Both the House and Senate passed their respective budget resolutions last week—moving the budget process one step further toward a possible Budget Reconciliation bill sometime later this year. Both of the budgets passed are non-binding and represent only a marker on the majority’s current priorities—basically an initial shot across the bow for future discussions and appropriation bills.
By way of background, it is important to remember that the budget resolution is not a “traditional” bill, but rather a “resolution;” it requires only a majority vote to pass, cannot be filibustered, and is not sent to the President for his signature or veto. Accordingly, it cannot actually enact spending or tax law but instead sets budget targets for other congressional committees that do have the power to propose legislation directly impacting spending and revenue or the discretionary appropriations process.
Traditionally, now that both the House and Senate have passed their own budget resolutions, the next step would be for the House and Senate to “conference” and develop a joint budget resolution for final passage, though that has not happened in a number of years and there is no guarantee it will happen this year either.
In the meantime, however, here is what you need to know about the House and Senate passed budgets:
Senate
The Senate passed its final budget in the middle of the night/early morning Friday, March 27th, with a nearly party-line vote of 52 to 46. The Senate spent many hours debating and considering literally hundreds of different amendments, known inside the Beltway as “vote-a-rama.” At its core, the key components of the Senate budget that are of interest to health centers include a complete re-structuring of the Medicaid program: turning it into two separate block grants with a joint savings of $400 billion over the next decade and also repealing the Medicaid expansion in the ACA—for a combined total of approximately $1.3 trillion in cuts over the next ten years.
The two block grants would essentially mean two separate pools of Federal spending available to each state—one for children, pregnant women, and non-elderly, non-disabled adults, and one for long term care supports and services (which would be financed completely differently than at present). Federal Medicaid spending for acute care for seniors and individuals with disabilities would continue as under present law. Any resulting spending beyond the Federal portion would fall to the states. It also would repeal ACA Marketplace subsidies.
Interestingly, the final passed budget also included Democratic amendments that would guarantee Social Security and veterans’ benefits for same-sex couples in states that do not recognize same-sex marriage, as well as federally guaranteed paid sick leave.
House
The House also passed its budget, albeit a few days before the Senate on Wednesday, March 25th and with a very different procedural process in which they voted on six different budget proposals. Ultimately, the budget that passed was one proposed by the House Leadership that included an additional $20 billion in military spending beyond what had previously passed the Budget Committee markup, in an attempt to appeal to defense hawks concerned with spending caps. The bill passed 228-199. It also included a block grant to the Medicaid program, albeit in a completely different manner than the Senate block grant. And while the House and Senate proposed block grants are not the same, they both have similar underlying themes and would have a similar impact on patients and providers.
The House Medicaid block grant proposal would cut the program by $913 billion over the next decade and funding would not be split into multiple different block grant “categories,” as it was in the Senate. Like the Senate, however, it would also repeal the ACA Medicaid expansion, for a combined cut of approximately $1.8 trillion over the next decade. In exchange for the significantly-limited funding, states would be permitted additional flexibility to cut benefits, cut eligibility, and reduce payments to providers—likely including FQHCs.
The House budget would also block-grant the Supplemental Nutrition Assistance Program (SNAP) beginning in 2021 and cut funding by $125 billion between 2021 and 2025—impacting food assistance relied on by many health center patients.
What’s Next?
Despite these and other cuts to health care spending, tax reforms, and other spending changes to programs running the gamut across all types of Federal spending (from education to defense), it is vitally important to remember that NOTHING in either budget is binding. While it may seem like an exercise in futility to spend so much time and effort on a non-binding resolution, it is an important marker of the Majority party’s desires and intentions for the coming Congress.
Another possibility that has been raised is that of a budget reconciliation process taking place later this year—an optional procedure used to make direct changes to spending and taxes. Many of you will remember that this is the procedure ultimately used to finalize passage of the Affordable Care Act. There has been significant discussion by Leadership in both Houses about using budget reconciliation as a vehicle later this year, since Congress may be compelled to act in the wake of the Supreme Court’s decision on King v Burwell—and so the provisions laid out in these two respective budgets may well set the agenda for what will be included in any such budget reconciliation process. Accordingly, NACHC staff is closely tracking and monitoring the continued budget process, budget instructions to key committees, and the receptivity of such proposals both on and off Capitol Hill. We will be sure to keep you apprised of any potential changes impacting health centers and let you know the likelihood of budget reconciliation pending the outcome of King v Burwell in the Supreme Court.