Congressional Corner




May 10, 2018

Federal Budget Update

On May 8, the White House submitted a special message to Congress requesting they rescind $15.4 billion in budget authority. The proposal includes unobligated balances from prior-year appropriations and reductions to budget authority for mandatory programs.

ASTHO created a summary here. View the full rescission proposal here. House Republicans are working quickly on the proposal and legislative text could be published soon.

The Congressional Budget Office (CBO) provided an analysis on the rescissions proposal focused on the Children’s Health Insurance Program (CHIP), specifically the potential effect on federal spending and insurance coverage. The CBO estimated that rescinding the unobligated balances would reduce budget authority by $7 billion, but “would not affect outlays, or the number of individuals with insurance coverage.” Furthermore, “CBO projects that the rescission from the Child Enrollment Contingency Fund would not affect payments to states over the 2018-2028 period.”

However, of potential concern is the funding for the Child Enrollment Contingency Fund that is part of CHIP. This fund is there for unforeseen events such as increased enrollment related to natural disasters or to offset funding during government shutdowns. With the increase in natural disasters and other unpredictable events, this is an important reserve. ASTHO will continue to monitor the rescission process as it develops.

The House of Representatives continues its markup of several FY19 appropriations bills. ASTHO expects the Labor, Health and Human Services and Related Agencies bill to come later in the process—around late June.

On May 9, the House Appropriations Subcommittee on Agriculture, Rural Development, FDA, and Related Agencies, which sets funding for WIC, marked-up its appropriations bill. The House bill funds WIC at $6.00 billion, which is $175 million below the FY18 enacted level. Because WIC has carryover balances left over from previous years, the bill rescinds $300 million in unobligated balances, according to the House Appropriations Committee. However, the funding level is higher than the President’s Budget Request of $5.75 billion with a $215 million rescission. Funding for breastfeeding peer counselors remained level at $60 million out of an authorized $90 million, despite last year’s increase in the Senate bill at $80 million.

Public Health Preparedness Legislation

On May 4, ASTHO submitted comments on the Senate Health, Education, Labor, and Pensions Committee discussion draft legislation entitled, “The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018.” ASTHO is pleased that much of the current discussion draft bill retains elements proven to be necessary, reasonable, and successful, while making further refinements to the underlying statute. The comments included suggested improvements in the areas including authorization levels, funding for the emergency fund, the critical role that public health plays in preparedness and response efforts in partnership with the healthcare system, as well as addressing administrative efficiencies such as deleting the maintenance of effort requirement.

Opioid Bills Mark Up

On May 9, the House Energy and Commerce Committee held a mark-up and advanced 32 bills for further consideration by House of Representatives. Twenty-five of those bills are related to the opioid crisis. The hearing markup included H.R. 5327, the Comprehensive Opioid Recovery Centers Act of 2018, which creates comprehensive opioid recovery centers, including medication assisted treatment, among other services. Another bill, H.R. 5176, the Preventing Overdoses While in Emergency Rooms Act of 2018, creates a new grant program to coordinate long-term substance abuse treatment for patients who have been discharged from the emergency room following an overdose, as well as proposed legislation to help providers detect fraudulent prescriptions. This is the first of two hearings for this committee to mark-up opioid-related bills with the second happening on May 17. A full package of bills was expected before Memorial Day but could slip to June. The Senate HELP Committee will focus on its opioid bill once the House finishes its work

CMS Announces Agency’s First Rural Health Strategy

On May 8, the Centers for Medicare and Medicaid Services (CMS) released the agency’s first rural health strategy “intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.” The strategy focuses on five objectives to achieve the agency’s vision for rural health: (1) Apply a rural lens to CMS programs and policies, (2) Improve access to care through provider engagement and support, (3) advance telehealth and telemedicine, (4) empower patients in rural communities to make decisions about their healthcare, and (5) leverage partnerships to achieve the goals of the CMS Rural Health Strategy.

Prescription Drug Pricing Speech

The President confirmed that he will deliver a speech on lowering drug prices on Friday. HHS Secretary Alex Azar said that the Administration would attack several problems, including high list prices set by drug manufacturers, rising out-of-pocket costs for consumers, and “foreign governments free-riding off of American investment in innovation.”


The Senate Labor, Health and Human Services, Education Appropriations Subcommittee will held a hearing today with HHS Secretary Alex Azar on the department’s FY19 budget request. Secretary Azar is expected to face questions related to the Title X family planning program, as well as funding for mental health programs related to the opioid crisis. View more information on the hearing and the livestream here

The Senate Appropriations Subcommittee on Department of the Interior, Environment, and Related Agencies held a hearing today to examine proposed FY19 budget estimates and justification for EPA.

Upcoming Hearings:

The Senate Appropriations Subcommittee on Health, Education, Labor and Pensions will hold a full committee hearing on Examining Oversight Reports on the 340B Drug Pricing Program on May 15 at 10 a.m. EDT.