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Steady Funding for Health Care Law in Senate Labor-HHS Bill

By Emily Ethridge and Kerry Young, CQ Roll Call

July 25, 2014 -- Senate appropriators would provide steady funding in a draft spending bill for the 2010 health care law and a public health fund, both prime GOP targets and priorities of outgoing subcommittee chairman Tom Harkin.

Harkin, chairman of the Senate Appropriations Subcommittee on Labor, Health and Human Services (HHS), and Education, included the prevention and public health fund in the law (PL 111-148, PL 111-152) and has fought to defend its funding against repeated GOP attacks. 

The Iowa Democrat is retiring after this year, and the draft of his fiscal 2015 Labor-HHS-Education bill would provide $156.8 billion overall and fund several of his favorite programs. The Appropriations Committee has released a draft fiscal 2015 bill text and a report, more than a month after the subcommittee approved the measure by voice vote. 

With the appropriations process slowing, it looks likely that lawmakers will negotiate an omnibus or short-term continuing resolution to move into fiscal 2015—and the draft bill language could lay a placeholder for future conference negotiations. The House has yet to unveil a draft of its fiscal 2015 Labor-HHS-Education bill.

In the Senate bill, the Centers for Medicare and Medicaid Services (CMS), which oversees the health insurance exchanges, would receive $3 billion for program operations. The committee summary says the bill would provide funding equal to fiscal 2014 levels to implement the health care law. 

But with that steady funding comes more demands for transparency and information sharing. The lawmakers noted that the CMS has failed to promptly notify Congress about important issues such as exchange enrollment figures and innovation grants awarded under the law. In some cases, the CMS has notified other organizations before telling the committee—or without telling the committee at all, they said. 

The bill would direct the CMS to notify the committee no less than one business day before data and grant opportunities related to the law are released. It also would require the CMS to provide information on the cost of several parts of the law, including marketplace IT, consumer information and outreach, navigator grants, and the small business health insurance exchange—along with estimated costs for fiscal 2016.  

The Prevention and Public Health Fund would have $927 million for fiscal 2015, after accounting for cuts under sequestration. Of that, $887 million will go to the Centers for Disease Control and Prevention (CDC), including $121 million for tobacco prevention activities, $160.3 million for the National Center for Immunization and Respiratory Diseases, and $104 million for cancer prevention and control. 

Overall, the CDC would get $7.1 billion under the Senate bill, which is more than the president's request of $6.7 billion and its fiscal 2014 funding of $6.9 billion. 

Another relative winner is the National Institutes of Health (NIH), which would receive $30.5 billion under the proposal, an increase of $605.7 million. According to the report, that bump, along with an increase provided for fiscal 2014, would bring the NIH's budget back to roughly what appropriators intended to provide in fiscal 2013 before the sequester kicked in.

But they also noted that the NIH's budget is lagging the rate of growth of the costs of health research.

Just keeping up with the reported biomedical inflation rate would have put the NIH appropriation at $37 billion for fiscal 2013, instead of the $28.9 billion that was enacted, the appropriators said in their report. This amounts to a loss of $8.1 billion in their estimation.

"Due to the impact of inflation, restraining growth in the discretionary spending caps is tantamount to a cut," the report said.

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