Congressional lawmakers remain divided over how to extend federal funding for key health safety net programs, such as the Children’s Health Insurance Program (CHIP), community health centers and disproportionate share hospital (DSH) payments, nearly three months after program funding expired on September 30, 2017.
Since funding lapsed, Democrats and Republicans in Congress have struggled to reach a consensus over the budgetary offsets required to continue supporting these programs. Lawmakers also face a crowded legislative calendar through the end of the year, including consideration of a tax overhaul package and a must-pass Fiscal Year (FY) 2018 funding bill needed to avoid a government shutdown, among other items.
On December 13, the U.S. House of Representatives introduced a proposal to attach health program reauthorizations to a continuing resolution (CR) (H.J. Res. 124) to fund the federal government from December 22, 2017 to January 19, 2018 – a proposal that comes on the heels of a two-week CR passed on December 7. If enacted, the upcoming CR would extend CHIP for five years, from FY 2018 through FY 2022, and fund community health centers for two years. In addition, the bill would delay for two years scheduled cuts to DSH payments, which support county hospitals treating disproportionately large shares of Medicaid patients, as well as individuals unable to pay their medical bills.
It remains uncertain, however, whether the CR can gain the support needed for passage. To offset the cost of reauthorizing CHIP and community health centers, the bill proposes a $6.35 billion cut in future appropriations to the Prevention and Public Health Fund (PPHF) – an offset opposed by Democrats. Bipartisan support for the spending package will be necessary, however, since appropriations bills require at least 60 votes in the U.S. Senate; Republicans currently hold a 52-seat majority in the U.S. Senate, and will require the support of at least eight Democrats.
NACo supports congressional efforts to extend CHIP, fund community health centers, and delay scheduled cuts to DSH payments and other health safety net programs, but remains concerned about efforts to cut federal funding for the PPHF. The fund provides approximately $900 million annually to support local and state public health and prevention efforts, and this federal funding source is crucial to the nation’s 2,800 local public health departments, two-thirds of which are county-based. Cuts to the PPHF would harm already-strained county public health departments and inhibit their ability to implement activities that keep their residents healthy and safe. On December 20, NACo, along with the National League of Cities and U.S. Conference of Mayors, wrote a letter to Congress urging lawmakers to extend these critical health care programs without offsets to the PPHF.
NACo will continue engaging with our federal partners to ensure county interests are represented in FY 2018 appropriations bills.
Please see the following NACo resources on health safety net programs important to counties: