Congress enacted and the president signed into law two “minibus” appropriations packages: 1) the Energy and Water, Legislative Branch, and Military Construction and Veterans Affairs Appropriations Act; and 2) the Defense and Labor, Health and Human Services, Education Act. The Defense and Labor-HHS package also included a continuing resolution to keep all of the other federal agencies funded at existing levels through December 7. The House also cleared conference reports for the opioid bill and the Federal Aviation Administration Reauthorization bill. The House also approved several tax measures, as well as the Empowering Students Through Enhanced Financial Counseling Act, the Ensuring Small Scale LNG Certainty and Access Act, and the Community Safety and Security Act.
Rare Feat: Congress Approves Major Appropriations Bills Before End of the Fiscal Year
For the first time in more than 20 years, Congress enacted into law the annual Labor-Health and Human Services-Education Act prior to the end of the fiscal year (September 30). For the first time in more than 10 years, it also enacted the Defense Appropriations Act prior to September 30. Weighing in at a price tag of $854 billion, these two bills together account for more than 60 percent of the federal discretionary budget.
Given the extreme partisanship surrounding the U.S. Supreme Court confirmation hearings for Judge Brett Kavanaugh, the president’s domestic and foreign policies, and the upcoming mid-term congressional elections, the enactment of these two appropriations “minibus” packages is a remarkable feat.
How was this possible given the toxic environment in which it was accomplished?
First, Congress set the stage last February for a less difficult appropriations process when it enacted the Bipartisan Budget Agreement of 2018. This agreement set overall spending levels for fiscal years 2018 and 2019 for defense spending and non-defense discretionary spending. Usually differences between political parties on overall spending levels create the gridlock that in the past has significantly delayed action on the appropriations bills and has brought the process to the brink of a government shutdown.
Second, spending and deficits appear to be less important political factors going into the mid-term elections. With few exceptions, most Republicans did not object to increases for spending on popular Democratic priorities, while Democrats were willing to accept large increases in defense spending. Marrying the Defense bill (favored mostly by Republicans) with the Labor-HHS bill (favored mostly by Democrats) resulted in a bipartisan package that could be approved by majorities in both the House and Senate.
Notably, seven of the 12 appropriations bills must still be enacted by Congress, and they won’t even be considered by Congress until after the November elections. The president has threatened to veto the remaining bills unless Congress funds his southern border wall proposal, a debate that will play out in the Homeland Security Appropriations bill. Despite its remarkable accomplishment in clearing two major appropriations packages, Congress still has a great deal of work to do on the FY19 budget, and a partial government shutdown in December is still a possibility.
No Action on Commerce-Justice-Science bill, but National Science Foundation funded through December 7
While Congress demonstrated considerable bipartisan progress on the two minibus packages, it failed to make any progress on the FY19 Commerce-Justice-Science (CJS) Appropriations Act, which includes the fiscal year 2019 funding for the National Science Foundation (NSF). However, the programs included in this bill, including NSF, will be funded at FY18 levels until December 7, due to the inclusion of a “continuing resolution” on the Defense/Labor-HHS Appropriations package. If Congress does not approve the CJS bill after it returns from the mid-term elections and before December 7, it must pass another continuing resolution or risk a shutdown of NSF’s programs.
Comprehensive Opioid Crisis Bill Includes Behavioral Science Provisions
The opioid addiction crisis that has gripped the U.S. for the past few years is largely a behavioral health crisis, involving not just the behavior of those addicted, but also the behavior of physicians, hospitals and health systems who prescribe opioids for pain management.
It should come as no surprise that the comprehensive opioid legislative package recently cleared by Congress includes several provisions addressing the behavioral aspects of the crisis. The “SUPPORT for Patients and Communities Act” includes a provision that modifies the Children’s Health Insurance Program to explicitly state that the program covers mental health and substance use disorder services, beginning a year after enactment. It defines mental health coverage as services — including behavioral health treatment — necessary to prevent, diagnose and treat mental health symptoms and disorders, including substance use disorders. The care must be delivered in a culturally and linguistically appropriate manner.
The bill also authorizes the Centers for Medicare and Medicaid Services (CMS) to provide incentive payments to behavioral health providers to encourage them to adopt and use certified electronic health records. CMS has been pushing for universal use of electronic health records to facilitate the transfer of medical records between health care providers. Access to information from previous care providers can alert health professionals to risky behaviors.
Furthermore, the bill includes provisions intended to change Medicare beneficiary behavior by alerting patients to the potential dangers of opioid addictions and making it less likely that they can “pharmacy shop” to feed an existing addiction. The bill also seeks to prevent addiction by changing the behavior of health providers through education regarding opioid risks and by incentivizing the use of health care records to alert providers to at-risk patients. It requires investigations into whether the drug programs provided under Medicare provide an incentive for health care providers to prescribe opioids rather than other treatments.
The policies included in the opioid bill are driven largely by years of research in both biomedical and behavioral science, and reflect the importance of utilizing convergent, inter-disciplinary research to frame policy debates. This bipartisan legislation is expected to be signed into law in the coming days.
In the News…
As Trolls Trash Twitter CEO @Jack, Social Science Explains Why People Are So Mean Online | Forbes, September 17
Fewer people are answering a U.S. agency’s citizenship query. That’s fueling fears for the 2020 census | Science, Jeff Mervis, September 10
National Public Radio (The Hidden Brain), September 24
Upcoming Hearings and Briefings
“Election Aftermath: Winners, Losers, and What It All Means”
10-11 a.m November 14
Third Way, 1025 Connecticut Avenue, NW, Suite 400
Late Night Quotable
“Canadians are now eligible to compete on ‘Survivor.’ Which will be great until they all politely vote themselves off.”
Jimmy Fallon, September 28
“Did you know that today is Google’s 20th anniversary? It’s true —Google it. Traditional gift for a 20th anniversary is china. Unfortunately, Google is banned in China, so we can’t do that.”
Jimmy Kimmel, September 27
“Scientists developed a robotic skin that can make stuffed animals appear to come to life. It’s being hailed as a ‘breakthrough’ for people who like to scare small children.”
Conan O’Brien, September 25
“The Texas Board of Education has voted to remove a lot of famous Americans from their curriculum, including Hillary Clinton, Helen Keller, Eleanor Roosevelt, feminist Betty Friedan, and the father of modern conservativism, Barry Goldwater. Great, now kids will have to learn about Barry Goldwater like I did — in the streets, passing around dog-eared old copies of the National Review they found buried in the woods.”
Stephen Colbert, September 21