
With government funding set to expire on September 30, the House leadership has indicated that it plans to vote on a fiscal year 2018 omnibus appropriations bill soon after Labor Day. The 12-bill spending package calls for significant increases in defense spending as well as some funding for construction of a border wall. But the Senate leadership has given every indication that it is not interested in considering the catch-all measure because it breeches statutory spending caps already in place for the year.
Unless the House and Senate can strike a compromise on spending priorities by September 30—an unlikely occurrence—Congress will have to pass a continuing resolution (CR), most likely through December. But President Trump, who has vowed to close down the government if Congress doesn’t agree to provide funding for a border wall, could refuse to sign the stop-gap measure, forcing a government shutdown – and earning even greater disdain from his fellow Republicans.
Debt Ceiling Deliberations
Whether the government remains open, the ACA is stabilized, a border wall is built and the tax rates are changed could all come down to a vote on raising the debt ceiling.
Since mid-March, the Treasury Department has been using special accounting measures to stay under the federal debt limit. But those measures will be tapped out by the end of September at the latest. Absent a suspension of the debt limit, Congress and the president will have to agree to raise the limit, or risk serious economic consequences. The prospect of the world’s largest economy defaulting on its debts has the potential to create cataclysmic ripples through the world economy.
Securing enough votes to raise the debt ceiling is likely to require “sweeteners” to entice lawmakers. Those could come in a variety of forms—including spending cuts for some, spending increases for others, entitlement reforms and a tax code overhaul.
AASLD will continue to closely monitor all these issues with special attention to how they might impact issues like NIH funding, Medicare reimbursement and other critical programs. It promises to be a rocky ride.