By Lyle Dennis, Cavarocchi – Ruscio – Dennis Associates, Consultants to AASLD
We have written periodically throughout the year about the appropriations process in the House and Senate and the congressional leadership’s determination to get their FY19 funding legislation passed and signed into law in a timely manner. However, we are starting to see some indications of the possibility that the usual problem – too little money for too great a need, as well as significant unaddressed policy issues – could begin to derail the progress that has been made to date.
Both the House and Senate Appropriations Committees have completed work on the bill that includes funding for most of the agencies within the Department of Health and Human Services. The debate will be long and loud as the bill, among other things, the House bill eliminates all funding for the Title X Family Planning program and has an inadequate amount of money for the unaccompanied and separated minors at the border. The Senate’s comparable bill fully funds Title X, but it is also not fully addressing the border situation.
On balance, the funding news in both the House and Senate bills is generally positive. NIH is increased by $1.25 billion in the House and by $2.0 billion in the Senate. The proposal to cut AHRQ’s funding and merge it into NIH is rejected in both bills, for the second year in a row. Both bills restore cuts that were recommended by the administration in the area of health professions education and training.
So what is the problem?
Congress seems to be losing its will to move these bills to the floor of the respective houses for votes on passage. The shadow of the 2018 midterm election is looming larger and larger. Appropriations bills are traditionally brought to the floor of the House under a provision that makes all amendments in order – and there are thousands of line items in these bills that could be subject to an amendment vote that could be politically embarrassing to one party or the other.
And then there is the problem that the bills might not pass and will embarrass the congressional leadership by making them look incapable of governing. This problem is one of the unintended consequences of “earmark reform.”
Appropriations bills were once considered must-pass legislation. However, since the elimination of earmarks – congressionally directed funding to a specific institution – there is very little reason to take tough votes on appropriations bills. If you are a conservative member of Congress, it is very easy to say, “This bill spends too much money. I am voting no.” On the other hand, if you are a progressive member of the House or Senate, it is just as easy to say “This bill shortchanges my constituents’ interests. I am voting no.”
This is the political reality of trying to fund the government in the current hyper-partisan environment. For groups like AASLD and many others in Washington, it is critical that we make clear to our elected representatives that failure to fund the government, or funding it under a Continuing Resolution at last year’s level, is an abrogation of their responsibility as stewards of public funds – and that such action have real consequences. New research grants are delayed; continuation grants are reduced by 10 to 20 percent depending on the agency; programs have to be scaled back.
None of these outcomes benefit the American people.