March 18th Health Care Reform Update

This week's update involves the budget/appropriations process and the future health care reform (Affordable Care Act, or ACA), including the Medicaid "maintenance of effort" provision.


Budget/Appropriations.  For the next three weeks (until April 8), the government will be operating under another “continuing resolution” to fund “discretionary” programs of the government for the current (2011) federal fiscal year.  The legislation would cut spending by $6 billion from the FY 2010 spending level by reducing or eliminating some smaller programs and eliminating various earmarks.  (None of these cuts would affect programs related to CYSHCN.)  Negotiations are underway among the House, Senate and administration to attempt to reach an agreement on a spending bill to fund the remaining 6+ months of the fiscal year.  The parties seem no closer to an agreement than they have been, however; there is still a huge gap between the amounts that each side is willing to cut from the budget, so it’s looking like a government shut-down is a real possibility. 


There is increasing buzz about “entitlement reform,” which would encompass possible cuts in Medicare, Medicaid and Social Security, although it is not clear that any changes to entitlements will be part of the FY 2011 budget deal. 


Health Care Reform/Maintenance of Effort.  As proponents of health care reform get ready to celebrate the law’s first anniversary on March 23, others are still talking about repealing all or parts of the ACA.  Senator Orrin Hatch (R-UT) has indicated that he will introduce legislation to repeal the so-called “Maintenance-of-Effort” (MOE) provision of the law, which requires states to maintain their current Medicaid and CHIP eligibility standards and enrollment procedures.  To read more about recent hearings on health care reform, see the blog of the Georgetown Center for Children and Families at


MACPAC.  The Medicaid and CHIP Payment and Access Commission (MACPAC) is tasked with reviewing state and federal Medicaid and CHIP access and payment policies and making recommendations to Congress, the Secretary of Health and Human Services (HHS), and the states on policies affecting the Medicaid and CHIP populations, including health care reform.  This week MACPAC issued its first report, which provides useful background information on Medicaid and CHIP.  The report can be found at


Congressional recess.  This coming week, Members of both the House and Senate will be back in their home districts/state.