Buckle up, it's going to be a bumpy ride.
Congress is heading into its final week of action before the end of the year. Whether the entire government shuts down remains to be seen. The current continuing resolution—a stopgap that Congress uses to sustain government funding when lawmakers can't pass a more comprehensive budget—ends Dec. 22. Members of both chambers have been scrambling to assemble a short-term spending plan to keep the lights on until Jan. 19.
As usual, Defense Department appropriations are a major sticking point, but this year healthcare issues are front and center as well.
Steep divisions remain, not just along party lines but between the House and Senate. House conservatives support the defense bill and don't want extra spending provisions beyond the reauthorization of the Children's Health Insurance Program and federally qualified health centers. But the plan they've laid out to pay for CHIP and health centers is meeting stiff opposition from Democrats.
House Republicans want to fund the five-year CHIP reauthorization with money from the Affordable Care Act Prevention and Public Health Fund and higher Medicare Advantage premiums for wealthy people. This bitter fight over the so-called pay-fors has kept CHIP in limbo for months. Funding for Medicare programs that are crucial for rural hospitals and money to help battle the opioid crisis also hang in the balance. And, at deadline, it still wasn't clear what was going to happen with ACA cost-sharing reduction payments for insurers.
Rep. Frank Pallone (D-N.J.), the top Democrat on the Energy and Commerce Committee, which oversees health policy, said he is hopeful that the Senate can force the House's hand and shake loose some money for healthcare programs.
"Can the Senate send back a clean CR and lose some Republican votes and gain some Democrats? We won't know until we go through motions," said Rep. Tom Cole (R-Okla.), chairman of the House's health appropriations subcommittee.
As if that weren't enough, GOP leaders are eager to pass their massive tax overhaul bill quickly. Key healthcare issues—besides the likely repeal of the ACA's individual mandate—are in play, including:
• Ending the tax exemption for municipal private activity bonds, which are used by hospitals to finance capital projects.
• Ending tax breaks for higher education, including the tax exemption for tuition waivers for graduate medical students.
• Ending the corporate tax deduction for debt, used by companies like Tenet Healthcare Corp. and Community Health Systms.
• Imposing a new excise tax on compensation to not-for-profit executives exceeding $1 million.
• Imposing a new tax on endowments of universities and academic medical centers.