A Budget to Nowhere

  

 

The good news is that the budget unveiled Monday by the Trump administration is dead on arrival. The two-year agreement reached by Congress last week makes this budget even less relevant than most presidential budgets, and more importantly the congressional spending deal funds a number of crucial health programs that were in danger of losing funds. The bad news is that the President’s budget seeks to normalize policy proposals that would either cripple or eliminate altogether a number of crucial federal programs that provide critical aid for nurses and their patients.

Nursing Workforce Development Programs covered under Title VIII of the Public Health Service Act would be particularly hard hit, with cuts of almost 65% at a time when nurses nationwide desperately need this funding to continue providing quality care. The budget slashes $145 billion overall, eliminating all but one program under Title VIII (the NURSE Corps Loan Repayment and Scholarship Program, which would be funded at $83 million). As a result of this drastic and misguided approach, the Nursing Community Coalition (of which ANA is a member) announced their strong opposition earlier today.

Even when the President’s budget takes one step forward by allocating new funds, it simultaneously takes two steps back, as with funding to combat the opioid crisis. While the budget proposal would allocate $13 billion, experts estimate that at least $32 billion is needed to address this lethal epidemic. This new funding would also come at the expense of the Centers for Disease Control and Prevention (CDC), which would lose $1 billion and suffer particularly deep cuts to programs aimed at reducing chronic disease, bolstering public health preparedness, and overseeing occupational safety and health.

Perhaps most alarmingly, the budget embraces the approach of the already-rejected Graham-Cassidy legislation to repeal and replace the Affordable Care Act. This approach would implement massive cuts to Medicaid and eliminate its state-based expansion (which 33 states to date have chosen to embrace). It would also end the subsidies that help a vast majority of Americans who obtained health coverage under the ACA-implemented marketplace pay for their premiums.

Rather than promoting a misguided and out-of-touch budget, ANA urges the administration to instead focus on more pressing priorities, including helping Congress reach an agreement on those affected by the Deferred Action for Childhood Arrivals (DACA) program, as well as efforts to stabilize the health insurance marketplace following the repeal of the individual mandate late last year. Too many of the ideas included in this budget have been rejected by bipartisan congressional majorities. Like those ideas, this budget should similarly be put aside.

Congress Passes Bipartisan Spending Measure with Funding for Critical Health Programs

  

Following a brief, overnight government shutdown, President Trump this morning signed a spending measure and continuing resolution which reopens the government and provides funding through March 23rd while setting broad spending levels through FY 2019. The measure provides roughly $500 billion in additional funding over the next two years, including roughly $140 billion in additional non-defense domestic spending, a similar increase in defense spending, and roughly $90 billion in federal relief funding for Puerto Rico, the U.S. Virgin Islands, Texas, and Florida, which were pummeled by devastating hurricanes last summer, and for those impacted by the California wildfires. The bill also waives the debt ceiling until March 1, 2019.

Crucially, the spending bill provides additional funding for some of the nation’s most important public health programs. It provides $7 billion in funding for the nation’s 2,600 community health centers, which provided care to 26.5 million Americans in 2016; this was a critical need and the $7 billion in this bill represents roughly 2 years of federal funding for the nation’s centers.

The spending measure also extends the Children’s Health Insurance Program (CHIP) for another 4 years, meaning that the program will now be fully funded at the federal level for 10 years. CHIP provides healthcare coverage for roughly nine million American children and is a critical provider of healthcare services. The measure also provides an additional $2 billion in funding to the Department of Veterans’ Affairs to better manage their health system and prevents automatic cuts to Medicare and Medicaid, while eliminating the Independent Payment Advisory Board (IPAB). The measure critically provides $6 billion in funding over the next two FYs to fight the opioid epidemic.

With a large portion of the nation’s fiscal policy taken care of, the House and Senate have now cleared their plates to work on a solution to the Deferred Action for Childhood Arrivals Program, better known as DACA. The Trump administration plans on ending the DACA Program on March 5th, giving Congress roughly four weeks to come up with a solution to shield hundreds of thousands of young immigrants from deportation. ANA supports the DACA program and urges the House and Senate to quickly come to an agreement to keep these young Americans in the country. The Senate has already taken up a measure this morning to begin debate on the fate of DACA; ANA will continue to monitor this important issue.

We applaud Congress for coming to a bipartisan, long-term spending deal which ensures that several of the nation’s most important healthcare programs receive long-term funding. CHIP, the nation’s community health centers, and the VA all provide critical healthcare access to some of the nation’s most vulnerable populations, and Congress should be commended for recognizing their importance.

ANA also applauds Congress for providing additional funding to areas hit hard by this summer’s devastating hurricanes and by the wildfires in California; the American Nurses Foundation teamed with the Texas Nurses Association in August to raise donations for victims, and numerous nurses went down to Texas, Florida, and the Caribbean to help out. The spending measure signed into law this morning, however, only provides funding for the government through March 23rd; until then, members of Congress will continue to work to hammer out appropriations for federal agencies and programs for the remainder of FY 2018 and FY 2019. We strongly urge you to make your voices heard and let your member of Congress know that funding for the nation’s healthcare programs is critical to the overall health of the nation.

Photo Credit: Tom Brenner/The New York Times

Trump, Congress can’t close deal as shutdown looms

  

 As the federal government appears headed toward its first shutdown since 2013, congressional leadership and Trump administration figures have engaged in an increasingly public back and forth over which side should be held most responsible for the high-stakes stalemate. Major sticking points remain around immigration, specifically Deferred Action for Childhood Arrivals (DACA), as well as the Children’s Health Insurance Program, which has now gone more than three months since its long-term funding expired (and after Congress kicked the can down the road before the holidays late last year).

While the House of Representatives was able to pass a short-term funding bill by a slim margin, Senate Democrats refuse to support any legislation that does not include long-term CHIP funding and a solution on DACA, which the President unilaterally decided to end last year, a move ANA condemned at the time.

While the House spending bill included a long-term funding solution for CHIP, it did not address DACA, and the President rejected a bipartisan immigration deal earlier this week. With 49 Democrats currently serving in the Senate, and any funding bill needing to enjoy filibuster-proof support of 60 votes, Democratic buy-in is necessary to keep the government open.

Additionally, while inclusion of long-term CHIP funding in the House bill is heartening to see, House Republican leaders have had ample opportunity to address CHIP long before this week. Moreover, due in part to the repeal of the individual mandate as part of last year’s tax reform legislation, the Congressional Budget Office (CBO) earlier this month revised its estimate of CHIP’s cost to the federal government and showed that it now stands at $800 million, down from $8.2 billion.

The President, largely via his Twitter feed, has repeatedly attempted to pin responsibility over a potential shutdown on congressional Democrats. Polling released Friday indicates he’s enjoying little success: 48% said they would blame the President and Republicans (who control every branch of government), with just 28% placing the blame on Democrats.

On Friday afternoon, Senate minority leader Chuck Schumer (D-NY) visited the White House to meet with President Trump, a meeting at which Speaker of the House Paul Ryan (R-WI) and Senate majority leader Mitch McConnell (R-KY) were not present. Following the meeting, Schumer indicated that progress was being made but that no agreement had yet been reached; nor was it clear what deal the President could reach with Schumer that would be acceptable to more conservative House Republicans, particularly those in the Freedom Caucus.

Regardless of the outcome, this episode is just the latest reminder for congressional leadership and the administration that a bipartisan, long-term budget is sorely needed, and that any such budget should include input from experts, including America’s nurses. Families who are affected by DACA or reliant on CHIP deserve better than what Washington has so far failed to deliver.