CSAC Bulletin Article

Senate Republican Leaders Aim for Final Health Care Vote

July 27, 2017

At press time, the Senate was continuing to debate proposals to repeal and replace the Affordable Care Act (ACA), albeit with no clear legislative path in sight. Earlier in the week, the chamber voted 51-50 to begin consideration of health care legislation. Vice President Mike Pence was called upon to cast the deciding vote after Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) joined all Democrats in opposition to the motion to proceed. 

Since debate began, there have been two key votes on the Senate floor, both of which were defeated due to Republican defections. The Senate first rejected a comprehensive repeal and replace bill by a vote of 43-57 – with nine Republicans joining all Democrats in opposition. Notably, the opposing Republicans were a mix of conservative members who want a total ACA repeal and GOP moderates concerned about the proposed cuts to Medicaid. The second measure, which was defeated by a vote of 45-55, would have repealed the ACA in two years, with a replacement bill to be developed in the interim.

GOP lawmakers met this afternoon to discuss which provisions to include in a scaled-down version of a repeal bill. At this point, it is difficult to predict what will ultimately be incorporated into the so-called “skinny repeal” legislation, particularly as the potential contents of such a proposal have changed over the past 24 hours. 

However, it has been widely speculated that the soon-to-be-released Senate bill could include a provision that would eliminate the financial penalties imposed on individuals/small businesses for not purchasing health insurance, a prospect that would effectively render the ACA mandate moot. In fact, according to an estimate from the Congressional Budget Office (CBO), the effect of repealing the mandate would cause an additional 15 million individuals to lose coverage next year. Republican leaders are also considering language that would defund Planned Parenthood, terminate the medical-device tax, and eliminate the Public Health and Prevention Fund, which is used by state and local public health departments to meet community health needs.  

Of particular interest to California’s counties, Medicaid cuts are not expected to be included in the skinny measure. While such a concession will surely provide political cover for certain moderate GOP senators, large reductions to the Medicaid program would remain central to conference committee deliberations.  

For his part, Majority Leader Mitch McConnell (R-KY) has stated that he wants to hold a final vote before the weekend. Again, the exact contents of the legislative product remain unclear.  As such, Republican support for a final measure cannot be predicted until the concluding hours of debate.  It should be noted that Senate passage of a minimalist bill would allow House and Senate GOP members to work together on crafting yet another bill by convening a bicameral conference committee over the reminder of the summer and into the fall.

Fiscal Year 2018 Appropriations

The House spent much of the week debating a nearly $800 billion “minibus” appropriations package. The legislation includes the text of four fiscal year 2018 spending measures: Defense; Military Construction-Veterans Affairs; Legislative Branch; and, Energy & Water. At press time, lawmakers were considering the Defense portion of the legislation, with GOP leaders hoping to bring the minibus to a vote by week’s end.

Prior to floor consideration of the spending bill, Republican leaders added $1.6 billion for President Trump’s border wall. Funds for the project originated in the fiscal year 2018 Department of Homeland Security (DHS) spending measure, but were ultimately stripped out of the DHS bill and added to the minibus. The decision to add the funding to the broader spending measure means Republicans can avoid a separate up-or-down vote on the controversial border-wall project.

Looking ahead, House leadership has indicated that the remaining eight spending measures will be readied for floor consideration sometime in September. Lawmakers will have until midnight on September 30 to pass a new budget, which – with a limited number of legislative days remaining on the calendar – means Congress will likely be forced to pass a stop-gap funding bill.

Across Capitol Hill, the Senate Appropriations Committee this week continued to mark up its own fiscal year 2018 spending measures. On Thursday, the committee approved its Commerce-Justice-Science (CJS) appropriations package, as well as its Transportation-HUD (T-HUD) funding bill.

The CJS package would provide $53.4 billion in fiscal year 2018 discretionary spending, or $3.2 billion below the fiscal year 2017 level.  Among other things, the legislation would provide $100 million for the State Criminal Alien Assistance Program (SCAAP), or a proposed cut of $110 million.  Notably, the upper chamber typically provides limited funding for SCAAP, with senators dedicating resources to other local justice programs. In the House, lawmakers have included $220 million for SCAAP (a $10 million increase) as part of the chamber’s Justice spending bill.

In addition, the Senate legislation would provide $405 million for Byrne Justice Assistance Grants (JAG), or a slight boost in funding. dditionally, the bill would dedicate $3.64 billion for the Victims of Crime Act (VOCA) fund in fiscal year 2018, or a $1.06 billion increase over the fiscal year 2017 cap. 

With regard to transportation spending, the Senate’s T-HUD bill would allocate $45 billion from the Highway Trust Fund for the Federal-aid Highway Program, which is $968 million above current spending. The proposed funding – which supports local road, bridge, and safety projects – mirrors the levels authorized in the latest highway reauthorization measure (FAST Act). All told, the Senate T-HUD bill would provide over $60 billion in discretionary funding in fiscal year 2018, or roughly $2.4 billion above the fiscal year 2017 level.

The Senate measure also would provide $550 million for DOT’s discretionary TIGER Grant program, a proposed $50 million increase.  Notably, the House T-HUD bill would eliminate TIGER grant funding.

In terms of funding for housing and community development, the Senate bill would allocate $3 billion for the Community Development Block Grant (CDBG) formula program, or level funding. In addition, the legislation would provide $2.456 billion for Homeless Assistance Grants (a roughly $200 million increase from current spending) and $950 million for the HOME program (level funding).

Finally, the Senate Appropriations Committee approved as part of its T-HUD spending bill language that would allow airports to increase their airline passenger facility charges (PFCs), up to $8.50 from $4.50. The PFC fee, which airports use to fund improvements to safety, security, or capacity, could only be increased on the origination flight under the terms of the Senate language.

 

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