When it comes to healthcare, Congress has passed the point of governing by deadline. And so far this fiscal year, lawmakers have defaulted on their fiscal responsibility to programs that are vital to hospitals, providers, clinics and other segments of the industry.
With health policy now being driven by the sporadic schedule of controversial stopgap spending measures, GOP leaders in the Senate are pushing for a game change—ending the filibuster on appropriations bills.
Their talk is getting louder in the wake of the brief government shutdown over the weekend.
Healthcare policies in particular have been caught in the stranglehold of partisan politics and debate over spending. The months-long delay of extending the Children's Health Insurance Program became the symbol of congressional malfunction. As House and Senate leadership kept punting CHIP funding, states found themselves in perpetual turmoil.
"The best way to prevent all this from happening again is to break the pattern of one big spending bill with everything dependent on the one bill passing," said Sen. Roy Blunt (R-Mo.), chair of the HHS appropriations committee in the Senate.
Blunt conceded that the situation has exacerbated another problem—legislating through appropriations.
"It's a big mistake," he said. "I think that members, particularly those who are not appropriators, are totally left out of the system and don't have a say."
A six-year CHIP extension finally passed on Monday, along with a three-week stopgap measure to keep the government running. Yet community health centers and key Medicare programs that rural hospitals in particular depend on have lapsed and wait for funding either in another short-term spending bill, or an omnibus package that will take care of appropriations for the rest of the fiscal year. Medicaid-dependent hospitals are also waiting for another delay to payment cuts for disproportionate-share hospitals.
The deal is mostly done to fund these programs and delay DSH cuts, but negotiations belong to the leaders of both parties. It's up to them to give the green light, and until then everyone else is left in the dark.
The uncertainty hasn't helped anything besides the lobbying industry.
The CMS has gone ahead and processed cuts in Medicare reimbursements to hospitals.
When asked if he is frustrated by not knowing what will happen and what he tells hospital leaders back home, Sen. Richard Shelby (R-Ala.) told Modern Healthcare: "The uncertainty with [the hospitals]; it's not good."
"It's a problem," added Sen. Pat Roberts (R-Kan.). "It's a big problem."
The fact that Medicare payments are among the policies getting delayed exacerbates the political nature of the problem.
"Medicare reimbursement has always been a tough fight, no matter when it happens," he added.
GOP senators haven't been shy this week about pushing for an end to the filibuster of appropriations bills and they cite their frustration with the holdup of funding for CHIP and other programs as evidence for their argument. They want to reduce the procedural vote threshold to 51 so bills can go to the floor for debate.
Republican chatter to change the rules is "very serious," said Sen. Mike Rounds, a moderate Republican from South Dakota. "It's got to be fixed."
For the most part, bills move out of appropriations with consensus, said Sen. John Hoeven (R-N.D.), who sits on the appropriations committee.
"We've got to get back to regular order," he added.
Blunt, who sits on the GOP leadership team, conceded that talk is mounting to end the filibuster, but he stopped short of advocating for it himself.
"I think there are clearly 60 senators who would like to have these bills on the floor," he said, blaming Democratic leadership for the delay. But he said he is considering ways to move past the current logjam.
"I'm going to spend some time on it, and I hope we can create an environment where we can get that done," he said.
Sen. Jerry Moran (R-Kan.), another appropriator, said he completely supports ending the filibuster, but he wants a rules change with 60 votes that includes buy-in from the Democrats.
"Clearly, we have people who believe appropriations bills are leverage and this would alleviate that problem," Moran said.
Despite Moran's optimism about bipartisan buy-in, the push threatens to fuel further distrust between the two parties as Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Charles Schumer (D-N.Y.) try to broach a spending caps deal and immigration policy.
"Rather than threatening to change the Senate rules, we hope to reach a budget deal that's fair to both sides and would facilitate the smooth passage of all of the appropriations bills," a Senate Democratic aide said.