House Narrowly Passes Cromnibus, Advances Bill to Senate
On Thursday, the House narrowly passed a continuing resolution omnibus spending bill, or "cromnibus," to fund the federal government through September 2015, the New York Times reports (Parker/Pear, New York Times, 12/11).
The measure passed 219-206. According to Reuters, 67 Republicans voted against the bill, while 57 Democrats supported the measure. Although the House passed the measure before the Thursday deadline to avoid a government shutdown, the measure did not reach the Senate in time.
To address the delay, the House also passed a 48-hour stopgap spending measure to continue funding the federal government until a larger spending measure is passed by both chambers (Lawder/Cowan, Reuters, 12/12).
Cromnibus' Health Provisions
The bill contains various health provisions that eventually could affect hospitals, home health agencies and drugmakers. For example, one provision requests information from CMS about a requirement that home health agencies provide a face-to-face certification from a physician before CMS will cover home health care services for Medicare and Medicaid patients. Specifically, the measure would mandate that CMS explain in its 2016 budget proposal how the requirement has:
- Affected Medicare and Medicaid costs;
- Increased patients' access to health care services; and
- Prevented fraud.
In addition, the spending bill calls on CMS to:
- Present a plan for how the home health agency requirements can be streamlined;
- Provide within 90 days an analysis on how "rebasing" efforts are affecting home health agencies; and
- Provide within 90 days a report that examines how a proposed rule that would eliminate critical-access designation for hospitals within 10 miles of each other would affect access to health care providers in rural areas.
The cromnibus also includes provisions affecting the Health Resources and Services Administration and a CDC initiative to fund prescription drug overdose prevention programs (Demko, Modern Healthcare, 12/10).
Meanwhile, the spending bill contains measures that target various provisions of the Affordable Care Act. Specifically, the cromnibus would prohibit CMS from providing new government funds to health insurers to subsidize potential revenue losses under the ACA's so-called risk corridor provision. However, the provision would continue to allow the federal government to collect payments from insurers whose revenues are higher than expected, which it might then give to companies with losses (Viebeck , The Hill, 12/10). Further, another cromnibus provision would cut the ACA's Independent Payment Advisory Board's budget by $10 million (Viebeck , The Hill, 12/10).
In addition, the bill provides funding for U.S. efforts to combat Ebola and other health initiatives. Specifically, the bill includes:
- $5.4 billion of President Obama's $6.2 billion funding request for U.S. Ebola efforts;
- Just under $30.1 billion for NIH, in part for Ebola research and clinical trials (Rogers, Politico, 12/10);
- $49 billion in foreign aid funds, including about $6 billion to help global HIV/AIDS initiatives;
- $10 billion for housing programs, including those that help the elderly and disabled;
- $21 billion to child nutrition and school lunch programs;
- An exemption for schools from a federal nutrition requirement that the grain products they serve be mostly whole-grain foods if the schools can prove financial or other hardships in purchasing such products (Jalonick, AP/San Francisco Chronicle, 12/10).; and
- A provision that would continue to prohibit federal funds from being used for abortion, except in cases of rape or incest or when a woman's life is in danger (Hughes, "Washington Wire," Wall Street Journal, 12/10).
Cromnibus Heads to Senate
The bill now heads to the Senate for consideration. Senate Majority Leader Harry Reid (D-Nev.) said he hopes the measure will pass on Friday. However, Reid noted the possibility that a vote will not be held until the weekend.
According to the AP/Miami Herald, the cromnibus could face some resistance in the Senate, despite overall White House support for the measure (Taylor, AP/Miami Herald, 12/12).
Cromnibus Could Impede IRS' ACA Enforcement
In related news, budget cuts included in the cromnibus could impede the Internal Revenue Services' ability to enforce some portions of the ACA, The Hill reports.
The spending bill would cut IRS' budget by $350 million. According to The Hill, the IRS is responsible for determining whether U.S. residents are eligible for subsidies to help purchase coverage through the ACA's exchanges, as well as administering financial penalties to individuals and employers who do not comply with the law's individual and employer mandates.
IRS Commissioner John Koskinen has said that 2015 could be the most difficult tax-filing season to date, noting that the ACA provisions are "perhaps our most intense challenge." During a House Ways and Means Committee hearing in September, Koskinen testified that he was "deeply concerned about the ability of the IRS to continue to fulfill its mission if the agency lacks adequate funding" (Ferris, The Hill, 12/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.