(Aug. 4, 2023) – As the calendar turns to August, Capitol Hill becomes a ghost town as representatives, senators and their staffs leave Washington to go back to their home states and districts for extensive listening tours. The House and Senate are out of session until September having passed a bevy of important bills in recent weeks. Most notably, both chambers approved their versions of the National Defense Authorization Act, the bill outlining the spending parameters for the largest chunk of the federal government's annual discretionary budget. Additionally, the Appropriations Committees in both chambers have approved all (Senate) or most (House) of their annual spending bills.
The fiscal year 2024 budget process faces substantial challenges as members leave town for the August recess. Only one appropriations bill – the House Military Construction/Veterans Affairs bill – has been passed by its chamber of origin. Additionally, the Labor/HHS/Education and the Commerce/Justice/Science Appropriations bills have yet to be approved by the House Appropriations Committee. The federal fiscal year ends on Sept. 30, and while it's become traditional for bills to lag for passage until Christmas, this year presents a unique challenge.
The Fiscal Responsibility Act of 2023, commonly known as the "debt ceiling deal," increased the debt ceiling for the duration of President Joe Biden's current term of office in exchange for a limitation on spending in FY 2024 more or less at FY 2023 levels. However, the bill also has an automatic year-long continuing resolution trigger for FY 2024 that goes into effect on Jan. 1, if the annual appropriations bills have not been passed by Congress and signed by the president. That year-long continuing resolution would fund the government at FY 2023 levels minus one percent overall with the largest weight of these cuts falling on the Department of Defense. This trigger is designed to get everyone to the table, as Democrats would see the government funded at a lower level than they would prefer, and Republicans would see the military funded far below the level they would prefer.
At present, the House and Senate appropriations bills vary greatly in terms of their top-line budget allocations. The House has come down at amounts closer to FY 2022 levels, while the Senate has exceeded the amounts allowed in the debt ceiling deal. While one can see how this should play out in terms of compromising to a final package, any compromise will be difficult to pass in either chamber, likely requiring bipartisan majorities in both. It will be a bumpy ride to a conclusion, possibly with multiple threats of government shutdowns along the way.
We at the Kansas Hospital Association have been active throughout the summer session of Congress in combatting various site-neutral payment proposals. Generally speaking, these proposals have broken down into two categories: those that seek to cap Medicare reimbursement rates for hospital outpatient departments at the same level as health clinics and small providers, and those that seek to install similar payment caps but for private insurance companies instead of Medicare.
Two bills – H.R. 3821, written by the House Energy and Commerce Committee, and H.R. 4822, written by the House Ways and Means Committee – contained HOPD Medicare site-neutral payment provisions as part of larger price transparency sections. While both bills were reported from their respective committees, H.R. 4822 – the more recent of the two – was reported on a party-line vote because, as we and our partners in the hospital industry pointed out, it lacked any meaningful oversight of Medicare Advantage plans. This means, such a bill cannot pass Congress in its current form but would need to undergo profound changes.
KHA worked with Senator Roger Marshall to stop a private sector version of site-neutral payment limitations that was being proposed in an untitled primary care bill before the Senate Health, Education, Labor and Pensions Committee. This proposal would have capped the amount insurance companies would have to pay to HOPDs for certain procedures at the medial local rate for non-hospital providers. We argued this would represent a massive government intrusion into private sector contracts, and the committee decided to abandon this provision, at least temporarily. This bill is likely to be redrafted and reconsidered sometime in September, so we will continue to work with Senator Marshall, and his staff, on our concerns.
Finally, KHA has been deeply involved in providing guidance to the United States Senate's 340B Working Group as they look to craft permanent solutions to stabilize this vital program. You can find our letter to them here. We outlined important changes that need to be made including choosing one oversight agency – either HRSA or CMS – that would have actual authority to enforce the program's provisions, the ability of hospitals to be able to contract with multiple 340B pharmacies and a tiered system of reporting that would reduce regulatory burdens on hospitals.
Kansas' members of Congress are coming soon to a town near you! Below is a current schedule of hospital roundtable events to be hosted by KHA during the August recess. More events may be added soon, likely in Salina and Topeka!
Tuesday, Aug. 22, 11:00 a.m. – noon; Congressman Jake LaTurner
Labette Health, 1902 S. US Highway 59, Parsons, KS
Wednesday, Aug. 23, 11:00 a.m. – noon; Congressman Ron Estes
SCK Health, 6403 Patterson Parkway, Ark City, KS
Friday, Sept. 1, 3:00 - 4:00 p.m.; Congresswoman Sharice Davids
KU Westwood Campus, 2650 Shawnee Mission Pkwy, Westwood, KS
--Chad Austin