Congress returns this week with little time to pass annual spending bills that fund agencies including the Health and Human Services Department — but a new fight over migrant voting threatens to derail those efforts.
Lawmakers are supposed to pass 12 appropriations bills before the start of each new fiscal year Oct. 1. When lawmakers left town at the end of the July, the House had passed just five, despite Speaker Mike Johnson's (R-La.) pledge to pass them all. The Senate had passed none. Congress hasn't managed to pass its spending bills in the regular manner since 1996, and generally resorts to some sort of stopgap measure known as a continuing resolution, often with short-term extensions of expiring health spending policies.
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The stage is set for another such move this year.
Parts of HHS funded by the annual discretionary budget, including administrative functions, much of the Health Resources and Services Administration, parts of the Food and Drug Administration and a number of other divisions are at stake, as these agencies would severely curtail activities in the event of a government shutdown. But other parts of HHS, like the Centers for Medicare and Medicaid Services, are mostly funded under mandatory spending laws and would be largely unaffected.
Lawmakers have also said they would like to pass a raft of healthcare measures in the lameduck session of Congress, including bills on pharmacy benefit managers, transparency, prior authorization, privacy, hospital pay, and more. Adding these priorities into a budget battle that stretches beyond the presidential election could complicate matters.
The upcoming presidential election is already adding heat to the spending debate. GOP nominee and former President Donald Trump has called for a measure that would crack down on non-citizens voting in federal elections as part of an appropriations package, even though it is already illegal. Johnson decided to heed that call by adding the Safeguard American Voter Eligibility Act to a House package.
Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Appropriations Committee Chair Patty Murray (D-Wash.) said pushing the SAVE Act increases the odds of a government shutdown, "and Americans will know that the responsibility of a shutdown will be on the House Republicans’ hands.”
Republicans have publicly expressed confidence that looming impasses will be worked out, the government won't be shut down, and key priorities will pass.
Further complicating the budget battle, conservative Republicans hoping for a Trump victory have been pushing for a continuing resolution that lasts until March to allow a new administration to shape spending. Democrats and some Republicans have spoken out against such a long stopgap, and would like a bill that lasts into December.
Many lawmakers assumed there would be a short-term continuing resolution, and a full-year spending bill passed after the election would be an opportunity to include numerous bipartisan healthcare priorities.
Among those are bills to ramp up restrictions on pharmacy benefit managers, increase transparency in various healthcare sectors, regulate artificial intelligence and cybersecurity, address concerns with the 340B drug discount program, curtail prior authorizations, and enact site-neutral payments for certain outpatient services.
But in the multiple stopgaps that Congress passed for this year's spending, attempts to add popular, bipartisan health measures failed.
However Congress works out the immediate budget showdown, there are also other important funding questions that need to be solved by the end of the year. Congress previously extended several key healthcare spending programs through the end of 2024, including funding for community health centers and extending pandemic-era rules that allowed telehealth and hospital-at-home care. Congress must also decide whether to forestall some $8 billion in cuts to safety net hospitals that serve a disproportionate share of people who can't pay, and whether it will ease cuts to physician pay in Medicare.
