Health-care fights could complicate 2018 funding deal

Health-care fights could complicate 2018 funding deal
© Greg Nash

A host of health-care issues could complicate a deal to fund the government in what will be a hectic January for Congress.

Lawmakers agreed to a short-term continuing resolution that funds the government through Jan. 19. When they return, they will face a number of dicey issues with two weeks to reach a new full-year funding deal.


Among the big issues are finding a path to long-term funding for the Children's Health Insurance Program and community health centers, a priority for Democrats. In the Senate, Republicans plan to take up two bills to help shore up ObamaCare insurance markets. But that will be a hard sell in the House, where conservatives oppose those measures.

Here are the biggest potential health-care related obstacles to securing a government funding deal.


ObamaCare bills

Republican Sens. Susan CollinsSusan Margaret CollinsDemocrats search for 51st net neutrality vote Overnight Tech: States sue FCC over net neutrality repeal | Senate Dems reach 50 votes on measure to override repeal | Dems press Apple on phone slowdowns, kids' health | New Android malware found Overnight Regulation: Dems claim 50 votes in Senate to block net neutrality repeal | Consumer bureau takes first step to revising payday lending rule | Trump wants to loosen rules on bank loans | Pentagon, FDA to speed up military drug approvals MORE (Maine) and Lamar AlexanderAndrew (Lamar) Lamar AlexanderWeek ahead: Lawmakers near deal on children's health funding Ryan suggests room for bipartisanship on ObamaCare Time to end fiscal year foolishness MORE (Tenn.) are pushing for a vote in the new year on two bills aimed at shoring up ObamaCare insurance markets following the repeal of the law's mandate that people have health insurance or pay a fine.

One bill would fund ObamaCare’s cost-sharing reduction payments for insurers, and another would provide “reinsurance” money to pay for the costs of sick enrollees and bring down premiums.

Collins sought to tie the measures to the late December continuing resolution and was promised a vote on the bills from Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellSessions: 'We should be like Canada' in how we take in immigrants NSA spying program overcomes key Senate hurdle Overnight Finance: Lawmakers see shutdown odds rising | Trump calls for looser rules for bank loans | Consumer bureau moves to revise payday lending rule | Trump warns China on trade deficit MORE (R-Ky.).

But both House conservatives and Senate Democrats objected to including the bills in the year-end spending package, forcing leaders to push them to 2018.

House conservatives strongly oppose the insurer payments and say they have little interest in funding a "bailout" for a law they still want to repeal entirely.

Complicating matters, anti-abortion rights groups and conservatives want the bills to include Hyde Amendment language, which prohibits the use of federal funds for abortions. That could make the ObamaCare bills nonstarters for Democrats. Democrats could insist on other provisions in the spending deal in exchange for backing the ObamaCare bills.

“I think the administration made a commitment to Susan Collins. And so, how we can help with that commitment becomes the fundamental question, but right now, there's a lot of work that needs to be done,” said House Freedom Caucus Chairman Mark MeadowsMark Randall MeadowsFreedom Caucus chair: GOP leaders don't have votes to avoid shutdown GOP leaders pitch children's health funding in plan to avert shutdown House to consider another short-term spending bill MORE (R-N.C.).


Puerto Rico Medicaid funding

Lawmakers must also address a deepening Medicaid funding crisis for Puerto Rico.

Nearly half of the island’s residents are on Medicaid, and because it’s a territory, the island receives less money in matching federal funds than states. Neither the stopgap spending bill nor the disaster aid package passed by the House, however, contain any extra funds to help the island’s poor and disabled residents.

Democrats and Republicans were reportedly close to including at least some extra Medicaid funding in the House disaster bill, but the deal fell apart.

The Senate stalled on disaster aid though, leaving advocates hoping Democrats can get Medicaid funds in the package when the bill is taken up in 2018.

Medicaid programs in Puerto Rico were slated to run out of money in early 2018 without more funds from Congress, but Hurricane Maria, which battered the island, has only worsened the already dire situation.

Puerto Rican Gov. Ricardo Roselló has requested $1.6 billion a year over the next five years to deal with the Medicaid funding cliff, but it’s not clear how much of that request Congress will meet.


Children’s health insurance

The stopgap spending bill lawmakers passed before leaving Washington for the holidays provided $2.85 billion for the Children's Health Insurance Program (CHIP) and $550 million for community health centers through March 31, but a long-term bipartisan deal remains elusive.

Democrats and Republicans are divided over how to pay for the program. A five-year extension of CHIP would cost about $8 billion.

The House passed a five-year extension of CHIP, but Democrats objected to using funds from ObamaCare's prevention and public health fund.

A bill that cleared the Senate Finance Committee does not detail how the program would be funded and was never taken up by the full chamber.

Democrats have pushed for a bipartisan deal on funding and questioned why children's health-care funds need to be offset. Intensifying the fight was the Republicans' massive tax overhaul package, which is projected to add to the deficit.

Congress let funding for the program expire at the end of September. Since then states have been running low on funds and are pressing lawmakers to act quickly.


ObamaCare taxes

There’s been bipartisan support for delaying certain ObamaCare taxes, but the talks hit a snag at the end of the year. Adding a measure to delay those to an omnibus spending bill could spark a new fight.

Democrats have been pushing to delay the “Cadillac tax” on high-cost insurance plans. The tax is despised by unions, but Republicans have resisted including it in a package. The tax is already delayed until 2020, but critics want it delayed even further.

Democrats are wary that Republicans will use it as a bargaining chip to seek concessions on limiting the exemption for employer-sponsored health insurance from taxes.

There is more bipartisan support for delaying two other taxes on medical devices and health insurance. But with the parties at odds over the Cadillac tax, those delays are also being stalled. 

The health insurance tax and the device tax both kick in next year.