Summary
Continuing Resolution
This week, the House is slated to vote on a continuing resolution to avoid an October 1 government shutdown. The duration of the stopgap measure has not yet been announced, but Democratic leaders are eyeing early December – possibly December 3 or 10 – just before the scheduled holiday recess. The potential end-of-year package could also serve as a vehicle for bipartisan legislative priorities (e.g., access to mental health care, Medicare telehealth reform, and Cures 2.0) – as we saw last year with the inclusion of the No Surprises Act in the Consolidated Appropriations Act, 2021 (P.L. 116-260).
Debt Limit
The House is also expected to vote on a measure to suspend the debt limit, but whether this language will be attached to the continuing resolution remains to be seen. Pairing the two measures together could increase the possibility of a government shutdown, since the Senate needs 60 votes to pass the continuing resolution. In a Dear Colleague letter, Speaker Nancy Pelosi (D-CA) reiterated her call for bipartisanship to suspend the debt limit, noting the parties came together in 2019 to do just that. However, Senate Republicans have adamantly opposed raising the debt limit as Democrats pursue a $3.5 trillion budget reconciliation package. Still, they generally may be more open to a suspension.
Budget Reconciliation
All 13 committees of jurisdiction have submitted their legislative recommendations, but the House Budget Committee will not mark up the consolidated budget reconciliation package this week. This delay complicates Pelosi’s deal with moderate Democrats to vote on the Senate-approved bipartisan infrastructure package by next Monday, September 27 since it could take weeks for House Democrats to reach a deal on how to generate and spend savings (and whether that deal is even viable in the Senate is questionable).
Negotiations over the $3.5 trillion Build Back Better Act remain active, especially due to the uncertainty surrounding prescription drug pricing reforms. If Democrats are ultimately unable to raise enough votes for Medicare drug price negotiation authority, as proposed in H.R. 3, they may have to reconfigure their budget reconciliation package without major savings generated from robust drug pricing reforms, which may require scaling back on health care-related items (e.g., fixing the Medicaid expansion coverage gap, adding dental, vision, and hearing benefits to Medicare, making permanent the ACA premium subsidy enhancements).
Other House Votes: Reproductive Rights, Defense, Cybersecurity
The House will also vote on the Women’s Health Protection Act of 2021 (H.R. 3755) – an attempt by congressional Democrats to save Roe v. Wade, as it faces an uncertain future. This fall, the Supreme Court will hear Dobbs v. Jackson Women’s Health Organization, which bans abortion after 15 weeks in Mississippi. With a conservative supermajority, the Supreme Court is well-position to issue a decision (likely in June 2022) that could overturn or further erode Roe v. Wade. The Women’s Health Protection Act of 2021 would protect the right to access abortion care by creating a safeguard against medically unnecessary restrictions. While the Women’s Health Protection Act of 2021 is expected to pass in the House, it is unlikely to clear the 60-vote filibuster threshold in the Senate.
Additionally, the House will also consider the National Defense Authorization Act for Fiscal Year 2022 (H.R. 4350). The House may also vote this week on several bills intended to bolster the federal government’s cybersecurity workforce (H.R. 3533, H.R. 3599, and S. 2382), among others.
COVID-19 and Children’s Health
On Wednesday, the House Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing to examine the health impacts of COVID-19 on children and adolescents. Members will hear from pediatric health experts and mental health leaders on ways to ensure the safety of children as they return to school, especially kids under 12 who are awaiting emergency use authorization of a COVID-19 vaccine for their age group.
Medicaid
Later this week, the Medicaid and CHIP Payment and Access Commission (MACPAC) will convene to discuss an array of timely issues, including:
- Associations between state eligibility processes and rates of churn and continuous coverage (important considerations as states prepare to phase out COVID-related continuous eligibility at the end of the public health emergency);
- Medicaid levers to address concerns about the primary and specialty care workforce and access to care for Medicaid beneficiaries (especially if Congress passes legislation to address the Medicaid expansion coverage gap); and
- Vaccine access, coverage, and payment for adults enrolled in Medicaid (which MACPAC examined in September 2020; states that did not expand Medicaid are not required to cover all vaccines recommended by CDC’s ACIP).
Additionally, MACPAC will host a panel discussion on the adoption and use of health IT by behavioral health providers to support care integration. The panel features Jessica Kahn, McKinsey & Company; Bebet Herminio Navia, Jr., New Jersey Medicaid Enterprise Systems; and Brooke Hammond, Integral Care.
Regulatory Update
The October 1 deadline for the release of a second interim final rule on surprise medical billing (i.e., Surprise Billing Part II) continues to draw near. This rule will establish the specifics for the independent dispute resolution (IDR) process (i.e., arbitration) and the patient-provider dispute resolution process (for uninsured individuals to appeal a bill charged that is substantially greater than the good faith estimate). The rule, however, has not yet appeared at the Office of Management and Budget (OMB), meaning the White House has not received the rule for final approval. Given the impending due date, we may see the rule appear at OMB in the coming days before its release expected by the end of the month.