December 12, 2020

December 12, 2020

Congress Still Working to Avoid Government Shutdown

If it weren’t for the coronavirus and the start of the vaccination program against it the top news story would probably be the fact that Congress still can’t reach a final agreement to keep the government from shutting down.  As we indicated in last week’s update, they had to pass another one-week Continuing Resolution (CR) last Friday in order to give them more time to try and pass the needed legislation.

The CR will fund the government through this coming Friday, Dec. 18, at the same level as fy2020 funding.  If they still can’t reach an agreement it is likely they will pass another CR that will go to the end of the year.  That would give them time to go home for Christmas and then return to Washington to continue trying to reach a final agreement.

It they can’t do that they will have to pass a longer CR which would take the funding issue well into January of next year and the new Congress will have to deal with it as its first order of business.

The funding of President Trump’s border wall, which is part of the funding for the Department of Homeland Security, had been a major sticking point but that has apparently been resolved.

Another major hurdle was about how to classify $12.5 billion in veterans’ health spending through the VA Mission Act — legislation that Trump himself has championed.  The chairmen/women of the Congressional committees that deal with government funding originally agreed to classify that money as “emergency spending” because then it would not violate the overall spending limits Congress has previously agreed to.

That would have allowed them to preserve what small increases are allowed in fiscal 2021 non-defense spending and spread that money elsewhere, while avoiding cuts to popular programs that would follow if they had to accommodate veterans’ health cost increases as non-emergency spending. But House Republicans objected to that arrangement.

Then on Monday there was a report that Congressional negotiators were closing in on a government spending bill agreement after keeping the funding for Veterans Affairs Mission Act under the $1.4 trillion budget cap, a significant victory for the House Republicans who insisted on this provision, according to two congressional aides.

The $12.5 billion for VA health care improvements will now be paid for with savings elsewhere in the budget.  However, one Democratic aide said the funds used to pay for the program were gimmicks that do not harm spending in vital programs.

So even as this is being written there are reports coming that Congressional leaders are close to a deal on both the legislation to fund the government for the remainder of the fiscal year as well as a new coronavirus economic stimulus bill.

We will all know if they were able to reach and agreement and get their job done by the end of this coming Friday.  However, President Trump’s position on this is not clear.  While Treasury Secretary Mnuchin has been in on the discussions of the legislation the President has not said where he stands.

If he should choose to veto the bill all bets are off as to what would happen next.

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Surprise! – Effort to End Surprise Billing Still Alive   

In last week’s update we told you about the pending retirement of Senator Lamar Alexander (R- Tenn.), who has been a champion of legislation to end surprise medical billing.  We feared the effort to end the practice would now be more difficult in Alexander’s absence.

Well, to our surprise, it was announced last Friday that House and Senate committee leaders have struck a deal on a bipartisan fix for the problem.

According to Bloomberg News, “The bipartisan agreement is between the top Democrats and Republicans on the House Energy and Commerce, Ways and Means, and Education and Labor committees, as well as the leaders of the Senate Health, Education, Labor and Pensions Committee.

“The measure would generally limit surprise billing in the following circumstances:

  • Out-of-network emergency services, which would include services furnished after a patient is stabilized unless notice and consent criteria are met.
  • Ancillary services, such as anesthesiology, radiology, and laboratory services, from an out-of-network provider.
  • Other services provided by an out-of-network provider at an in-network facility, unless notice and consent criteria are met.

Providers couldn’t send patients a balance bill for any amounts that exceed the cost-sharing requirement in those scenarios.

 Providers would have to give patients information on their network status, costs of out-of-network care, options for in-network providers, and other insurance requirements generally 72 hours before an appointment. The notice would have to clearly state that consent is optional, and that the patient could seek care from an in-network provider.

Patients would have to sign a consent form acknowledging they’ve been given written notice with the information and informed that the charges may not accrue toward any plan limitations.

 Health insurers would directly pay providers the difference between the out-of-network rate and the patient’s cost-sharing amount for those services. In states that don’t have their own systems, the out-of-network rate would be the amount that the provider and insurer agree to through an open negotiation process, or the amount set through an arbitration process.

It’s likely the surprise billing package will be attached to the year-end government spending bill, as lawmakers attempted to do late last year, assuming they can come to an agreement by the end of the year.

House Speaker Nancy Pelosi (D-Calif.) said in a statement that the House would push for the deal to be included in a year-end legislative package.  However, Senate leaders haven’t signed off on the deal, according to a committee aide.

The agreement would make patients responsible only for their in-network cost-sharing amounts for both emergency services, including air ambulances, and some non-emergency care, according to the outline.

Ending surprise billing has been a priority for TSCL this year so we are very hopeful this bill does, in fact, finally pass.

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Update No. 2 on Discount Drug Card

In one of our recent updates we said we hadn’t heard anything new about the $200 drug discount card for seniors that President Trump had announced in September.  The program ran into obstacles because of a number of issues, including how it was to be paid for and the fact that it could violate federal election laws as an attempt to buy votes using taxpayer money.

But according to a report in Politco last week, “… the administration’s Medicare team has put together a revised plan — which was circulated inside the administration on Tuesday, with instructions to expedite approval — to start sending letters to 39 million beneficiaries within the next week, touting the drug-discount cards. The cards would then arrive across December and January, according to four officials with knowledge of the plan.”

The most recent report is that the Trump administration expects to begin sending $200 prescription drug discount cards to seniors by Jan. 1.

The program is still controversial because it is expected to cost at least $6.6 billion and will be funded by taking money from other places within the Medicare budget.  One health official briefed on the revised plan called it a ‘horrible idea’ that would inappropriately dip into Medicare's trust fund, adding that the timing still raises questions.

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Congress Passes Defense Bill but President Trump says He Will Veto

Another major piece of legislation that Congress is working on, one which has been passed and been signed into law by whomever has been President for the past 59 years, is the National Defense Authorization Act (NDAA).  As we explained last week, that’s the annual bill that authorizes the pay for members of the U.S. military as well as other important issues dealing with the Department of Defense.

President Trump was threatening to veto it because it directs the Defense Department to rename military posts and bases that are named for Civil War Confederate generals.  Trump also demanded that a provision that would affect social media companies such as Facebook and Twitter be included in the bill.

Republicans as a whole did not object to the renaming provision and they agreed with Democrats that the NDAA was not the place for the social media provision that Trump wants.  As a result, both houses of Congress passed the NDAA last week with majorities that are large enough to override Trump’s threatened veto.

Nonetheless, this weekend the President said he will carry out his threat and veto the bill.  It is not clear if all Republican members of Congress who voted for the bill will do so again and override Trump but there were large enough majorities in both houses that they could lose a few votes and still override.

If Trump does, in fact, veto the bill it is likely Congress will attempt to override it this week although the timing of the override attempt may hinge on whether an agreement of government funding can be reached this week.

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Despite the coronavirus emergency, TSCL is continuing its fight for you to protect your Social Security, Medicare, and Medicaid benefits.  We have had to make some adjustments in the way we carry on our work, but we have not, and will not stop our work on your behalf.

For progress updates or for more information about these and other bills that would strengthen Social Security and Medicare programs, visit the Bill Tracking section of our website or follow TSCL on Twitter.