It looks like health providers serving low-income Americans just might ride the next wave of congressional funding after treading water for months.
The latest short-term spending bill, released by the House last night and scheduled for a vote today, includes two years of funding for community health centers -- which serve one out of every 12 Americans -- and would for 2018 and 2019 delay scheduled Medicaid cuts to hospitals with larger shares of low-income patients.
The bill, which would fund most of the government through March 23, is likely dead on arrival in the Senate. But the newest plan shows congressional leaders are serious about securing funding for those two priorities in whatever measure they pass to keep the government open past Thursday (another government shutdown is looming if they can't agree). And that is good news for health-care advocates who have been deeply discouraged over the past several months as Congress neglected to reauthorize funding for a number of their key programs.
"We're about to explode over here, holding our breath to see what the next [spending bill] has for us," Dan Hawkins, senior vice president for the National Association of Community Health Centers, wrote me in an email last night.
In a move that stands to heighten tension with Democrats and complicate plans to keep open the government, the House plans to vote on a measure funding the Pentagon through September while hiking its budget by about $30 billion (and funding the rest of the government at 2017 levels), my colleagues Erica Werner and Mike DeBonis report. But the path forward is still unclear, as Democrats have refused to sign on to any defense spending increase without bolstering nondefense spending too.
If community health center funding stays in a that spending bill, it still will have been more than 125 days since federal dollars have technically expired for the centers — an unprecedented situation that has seriously threatened their stability. About 2,800 health centers around the country would be forced to shutter without the funding, which comprises about 70 percent of their budgets, according to the Department of Health and Human Services.
The consequences, per the National Association of Community Health Centers:
"Nationwide, 20% of health centers have instituted a hiring freeze already, & 4% have laid off staff. Another 53% said they might lay off staff if federal funding is not forthcoming," via @KHNews https://t.co/VeqxtbPWXr #FQHC #FixtheCliff #RedAlert4CHCs— NACHC (@NACHC) February 5, 2018
Rep. Paul Tonko (D-N.Y.):
Community Health Centers & Medicaid Disproportionate Share Hospitals (DSH) are critical sources of care for rural & disadvantaged communities. Failing to fund them with a 5th consecutive CR or weak budget proposal would leave millions of families behind: https://t.co/LWc6gOn89W— Paul Tonko (@RepPaulTonko) February 2, 2018
MSNBC's Chris Hayes:
If they thought Community Health Centers should be funded for two years, they, obviously, could have done that in the last CR, but it was taken as a hostage.— Chris Hayes (@chrislhayes) February 6, 2018
Sen. Kamala Harris (D-Calif.):
Here’s something that hasn’t been discussed enough: funding for community health centers, which provide care for 26 million Americans, expired more than 100 days ago. https://t.co/ROxwplP1oe— Kamala Harris (@KamalaHarris) February 5, 2018
A Democrat running for Congress in New York:
We thought CHIP was saved, but Congress left out a key element: 10,000 Community Health Centers. It’s giving children a health care card, but no place to use it. The vote is on Feb 8th. Time to mobilize. Call your Reps. #TheResistance— Omar Vaid (@omarvaid) February 5, 2018
Even the hardline House Freedom Caucus is on board:
Official position: The House Freedom Caucus supports the House Republican plan to pass a CR to March 23 that includes full funding for the military and community health centers— House Freedom Caucus (@freedomcaucus) February 6, 2018
There’s no clear reason lawmakers haven’t authorized the money – besides the fact the centers were originally tied to disputes over funding the Children’s Health Insurance Program,which finally got its cash last month. Rank-and-file lawmakers have been yelling at leadership to resolve the situation.
Yesterday, two-thirds of all senators signed a letter to Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Chuck Schumer (D-N.Y.), asking them to ensure the funding is reauthorized “immediately” and noting the program’s long history of bipartisan support.
“The failure to reauthorize the fund has jeopardized access to care for millions of Americans, and made it difficult for community health centers to adequately plan for everything from staffing needs to securing loans for capital projects,” wrote the senators, led by Roy Blunt (R-Mo.) and Debbie Stabenow (D-Mich.).
More than 100 Republican members sent a similar letter to House Speaker Paul Ryan (R-Wis.) last Friday, saying community health center funding should be included in “the next moving piece of legislation to be signed into law.”
“Community health centers across the United States have delivered affordable, accessible and quality health-care to patients, regardless of their ability to pay, for more than 50 years,” the members wrote. “We know you are strong supporters of community health centers and we share your concern about the disruptions they are currently facing.”
As for the hospitals facing Medicaid cuts -- known in health policy lingo as "disproportionate share hospitals," or DSH -- Congress has already delayed their cuts several times before and is likely to do so again. Hospitals have argued that the cuts, laid out under the Affordable Care Act, are no longer fair because a number of states didn't expand their Medicaid programs as the ACA originally envisioned.
"We strongly urge Congress to retain this two-year DSH cut delay in the next continuing resolution," America's Essential Hospitals said in a statement last night. "A two-year delay averts a combined $5 billion in cuts, pays for itself, and gives Congress and hospitals time to work together on long-term solutions to the financial burden of uncompensated care."
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AHH: Anthem said yesterday it's making contributions of $1,000 to the retirement accounts of more than 58,000 employees and recent retirees in response to the GOP tax overhaul, USA Today reports. A few days earlier, CFO John Gallina said on an earnings call that half of the benefits would be returned to shareholders and the rest would be split nearly evenly between "accelerating investments" and on helping customers. The major insurer is the latest company to announce how it's responding to the tax bill, which is projected to reduce revenue to the government by more than $1.5 trillion over a decade.
Republicans touted the announcement, saying it adds proof to the argument their tax bill is helping workers. From Rep. Jim Banks (R-Ind.):
Great news out of Indy today – Anthem giving employees $1,000 bonus thanks to tax cuts.https://t.co/9QWVzGypIm— Jim Banks (@RepJimBanks) February 5, 2018
OOF: White House counselor Kellyanne Conway, who Trump has put in control of his opioid response, is quietly freezing out long-serving career staff and instead relying heavily on political aides, Politico's Brianna Ehley and Sarah Karlin-Smith report in a fascinating look at the recent upheaval and loss of influence inside the White House's Office of National Drug Control Policy. A former Trump administration stafefr told the two that ONDCP has been systematically excluded from key decisions and strategic planning for how the administration plans to address the opioid crisis.
Just look at the ONDCP's staffing situation -- the president hasn’t named a permanent director for the office, and the chief of staff was fired in December. "For months, the office’s top political appointee was a 24-year-old Trump campaign staffer with no relevant qualifications," Brianna and Sarah write. "Its senior leadership consists of a skeleton crew of three political appointees, down from nine a year ago....The office’s acting director, Rich Baum, who had served in the office for decades before Trump tapped him as the temporary leader, has not been invited to Conway’s opioid cabinet meetings."
"The upheaval in the drug policy office illustrates the Trump administration’s inconsistency in creating a real vision on the opioids crisis," they continue. "Trump declared a public health emergency at a televised White House event and talked frequently about the devastating human toll of overdoses and addiction. But critics say he hasn’t followed through with a consistent, comprehensive response."
OUCH: Nursing homes nationwide are still widely misusing antipsychotic drugs, a new report from the advocacy group Human Rights Watch has found. The group published a report yesterday that digs into government data showing there are about 179,000 people in nursing homes who are given antipsychotic medication every week without a proper diagnosis. The report also warns the nursing homes often give the residents the drugs without obtaining the proper consent from them or a family member.
There is some good news here: there's been a marked decrease in the percentage of nursing home residents being administered antipsychotic drugs. The rate dropped from 24 percent in late 2011 to less than 16 percent in 2017, the Associated Press reports, with decreases reported in all 50 states. But Hannah Flamm, the report’s lead author, told the AP the decline was not enough.
“Would you want to go into nursing home if there’s a one in six chance you’d be given a drug that robs you of your ability to communicate?” she asked. “It’s hard for me to applaud the reduction when it’s inexcusable to ever misuse these drugs.”
-- U.K. officials jumped to defend their National Health Service yesterday, after President Trump alleged that weekend protests against the country's public health-care system were because it is "going broke and not working."
The Democrats are pushing for Universal HealthCare while thousands of people are marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!— Donald J. Trump (@realDonaldTrump) February 5, 2018
Yet the rally Trump was referring to, which drew 60,000 people to central London on Saturday, was centered on demands for more money for the health-care system -- not efforts to dismantle it. While it's true that hospitals nationwide are struggling to cope with spikes in demand because of the horrible flu season, polls regularly show a strong majority of Britons are "satisfied" with their system.
The march was called “NHS in crisis: Fix it now” and was organized by the People’s Assembly and Health Campaigns Together, The Washington Post's Karla Adam writes from London. Demonstrators carried placards that read: “NHS: More staff, more beds, more funds” and “Saving lives costs money, Saving money costs lives.” "It’s hard to overstate just how proud Britons are of their health-care system," Karla writes. "In the lead-up to the Brexit vote in June 2016, the pro-Brexit side famously said that leaving the bloc would mean that an extra 350 million pounds ($467 million) a week could be repatriated and spent on health care."
U.K. officials weren't pleased with Trump's characterization of the protests:
Britain's secretary for health and social care:
I may disagree with claims made on that march but not ONE of them wants to live in a system where 28m people have no cover. NHS may have challenges but I’m proud to be from the country that invented universal coverage - where all get care no matter the size of their bank balance https://t.co/YJsKBAHsw7— Jeremy Hunt (@Jeremy_Hunt) February 5, 2018
Opposition and Labour Party leader:
Wrong. People were marching because we love our NHS and hate what the Tories are doing to it. Healthcare is a human right. https://t.co/Pmo2xYSqZh— Jeremy Corbyn (@jeremycorbyn) February 5, 2018
--Next week, Alex Azar will testify before Congress for the first time as secretary of Health and Human Services. The House Energy and Commerce health subcommittee announced Azar will appear on Feb. 15 to discuss Trump's upcoming budget proposal. The Health 202 predicts a hoard of reporters desperate for HHS intel will be awaiting him.
--The Public Health Service (PHS) has failed to provide thousands of its uniformed officers “special pay” designed to make those positions competitive with the private sector, Surgeon General Jerome Adams recently wrote to members of the uniformed corps, according to Post columnist Joe Davidson. Adams was vague on why the special pay was interrupted -- citing "a number of anticipated events" -- but said employees may not get fully paid for months while PHS transitions to a new payment system.
The officers -- who include physicians, dentists, pharmacists and veterinarians -- are upset, noting the new payment system had been years in the making. “I can tell you that some officers are decremented as much as $1,700 per month, an amount which is large enough to play havoc with even the most carefully crafted budget,” said Jim Currie, executive director of the Commissioned Officers Association of the U.S. Public Health Service.
--For all the apparent inaction on opioids at the White House, there are certainly lots of hearings on Capitol Hill these days on the crisis that kills more than 115 people per day. This afternoon, Vermont Gov. Phil Scott (R) and insurance officials from Aetna and Wellcare will testify before the House Ways and Means Health subcommittee in a hearing looking at how the Centers for Medicare and Medicaid Services can protect Medicare recipients from opioid abuse and addiction.
"While we have taken steps to reduce opioid abuse, such as passage of the Comprehensive Addiction and Recovery Act (CARA) last year, we have only begun to scratch the surface," health subcommittee Chairman Peter Roskam plans to say in remarks shared in advance with The Health 202. "With 10,000 baby boomers joining Medicare each day, we must harness innovation, technology and data to get ahead of this problem."
--A few more good reads from The Post and beyond:
- The Bipartisan Policy Center and America's Health Insurance Plans hold an event on employer-sponsored insurance.
- The House Ways and Means Subcommittee on Health holds a hearing on the opioid crisis.
- The Senate Veterans Affairs Committee holds a hearing on pending legislation on Wednesday.
- The Senate Health, Education, Labor and Pensions Committee holds an hearing on the opioid crisis on Thursday.
- George Mason University’s Law and Economics Center holds an event on generic drugmakers on Friday.
President Trump has started a trend: He cries "fake news" and the world follows:
Watch Stephen Colbert on Monday's stock market plunge:
Jimmy Kimmel gets a "visit from White House spokespuppet Kellyanne Conway:"