New budget battle erupts

Congress worked itself into a déjà vu budget stalemate with the healthcare reform law at the heart of it. Policy experts, though, said Washington's current fiscal fights won't have a significant impact on the healthcare industry this year. Still, they worry about the long-term effects of those financial policy decisions.

The latest budget battle centers on how congressional lawmakers—just back from their five-week summer recess—will agree to fund federal government operations when the federal fiscal year ends after Sept. 30. House GOP lawmakers, still wedded to the idea of dismantling the Patient Protection and Affordable Care Act, view the spending bill showdown with the Senate and the White House as a last-ditch opportunity to defund or delay key provisions of the law before open enrollment on the public insurance exchanges begins Oct. 1, the same day the government will shut down unless policymakers craft a temporary funding measure.

House Republicans had planned to vote last week on legislation that tied a $986 billion spending bill to fund the government through Dec. 15 with a separate measure that would defund implementation of the Affordable Care Act. But more conservative factions within the House GOP conference are making that a tough sell. House GOP leaders delayed the vote, now expected this week.

White House spokesman Jay Carney said the administration would reject any “politically motivated rider” that undermines President Barack Obama's signature domestic policy legislation and indicated such a move would lead to a government shutdown.

A corps of House Republicans who have promised voters they would repeal the Affordable Care Act see the spending showdown as their last chance before open enrollment begins Oct. 1. The way they see it, there's no going back after that, said Thomas Miller, resident fellow at the American Enterprise Institute, a right-of-center think tank. “If the dollars can flow out of the Treasury to some people who are happy with it, it's another marker even beyond the Supreme Court decision where this is coming in place,” Miller said.

Paul Van de Water, a senior fellow at the left-leaning Center on Budget and Policy Priorities, said he thinks “it's quite likely” Republican House members will reach an agreement on a spending resolution that includes an effort to undermine the Affordable Care Act, even though they don't want to be responsible for a government shutdown.

“At issue is what form that will take and how difficult the House will make it for the Senate to strip it out of the basic measure,” Van de Water said.

If lawmakers can't reach agreement by Sept. 30 and government operations come to a halt, it's unclear what that means for mandatory spending on programs such as Medicare.

An August report from the Congressional Research Service noted that programs funded by laws other than annual appropriations—such as entitlement programs—“may or may not be affected by a funding gap.” Even though funds may be available automatically because of permanent appropriations, those payments may be processed by employees whose salaries are provided by funding in appropriations bills.

Amid all of these funding woes for providers is sequestration, which kicked in this year. The continuing resolution put forward last week would hold funding for government programs at the current, post-sequestration annual rate. Ilisa Halpern Paul, managing government relations director at Drinker, Biddle & Reath, expressed concern about the future effects of sequestration on the healthcare industry.

“Sequestration is a bit like a slow drip or leak—you don't really notice until the cumulative negative effect of having the ceiling caving in from water damage or the tire going flat,” Halpern Paul said in an e-mail.

A panel of experts has settled on a set of recommendations on paying for long-term care. A 15-member congressionally mandated commission was established following Congress' repeal of the landmark Community Living Assistance and Supports Act (or CLASS) section of the healthcare law, which would have established a voluntary long-term care benefit for Americans financed by workers' payroll contributions.

Among the recommendations the panel intends to relay to Congress in a final report due Sept. 30 is an end to the three-day hospital stay requirement for Medicare coverage in a skilled-nursing facility. The commission also determined there should be a “sustainable balance” of private and public financing for long-term services and supports that allows individuals with functional limitations to remain in the workforce.

The members voted 9-6 on the blueprint, and the commission's chairman, Dr. Bruce Chernof, said in a news release that he hoped the panel's work “dispels the myth that our nation's long-term care crisis is just too hard a problem to tackle.”

Five commissioners, though, released a set of alternative ideas because, they said, the “unusually compressed timeframe” did not allow a broad range of views. Chief among those recommendations is a public social insurance program.

Follow Jessica Zigmond on Twitter: @MHjzigmond