Senate eyes changes to the House stopgap health package

The sizeable healthcare package unveiled Monday night by House GOP leaders may get a face lift in the Senate.

The House assembled a packet of legislation that includes two-year funding of the community health centers, a two-year delay of the payment cuts to Medicaid disproportionate share hospitals, and two-year funding extensions for Medicare programs rural hospitals in particular depend on. The CHRONIC Care Act, which would, among other things, expand telemedicine and adapt Medicare Advantage plans for chronically ill enrollees, is also included.

But all the programs came at a cost House Democrats don't like, most notably a $5 million chunk out of the Affordable Care Act's Prevention and Public Health Fund.

Once the stopgap bill heads out of the House—likely on a party-line vote—the Senate may switch it out for a bipartisan deal negotiated in the Senate Finance Committee, according to Senate aides.

Details of the Senate package aren't yet finalized or public. But an additional four years of funding for the Children's Health Insurance Program remains on the table. According to the Congressional Budget Office, a full 10-year extensions of CHIP funding would save the government about $6 billion. The reauthorization approved last month as part of a spending bill extended CHIP for six years.

Senate leaders are also closing in on a spending caps deal that would pave the way toward an overall omnibus budget bill that insurers hope would include a reinsurance provision for the individual market. It would also lead into a disaster aid supplemental that has stalled in the Senate with, among other issues for disaster-stricken states and territories, Medicaid funding for Puerto Rico.

"Maybe we'll have something tomorrow," Sen. Richard Shelby (R-Ala.) said Tuesday afternoon following the GOP conference lunches. "We're close, we're close."

Senate Majority Leader Mitch McConnell (R-Ky.) shot down the idea that the government could be hurtling toward another shutdown should he and Senate Minority Leader Charles Schumer (D-N.Y.) fail to come to an agreement.

"A government shutdown won't happen," McConnell told reporters Tuesday. "We are on our way to an agreement."

Several GOP senators said after leaving the meeting that they expect an overall agreement shortly.

But President Donald Trump's insistence that Congress address immigration throws a wild card into the dynamics.

"If we don't change it, let's have a shutdown. We'll do a shutdown and it's worth it for our country," said Tuesday afternoon in a roundtable meeting with law enforcement officials. "I'd love to see a shutdown if we don't get this stuff taken care of."

Schedule-wise, the House budget deal poses its own complications for the week: House Speaker Paul Ryan (R-Wisc.) included a full-year of defense spending along with the health package as a sweetener. This sets up a ping-pong match as the Senate is expected to strip out the defense-only funding and potentially swap in its parallel healthcare package among other things.

The clock ticks toward the Thursday budget deadline while the Senate amends and passes the measure the House is expected to pass tonight.