Summary
The House and Senate are both in recess until after Labor Day. During this Congressional break, we’d like to take the opportunity to dive a bit deeper into issues of interest. To start, we are highlighting federal investment in research and development.
Prior to adjournment, the Senate Appropriations Committee marked up all 12 of their fiscal year (FY) 2024 bills, all of which passed with overwhelming bipartisan votes. Senate Appropriations Committee leadership, Chair Patty Murray (D-WA) and Vice Chair Susan Collins (R-ME), stuck to the funding levels agreed to in the Fiscal Responsibility Act (also known as the bipartisan debt ceiling deal), however they added an additional $13+ billion in emergency spending. This allowed them to provide either flat funding or small increases to the domestic spending bills, and a larger increase to the Department of Defense. The House, on the other hand, used the debt ceiling deal as a starting point, and then cut an additional $119 billion while simultaneously rescinding $115 billion in recent spending. The Committee has managed to pass 10 of the 12 bills, but the Commerce-Justice-Science bill and the Labor-HHS-Education bill have not yet been brought up in Committee. Additionally, the Agriculture bill was pulled from a floor vote prior to recess due to disagreement over spending totals. The House Freedom Caucus is pushing even more cuts, while Republican moderates are balking at the spending levels the Committee passed.
It is no surprise that House Republicans are seeking to cut social programs, but what about research and development (R&D), typically an area of investment that receives bipartisan support? The American Association for the Advancement of Science (AAAS) put out a report last week detailing the R&D estimates in both the House and Senate spending plans. Surprisingly, the House plan is $237.67 billion, or 19% over FY 2023 final estimates, a significant departure from the drastic cuts that face many other programs. The Senate’s total R&D budget estimate is $191.25 billion, a 4% decrease from FY 2023, despite giving themselves more funding. The increases, however, are not widespread. The House provides a 56% increase in developmental science at the DOD (specifically Army and Defense-Wide RDT&E accounts) compared to the Senate’s more modest 2.2%. Outside of the DOD and a modest increase in research at the VA and a couple programs, most R&D programs are cut or flat funded in both the House and Senate bills. For example, the House cut funding for the National Institutes of Health (NIH), an agency that typically receives bipartisan support, by an unprecedented $2 billion and further cut the Centers for Disease Control by $1.6 billion. The Senate provided a $943 million increase to NIH, but flat funded the CDC. The overall cuts to non-defense R&D are distressing to the community considering the impact these cuts will have on our potential for innovation in the future and the U.S.’s standing as an international science superpower.
Regulatory Update
No new rules have cleared review at the Office of Management and Budget. OMB is reviewing the following rules:
- Minimum staffing standards for long-term care facilities – Proposed rule would address staffing requirements at long-term care facilities, including nursing homes. Industry pushback has delayed the release of the rule, initially intended for June. Stakeholders are meeting with OMB in early September, meaning we are unlikely to see the proposal until the fall.
- Medicaid and CHIP Enrollment and Eligibility – Final rules intended to simplify the processes for eligible individuals to enroll and retain eligibility in Medicaid, CHIP and the Basic Health Program. The first final rule expected in September 2023 will remove barriers and facilitate enrollment of new applicants, particularly those dually eligible for Medicare and Medicaid. The second final rule expected in February 2024 will implement changes to align enrollment and renewal requirements for most individuals in Medicaid and promote maintenance of coverage.
- Mandatory Medicaid and CHIP Cor Set Reporting – Final rule would establish requirements for mandatory reporting of the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP, the behavioral health measures on Adult Health Care Quality Measures for Medicaid, and the Core Set of Health Care Quality Measures for Medicaid Health Home Programs. The final rule is expected in August 2023.