Senators overcame last-minute political bickering to pass a $90 billion HHS appropriations bill, the first in 11 years.
Thursday's passage of the "mini-bus" moved fiscal 2019 spending for the departments of Labor, HHS, Education and Defense as part of the Senate's summer haul toward restoring regular order when it comes to funding the federal government. Along the way, leadership from both parties sacrificed key healthcare priorities that temporarily threatened to stall the entire vehicle.
Two amendments caused the snafu: a resolution to defend the Affordable Care Act's protections for pre-existing conditions and a measure to block federal money from Planned Parenthood.
Sen. Joe Manchin (D-W.Va.) pushed an amendment that would have authorized the Senate counsel to intervene in a lawsuit by 20 GOP states attorneys general aiming to overturn the Affordable Care Act. A vocally anti-Obamacare judge will hear oral arguments in early September and the Trump administration has sided with states. The Justice Department filed a brief in June explicitly asking the U.S. District Court in north Texas to topple the ACA's popular consumer protections, including guaranteed coverage for people with pre-existing conditions.
The case is being largely ignored by congressional Republicans, but red state Democrats in tight races are using it as a cudgel. Manchin is up for re-election against a challenge by his state's GOP attorney general, who is listed as a plaintiff in the lawsuit.
It is unclear whether the amendment would have carried much weight. Law professor and ACA expert Tim Jost noted that it authorized rather than directed the Senate counsel to intervene—although he added that the House Republican lawsuit against the Obama administration over cost-sharing reduction payments also started with a resolution that used the same language.
Senate Appropriations Chair Richard Shelby (R-Ala.) warned reporters after he stepped out of the Republican caucus lunch on Thursday afternoon that negotiations over the amendment threatened to delay the vote. He told Modern Healthcare that lawmakers have "voted on pre-existing conditions many times," adding the protection is popular.
"We've got to figure that out: It's part of Obamacare, but a lot of us have advocated for it. There's a cost to it, but also a social need for it," he said.
Manchin sent out a news release Thursday afternoon announcing that the Senate would vote on his resolution, while Sen. Rand Paul (R-Ky.) told reporters leadership had decided to block his amendment to defund Planned Parenthood.
"Republicans are going to block it," Paul told Modern Healthcare as he headed to the Senate chamber. "I'm going to go to the floor now to talk a little bit about how upset I am that Republicans are going to block it."
Ultimately GOP leadership put the Planned Parenthood measure on the floor and blocked Manchin's amendment. But leaders essentially guaranteed Paul's amendment would fail by requiring 60 votes for passage rather than a simple majority. Three Democratic senators were absent from Washington and would have missed the vote.
Manchin blasted the developments as "disgusting."
"Once again, Mitch McConnell is letting politics determine the work of the Senate by refusing to allow the Senate to vote on my common-sense amendment to protect healthcare access for those with pre-existing conditions," Manchin said of the GOP Senate majority leader's decision. "We had a bipartisan agreement to vote, but yet again Mitch McConnell chose to play politics with the healthcare of millions of Americans, 1.8 million of them in his home state of Kentucky."
One underdog amendment did make it into the mini-bus: a measure by Sens. Chuck Grassley (R-Iowa) and Dick Durbin (D-Ill.) to authorize HHS Secretary Alex Azar to require drug manufacturers to include their prices in direct-to-consumer advertising.
Grassley mounted a strong push for the measure this week over Twitter and on the Senate floor.
"Now the drug companies want you to know that there's a drug out there to help you," Grassley said in a Thursday floor speech. "They want you to know the benefits of the drugs, so why don't they also want you to know about the price of the drug? That is simply, by not having that information out there, it's simply not a transparent way of doing business."
The House and Senate will have to go to conference to agree on a final appropriations bill to send to the president's desk.
