Congress Averts Shutdown, Acts to Halt Medicare Cuts in 2018

Alicia Ault

December 22, 2017

Facing yet another imminent government shutdown, Congress approved a short-term spending bill last night that will keep the doors open, keep the Children's Health Insurance Program (CHIP) temporarily afloat, and avoid automatic Medicare cuts triggered by the massive tax code overhaul.

The latest continuing resolution (CR) passed the House 231 to 188 and the Senate 66 to 32. It is in lieu of the traditional 12 appropriations bills used to fund the government's operations. The federal fiscal year starts October 1, but Congress has been unable to pass a budget in time for that deadline in more than 20 years. Instead, legislators have used a CR 111 times since fiscal 1998 to extend the current year budget to avoid a government shutdown.

This is the second CR in 2017. Congress passed one on December 7, keeping the government open until December 22. The most recent CR, which was added on to H.R. 1370 keeps the government in operation until January 19.

It also contains several key healthcare measures. First, the CR includes language that lets legislators waive budget rules that would require automatic Medicare cuts triggered by the Tax Cuts and Jobs Act (H.R. 1) approved by Congress on December 20. The cuts — required under the 2010 Statutory Pay-As-You-Go (PAYGO) Act — would amount to a 4% ($25 billion) reduction in pay for physicians.

Soon after Congress approved the tax bill  Wednesday, physician organizations called on Congress to swiftly waive the PAYGO requirement. "Given that 60% of cancer patients in the United States are Medicare beneficiaries, a cut of this magnitude will cause further instability in the already fragile cancer care delivery system and threaten patient access to life-extending cancer care," said American Society of Clinical Oncology President Bruce E. Johnson, MD, in a statement.

CHIP Gets Short Reprieve

The new CR also once again temporarily extends funding for CHIP. The program, which was last renewed in 2015 and provides insurance for some 9 million children, expired on September 30. Legislators have said they cannot come up with the funds for a major renewal, although the House approved a 5-year extension in November (the Championing Healthy Kids Act, H.R. 3922). The Senate Finance Committee approved a slightly different long-term extension, the Keep Kids' Insurance Dependable and Secure (KIDS) Act (S. 1827), on October 4.

In the meantime, some states had started notifying parents that coverage would soon end. The Georgetown University Center for Children and Families recently reported  that 1.9 million children may lose their insurance starting in January, and another 1 million by the end of February, if Congress did not act.

The latest CR provides $2.85 billion in funds for CHIP through March 31.

But children's advocates and pediatricians said that is not enough. "What states and families need is stability. Instead, what they get from the House measure is a continuation of a dangerous trend: temporary, inadequate CHIP funding patches, delivered at the last possible moment with no comprehensive relief or assurance," said a joint statement from the American Academy of Pediatrics, Children's Defense Fund, Children's Dental Health Project, Children's Hospital Association, Family Voices, First Focus Campaign for Children, March of Dimes, and National Association of Pediatric Nurse Practitioners.

"Congress' failure to extend CHIP funding long-term has resulted in a manufactured emergency that has real consequences for children, families and pregnant women," they said.

"We are relieved that states will have temporary funding for children's health insurance, but Congress must pass a long-term reauthorization of CHIP," said American Psychiatric Association CEO and Medical Director Saul Levin, MD, MPA, in a statement, noting that 850,000 children with emotional disorders have CHIP coverage. "We urge Congress to act with all possible speed to pass a five-year reauthorization of CHIP," he said.

The American Medical Association (AMA) also expressed dismay. "For months, we have received direct assurance from members of Congress on both sides of the aisle and in both chambers that CHIP would be taken care of," said AMA President David O. Barbe, MD, in a statement emailed to Medscape Medical News.

"Given the broad support for CHIP in Congress, in the states, and across health care stakeholder groups, we are flummoxed about just what it takes for Washington to get the job done," he said. "Three full months after the program expired, the best Congress can come up with is another short-term extension for CHIP and other critical public health programs," said Dr Barbe.

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