FY 2015 and FY 2016 Appropriations

Last Tuesday the President signed into law H.R. 83, the Consolidated and Further Continuing Appropriations Act for 2015 (Public Law 113.183), which sets up a skirmish early next year between the White House and the new Republican House and Senate majority over the President’s immigration policy carried out as directives included in Executive memoranda. In general, H.R. 83 would extend FY 2015 federal funding until September 30, 2015 for all federal agencies with the exception of the Department of Homeland Security. The $1.013 trillion in discretionary and non-discretionary spending under the so-called CRomnibus is consistent with the Ryan/Murray budget deal which has guided Congress in setting federal spending levels through this year. The funding for Homeland Security would extend only through February 27th which would give congressional Republicans the leverage they seek to defund or scale-back the President’s executive actions which allow certain undocumented immigrants to remain in the United States and become eligible for various benefits, such as Social Security and Medicare. While House Budget Committee Chairman Tom Price (R-GA) has indicated a desire to finish up the FY 2016 budget resolution in regular order, a fight with President Obama on the immigration issue could stretch out the early spring timeline for the start of the budget period. Whether the House and Senate Budget committees will agree to hard spending caps for FY 2016 defense and non-defense spending levels (e.g. $523 billion and $492.3 billion, respectively as set under the debt limit law) or decide to defer to the sequestration process will be determined largely by the new Republican leaders—House Majority Leader John Boehner (R-OH) and Senate Majority Leader Mitch McConnell (R-KY); Senate Budget Committee Chairman Mike Enzi (R-WY) and his House counterpart Rep. Tom Price (R-GA); House Appropriations Committee Chairman Hal Rogers (R-KY) and the yet-to-beelected Senate Appropriations Committee Chairman; House Ways and Means Chairman Paul Ryan (R-WI) and Senate Finance Committee Chairman Orrin Hatch (R-UT); among others. In any event, Republican leaders in both houses have indicated their intent to pass individual FY 2016 appropriations bills before the end of the current fiscal year in order to avoid a continuation of the last-minute omnibus approach.

Senate Votes to Confirm U.S. Surgeon General

Last Monday the Senate voted 51-43 to confirm President Obama’s nominee, Dr. Vivek Murthy, as the next Surgeon General. Dr. Murthy is the former president and co-founder of Doctors for America.

PPACA Open Season Extended for Some

The U.S. Department of Health and Human Services (HHS) reported that health care plan enrollment under HealthCare.gov amounted to almost 2.5 million individuals with three days to go before the November 15th end of the Patient Protection and Affordable Care Act (PPACA) open enrollment season . Individuals covered in 2014 who did not access the website for 2015 will be automatically re-enrolled in the same or similar plans unless they subsequently make new plan decisions, in which case the effective date would be February 1, 2015. The next report on enrollment is expected to be released on December 23rd. The agency projects total enrollment to climb to 9-10 million by the end of 2015. Thirty-seven states will use the federal exchange for enrollment of their residents in 2015 while individuals residing in the remaining states will rely on their own state-run exchanges for health coverage. California announced that it is extending its open enrollment season until December 21 for individuals who started applying before December 15 and New York has extended its period through December 20. The PPACA was also instrumental in expanding Medicaid and the Children’s Health Insurance Program (CHIP) enrollment to about 9.7 million individuals through October. The White House Council of Economic Advisers said that the expanding coverage base has resulted in reducing the percentage of the population remaining uninsured to 11.3%, the lowest ever recorded.

State Innovation Model Awards

The CMS Center for Medicare and Medicaid Innovation (CMMI) announced it has awarded more than $665 million in the second round of the PPACA’s State Innovation Model (SIM) program to 28 states and DC to design and test health care payment and service delivery models. The SIM initiative is intended to support states in planning and implementing a customized, fully developed proposal capable of creating statewide health transformation to improve health care.

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