Earlier today the Senate voted 78-17 in Executive Session to confirm the nomination of Ms. Sylvia Mathews Burwell to be the new Secretary of The Department of Health and Human Services (HHS). Ms. Burwell was most recently the head of President Obama’s Office of Management and Budget before being nominated for her new role. Ms. Burwell takes the helm of HSS from the former Secretary Kathleen Sebelius. A native of Hinton, West Virginia—a town of roughly 3,000, Ms. Burwell held the position of Deputy Chief of Staff working with Erskine Bowles in President Bill Clinton’s second administration. Ms. Burwell becomes the 22nd Secretary of HHS, an agency of over 70,000 federal employees across a number of important departments: the Food and Drug Administration (FDA); the National Institutes of Health (NIH); the Health Resources and Services Administration (HRSA); the Centers for Disease Control and Prevention (CDC); and the Administration on Aging among others. The largest portion of the agency’s near trillion dollar annual budget is dedicated to funding the Centers for Medicare and Medicaid Services (CMS) charged with running the Medicare and Medicaid programs nationwide.
Term: 302 (b) Allocation
Definition: Each year, the House and Senate Appropriations Committees receive an overall funding allocation for the coming federal fiscal year. The House and Senate Appropriations Committees then, respectively, decide on how to apportion the overall amount to each of their corresponding 12 subcommittees. The amount assigned to each of the 12 subcommittees is known as a 302(b) allocation and taken together the 12 assigned amounts are known as 302(b) allocations. From this funding allocation starting point, the House and Senate Appropriations Subcommittees distribute federal spending authority throughout the specific departments, agencies, and programs under their jurisdiction.
Used in a sentence: “[Senator] Mikulski said that she and [Congressman] Rogers have discussed allotments, which appropriators call ‘302(b) allocations,’ for their section in the 1974 budget act. ‘I know what his are, but ours will be different,’ she said.”
History: The Congressional Budget and Impoundment Control Act of 1974 is a law that modifies Congress’ role with respect to the federal budgeting process. (Government Printing Office Public Law 93-344) The main provisions of the law created a process whereby both chambers of Congress agree on a single concurrent budget resolution. which is not signed by the President. Additionally, during budget debates members may raise budget points of order to have specific language removed from underlying legislation. (Senate Budget Committee) The final agreed upon Concurrent resolution passed in both chambers sets an overall top level spending figure (302(a) allocation) to guide appropriators as they craft the 12 individual appropriations bills. The chairs of the Appropriations Committees of the House and Senate then each release a document setting their respective top line numbers for each of the 12 appropriations bills, known as 302(b) allocations, named after section 302(b) of the Congressional Budget Control Act. The 302(b) allocations outline the maximum spending levels for each of the 12 individual spending measures. It is not uncommon for the House and Senate to apportion funding differently and for the 302(b) allocations between the chambers to diverge. These differences usually get resolved during either a formal or informal conference committee between House and Senate Appropriators.
House Committee on Energy and Commerce – Subcommittee on Health
“21st Century Cures Roundtable”
May 6, 2014 – 3:00pm
2123 Rayburn House Office Building
Senate Committee on Appropriations – Subcommittee on Departments of Labor, Health and Human Services, and Education, and Related Agencies
“FY15 Department of Health & Human Services Budget”
May 7, 2014 – 10:00am
138 Dirksen Senate Office Building
Senate Committee on Aging
“Hearings to Examine the Fight against Cancer, Focusing on Challenges, Progress, and Promise”
May 7, 2014 – 2:15pm
562 Dirksen Senate Office Building
Senate Committee on Health, Education, Labor, and Pensions
“Hearing on the Nomination of the Secretary of Health and Human Services-Designate, Sylvia Mathews Burwell”
May 8, 2014 – 10:00am
106 Dirksen Senate Office Building
The House and Senate are back from recess and the appropriations season is moving forward in full swing. The House passed the Military Construction and Veterans Affairs Appropriations bill and the Legislative Branch bill with overwhelming majorities.
On Wednesday, the House passed the Military Construction and Veterans Affairs Appropriations bill (H.R. 4486) which provides funds for the troops, their families, and veterans’ programs. The bill passed with a vote of 416-1 (Representative Labrador (R-ID-1st) voted against the bill). The total cost of the bill is significantly less ($1.8 billion) than FY 2014.
The Legislative Branch bill (H.R. 4487) includes funding for House Member offices, security, and Capitol operations and maintenance. The bill passed the House with a vote of 402-14. The bill is the same funding level as it was in FY 2014.
The House Commerce, Justice, Science (CJS) Subcommittee released their bill, which includes funding for the National Science Foundation (NSF), the Census Bureau, and other programs. The bill is $398 million below the FY 2014 enacted level. The bill passed out of the Subcommittee and now moves to the full committee.
For text of the bill and key provisions visit here: http://appropriations.house.gov/news/documentsingle.aspx?DocumentID=377757
The Senate Appropriations Committee is also working through their process and held their first full Committee hearing of the year on innovation. As previously noted, the Chairwoman wanted to use the opportunity to make the case for federal investment in research.
It is expected that the Senate subcommittees will soon turn to markups of individual bills. Note that Mikulski stated in this hearing that she intends to “finish our bills by October 1 and show that the Appropriations Committee gets its work done on behalf of the American people.”
To see Senator Mikulski’s full statement click here: http://www.appropriations.senate.gov/news/chairwoman-mikulski-remarks-federal-innovation-hearing
With the midterm elections just over six months away there are a number of notable retirements in Congress. To date nine Senators and 49 Representatives have decided to not run for reelection.
Notable in these retirements are the years of seniority and institutional knowledge leaving both chambers. A number of important Members will be leaving at the end of the 113th Congress.
Senator Tom Harkin (D-IA):
Harkin of Iowa will be retiring after five terms in the Senate. He is the current Chairman of the important Senate Health, Education, Labor, and Pension (HELP) Committee. This committee is responsible for overseeing the aforementioned including all discretionary health policy –anything that is not Medicare/Medicaid related. He is also an appropriator serving as chair of the Labor, Health and Human Services subcommittee tasked with funding those important agencies and programs. This dual role of authorizing legislation and appropriating the funds for those authorized programs have helped to make him an effective leader in the Senate.
Representative Dave Camp (R-MI):
Camp of Michigan will be retiring after 12 terms in the House. He is the Chairman of the powerful House Ways and Means Committee. This Committee has the constitutional privilege of introducing any revenue generating legislation giving the Chairman a significant amount of discretion over federal legislation in both chambers. In addition to taxation and some trade matters the Ways and Means Committee has oversight over all mandatory health policy meaning most matters dealing with Medicare or Medicaid.
Senator Tom Coburn, M.D. (R-OK):
Dr. Tom Coburn of Oklahoma will be leaving the Senate early, due to a medical condition, having served two years into his second term. “Dr. No,” as he is sometimes affectionately called, has adopted the role of dogged watchdog of the purse-strings. He has used the many rights and privileges he has as a Senator to demand cuts and request that legislation meet “pay-go” and statutory budget restrictions.
Representative Henry Waxman (D-CA):
Waxman of California will be leaving after serving 20 terms in the House of Representatives across nine Presidential terms. In addition to a wealth of institutional knowledge he is taking with him, he is one of the strongest Democratic voices on climate change. As Chairman of the important Energy and Commerce Committee, Mr. Waxman overseas energy policy as well as health policy from the FDA, to public health programs to Medicaid and some Medicare policy. He was instrumental in helping then-Speaker Nancy Pelosi with crafting and aiding the passage of the Affordable Care Act in the House in late 2009.
Representative George Miller (D-CA):
Miller of California is another important leader who will be leaving at the end of the 113th Congress. Also from California and having served 20 years like Mr. Waxman, Representative Miller leaves the Chairmanship of the House Education Labor and Workforce Committee. In addition to chairing an important committee he is close friends with Minority Leader Nancy Pelosi. The chamber will lose an able member of the leadership.
One hearing to watch when the Senate returns next week is the Full Appropriations Committee hearing on “Driving Innovation Through Federal Investments,” which will be held on April 29th, 2014 at 2:30 pm in Room SD-G50 of the Dirksen Senate Office Building.
“Chairwoman Mikulski is trying to drive home the point that the federal government generates a ton of innovation each year by funding smart people with big goals. Those innovations create jobs, patents, technologies, medicines, treatments — you name it,” Appropriations panel spokesman Vincent Morris said in a statement. Morris said the hearing won’t take the place of the regular yearly oversight hearings on the president’s budget, but instead “will open a new door. And to really reach out far and wide for opinions and insight, we decided to use Twitter to engage with organizations, universities and individuals.”
- The Honorable John P. Holdren, Ph.D., Director, Office of Science and Technology Policy, Executive Office of the President of the United States
- The Honorable Ernest Moniz, Ph.D., Secretary, Department of Energy
- The Honorable Francis S. Collins, M.D., Ph.D., Director, National Institutes of Health
- The Honorable France A. Córdova, Ph.D., Director, National Science Foundation
- Arati Prabhakar, Ph.D., Director, Defense Advanced Research Projects Agency, Department of Defense
After demonstrating hope, resolve, and bipartisanship with the passage of a 12 bill omnibus for Fiscal Year (FY) 2014, Senate Appropriations Chairwoman Barbara Mikulski and House Appropriations Chairman Hal Rogers have set a positive tone for the FY 2015 process. As the budget deal decided upon in December set an allocation level for FY 2015 ($1.014 trillion), there is momentum for action.
Deadlines for programmatic and report language requests have come and gone for the most part and the parade of interest groups making the rounds for staff meetings are filling security lines. While it remains too soon to tell how it will all play out, bipartisan hope that bills will move forward is appreciated by most of those who frequent the halls of Congress to lobby.
The House Full Appropriations Committee took a significant step forward in the Fiscal Year 2015 process by passing both the Military Construction and Veterans Affairs and the Legislative Branch bills on Wednesday, April 9th.
Draft Text of the Mil Con Bill: http://appropriations.house.gov/UploadedFiles/BILLS-113HR-SC-AP-FY2015-MilCon-SubcommitteeDraft.pdf
Draft Mil Con Report Language: http://appropriations.house.gov/uploadedfiles/hrpt-113-hr-fy2015-milcon.pdf
Draft Text of Leg Branch Bill: http://appropriations.house.gov/uploadedfiles/bills-113hr-fc-ap-fy2015-ap00-legbranch.pdf
Draft Leg Branch Report Language: http://appropriations.house.gov/uploadedfiles/hrpt-113-fy2015legbranch.pdf
What We Are Hearing:
The House is expected to keep moving through Subcommittee and full Committee markups and Senate should get started soon. The House and Senate both head out for two weeks of recess over Easter/Passover and then will be back for a month before the Memorial Day break.
It is rumored that there is a lot of support for Subcommittee Chairman Tom Harkin (retiring) to be able to take the Labor, Health, and Human Services (LHHS) bill to the floor for a vote. Given that this bill is notoriously controversial, it remains to be seen if that will actually happen.
For the 17th time since the Sustainable Growth Rate (SGR) became law as part of the Balanced Budget Act of 1997, last week the Congress passed a short-term “patch” to prevent scheduled cuts from going into effect for physicians who provide care to Medicare beneficiaries. Staving off the more than 20% in payment cuts, on April 1st, President Obama, signed into law the Protecting Access to Medicare Act of 2014. In addition to preventing the scheduled payment reductions from going into effect, the new law continues a 0.5 percent update for physicians through December 31, 2014, and then maintains reimbursement levels for the first quarter of 2015. The SGR, long-recognized by health care providers and policymakers as in serious need of reform, is the formula used by the Centers for Medicare and Medicaid Services (CMS) to control spending and growth related to physician services provided to Medicare beneficiaries. Over the past six months, leaders and members of the House Ways and Means, House Energy and Commerce, and Senate Finance Committee achieved a rare bipartisan, bicameral consensus with respect to how to repeal the SGR and replace it with a more appropriate payment policy. The result of their efforts culminated in the introduction of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014. Despite agreement on the policy, Members of Congress unfortunately were unable to craft a deal with respect to how to pay for the estimated $140-180 billion price-tag. Therefore, with the April 1st deadline looming, Congressional leaders negotiated a smaller package of health care policies, which included a short-term “patch” for the SGR. The policies include (but are not limited to): an extension of the partial enforcement delay for the Medicare so-called “two-midnight rule,” which effects payment for inpatient stays at acute care hospitals; a one-year delay in implementation of the new ICD-10 coding system; additional authorization for the Special Diabetes Program and the maternal, infant, and early childhood home visiting program; a Government Accountability Office study on Children’s Hospital Graduate Medical Education Program; a new program relating to value-based purchasing for skilled nursing facilities; and a new initiative related to quality, safety, and evidence-based care associated with diagnostic imaging. The costs of the bill are paid for through a variety of policy changes, including: extending the two percent Medicare sequestration; revaluing services under the physician fee schedule; reform of Medicare payment for clinical laboratory services; and rebasing of Medicaid Disproportionate Share Hospital payments. Providers continue to urge Congress to take action to enact a permanent fix. Given that the latest “patch” expires March 31, 2015, prior to that date, Congress will need to take action on a permanent fix or enact the 18th patch.
Definition: Outlays refers to the actual disbursement of funds by the U.S. Treasury to meet obligations incurred by the federal government. They are typically referred to as spending or expenditures.
Used in a sentence: “The U.S. government posted the widest monthly budget surplus in more than five years in June, as spending plunged 47 percent and a stronger economy lifted tax receipts, the Treasury Department said.
Receipts exceeded outlays by $116.5 billion last month, the biggest surplus since April 2008, compared with a $59.7 billion deficit in June 2012, the Treasury said today in Washington. The result exceeded the $115 billion median estimate in a Bloomberg survey of 21 economists.” -Bloomberg
History: Article I, Section 9, Clause 7 of the United States Constitution states:
“No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of Receipts and Expenditures of all public Money shall be published from time to time.”
In a textbook budget process, the President proposes a budget to Congress on a yearly basis in the beginning February. Subsequently, both the House and Senate propose and pass their own budgets and reconcile them to set “top-line” numbers for the relevant accounts within the federal government. These “budgets resolutions,” are not signed by the President, and do not carry the force of law. From these numbers, the House and Senate appropriations committees divide the allocations among the 12 subcommittees, thus determining the actual funding levels for each agency and program. These bills are signed by the President and carry the force of law. From this process the federal government is authorized to produce expenditures or outlays to pay for the programs necessary to continue government operations.