March 15 Washington Update
Greetings from Washington. Good news about legislation to extend funding for Family-to-Family Health Information Centers - a Senate companion bill was introduced! Also in this update: VERY IMPORTANT information about how your organization might be able to get funding to be a "navigator" if you live in a state that is not running its own Exchange; a rough explanation of the federal budget process and news on budget-related legislation; and announcements of informational sessions about the Affordable Care Act (ACA) to be held early next week -- a conference call on health care "marketplaces," and a webinar on assisting consumers in applying for public and private insurance under the ACA.
F2F funding legislation. As reported earlier, Representative Frank Pallone (D-NJ) introduced a bill (H.R. 564) to extend funding for Family-to-Family Health Information Centers (F2Fs) through FY 2016 at the current funding level of $5 million per year. Senator Robert Menendez (D-NJ) has now introduced an identical companion bill (S. 243). At this point, there are no cosponsors on the Senate bill and there is one, Rep. David Cicilline (D-RI), on the House bill. If you would like to urge your Representative and/or Senators to cosponsor these bills, you can find their contact information at http://www.congressmerge.com/onlinedb/index.htm.
** Navigator grants.** Under the ACA, Exchanges (a.k.a., "Marketplaces") are required to provide grants to "navigator" entities that will help people figure out how to select insurance in a post-reform world. There are required to be at least two types of entities serving as navigators in each state and one of those types must be a community or consumer-focused nonprofit organization. Since Family-to-Family Health Information Centers (F2Fs) have lots of experience as navigators, they should consider applying for navigator grants. In states not running their own Exchanges, the federal government will be selecting the navigators, and there are steps an organization can take in preparation for applying for funding. See this blog post from the Georgetown Center for Children and Families for more information.
Budget resolutions and continuing resolutions: What the heck are they?
This week, there has been activity on both the House and Senate "budget resolutions" for the upcoming fiscal year (FY 2014), AND "continuing resolutions" to appropriate funds for the remainder of FY 2013. Rather confusing, but an attempt to explain these concepts is below.
Budget resolutions. In theory, the annual budget process starts when the President transmits a detailed, "line-item" budget to Congress. Then, Congress develops a budget resolution that serves as an outline for spending and revenues. Each chamber of Congress approves its own resolution, a compromise is reached in a conference committee, and each chamber approves the conference agreement. Unlike a law, however, a budget resolution is not signed by the President. It is essentially a proposal; specific appropriations and policy changes must be made by law.
Working within the parameters of the budget resolution, and taking the President's budget proposals under advisement, the congressional appropriations committees appropriate money to be expended, and other committees may make changes in tax law and/or entitlement programs to comport with the revenue or spending targets set forth in the budget resolution.
In reality, the process often doesn't work this way. The President's budget proposal is weeks overdue this year. And the Senate has not approved a budget resolution for the past several years.
On Tuesday, House Budget Committee Chairman (and former vice-presidential candidate) Paul Ryan (R-WI) unveiled his proposed budget resolution for federal fiscal year 2014 (beginning October 1, 2013), and it was approved by the Committee. See http://budget.house.gov/. His budget proposes "premium supports" for Medicare, often referred to as a voucher program, and would transform Medicaid into a block grant to states. The Ryan budget also proposes to repeal the Affordable Care Act (ACA) and reverse defense cuts made by the sequester by making deeper cuts in non-defense programs. (For information on the proposed Medicaid cuts, see the Center on Budget and Policy Priorities blog at http://www.offthechartsblog.org/ryan-budget-again-includes-a-medicaid-block-grant-that-would-add-millions-to-the-ranks-of-uninsured-and-underinsured/.)
On Thursday, the Senate Budget Committee, chaired by Senator Patty Murray (D-WA), approved its budget resolution, which proposes to reverse the across-the-board sequester cuts by, generally speaking, making more targeted cuts and raising revenues by closing tax loopholes and increasing some individual and corporate taxes. Notably, the Committee approved an amendment offered by Senator Bill Nelson (D-FL) and advocated by children's hospitals, that would help to facilitate "legislation that promotes care coordination and reduces care fragmentation in order to improve outcomes and lower costs among medically complex children in Medicaid."
The House and Senate are each expected to approve their own budget resolutions, but it is highly unlikely that they will be able to reach a compromise that they can both agree to. As a practical matter, this will be of little consequence, however.
Appropriations bills and continuing resolutions. While a budget resolution is not essential, appropriations are essential for running the agencies of government and funding many of its programs ("discretionary" programs, as opposed to mandatory spending programs such as entitlements, although entitlement programs cannot be administered without appropriations for their administration).
Ideally, each of the 12 appropriations subcommittees in the House and Senate will develop a bill funding the agencies within that subcommittee's jurisdiction (e.g., the Labor, Health and Human Services, and Education appropriations bill, which is developed by a subcommittee bearing a parallel name). Sometimes, multiple appropriations bills are packaged into one "omnibus" appropriations bill.
When Congress and the President cannot reach agreement on appropriations bills, but do not want to cause a government shut-down, they will enact a continuing resolution ("CR") -- basically an extension of the previous year's funding level for each program. The government is currently being funded through a CR that expires on March 27.
Last week, the House approved legislation to fund the federal government for the remainder of the fiscal year, which ends on September 30. The House bill is actually a hybrid of appropriations bills for two departments that had already been agreed to by the full House, and a continuation of last year's funding levels for the other departments. The Senate considered similar legislation this week, and is expected to approve it next week. Then the two chambers will have to negotiate a compromise.
What about the sequester? As you may have heard in the news, President Obama has been meeting with both Democratic and Republican Members of Congress in an attempt to revitalize negotiations on a "grand bargain" (or even a "petite" bargain, as one lawmaker put it), that would replace the sequester with alternative spending cuts, measures to increase revenues, and possibly some cuts to entitlement programs. The President has said that he would not agree to entitlement cuts unless the Republicans agreed to revenue increases. Reportedly, the President would like to negotiate a deficit reduction deal by July or August, when the debt limit will need to be increased.
MACPAC Report. Today the Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2013 Report to the Congress on Medicaid and CHIP. The report provides new information based on the Commission's analyses of issues affecting persons who are dually eligible for both Medicaid and Medicare, and the Commission makes two recommendations to the Congress on Medicaid and CHIP eligibility policy: (1) for Congress to create a statutory option for states to implement 12-month continuous eligibility for children enrolled in CHIP and adults enrolled in Medicaid, as is now the case for children in Medicaid; and (2) for Congress to permanently fund Transitional Medical Assistance (TMA), while allowing states to opt out of TMA if they take up the ACA's Medicaid expansion. The MACPAC press release and fact sheet can be found at: http://www.macpac.gov/home/press-release, and the full report can be found at: http://www.macpac.gov/reports.
Secretary Sebelius begins to "tweet." This sounds like a symptom of an exotic disease, but actually it just means that HHS Secretary Kathleen Sebelius has launched an official Twitter account, @Sebelius. She just started tweeting on Monday and has already tweeted 16 messages, not counting re-tweets!
Resources on ACA Implementation
"Marketplace" conference call. On Monday, March 18, at 2:00 - 3:00 p.m. ET, the Center for Medicare & Medicaid Services (CMS) is holding a National Health Insurance Marketplace Stakeholder Conference Call. ("Marketplace" is the new term for an "Exchange," as envisioned by the Affordable Care Act. There will be state-run Marketplaces and a federally run Marketplace for states that choose not to have their own.)
The goal of the call is to keep stakeholders updated on the operational execution of the Marketplace as well as for CMS to hear directly from individuals and organizations that will use it. The call will feature CMS senior officials followed by time for Q&A. Speakers are:
• Gary Cohen, Deputy Administrator and Director, Center for Consumer Information and Insurance Oversight;
• Cindy Mann, Deputy Administrator and Director, Center for Medicaid and CHIP Services; and
• Julie Bataille, Director, Office of Communications.
CMS regional offices will also hold quarterly calls throughout 2013. State calls are also planned. CMS plans to use the information and feedback provided in the stakeholder consultation process in the development of the Marketplace.
Webinar: Translating The Medicaid Expansion Into Increased Coverage: The Role Of Application Assistance
At 2 p.m. to 3:15 ET on Tuesday, March 19, the Kaiser Family Foundation's Commission on Medicaid and the Uninsured will hold a webinar to examine the role of application assistance in ensuring eligible individuals successfully enroll in health coverage. To register for the webinar please RSVP here or call Tiffany Ford Fields at 202-347-5270. For further information, contact Chris Lee at CLee@kff.org or 202-347-5270.
The Health Care Law 101. A presentation on the main provisions in the Affordable Care Act and how to access care in your community will be held in Spanish on March 19 at 3:00 p.m. ET.
Frequently Asked Questions about ACA Implementation. CMS has posted a set of frequently asked questions about Medicaid and CHIP issues related to the ACA, including changes in Medicaid eligibility (under the "Eligibility Policy" category.)
From the National Academy on State Health Policy:
A recent webinar and slides are archived at "Beyond the Expansion Decision: Tackling the Other Changes in the ACA," where one can also engage in an ongoing discussion, and Q & A.
The 2014 Medicaid Eligibility Transition Toolkit for States is designed to assist states in systematically identifying issues and decisions they will face as they convert to 2014. Although intended to help states, it might be useful to advocates who wish to influence state policy. The toolkit includes: An issue brief, "Analysis of Eligibility Changes and Implications for Selected Medicaid and CHIP Eligibility Groups in 2014," which provides a detailed overview of the final federal Medicaid eligibility rules, transition issues and decision points for states.
As always, please feel free to contact us with any questions.
Best, Janis & Brooke
Janis Guerney, Esq.
Brooke Lehmann, MSW, Esq.