Washington Bulletin 1/15

January 16, 2018
Washington Update

On Capitol Hill

Stopgap Déjà vu

It’s deja vu all over again as Congress prepares to pass another stopgap spending bill to avoid a government shutdown and buy time to resolve partisan differences over defense and domestic funding priorities, the fate of young undocumented migrants, and border security.  The current temporary spending law — the third for fiscal 2018 — runs through Friday, January 19.

House Appropriations cardinal Tom Cole (R-OK.) said Republicans should be able to pass another stopgap with “minimal” defections from defense hawks as long as good-faith negotiations continue on spending levels. Democrats want defense increases to be paired with a boost in money for domestic discretionary programs. House Majority Leader Kevin McCarthy (R-CA) said on the floor last week that he didn’t expect policy riders on the next continuing resolution.

The Senate is considering legislation (S. 139) that would extend through 2023 the government’s authority to spy on foreigners’ digital communications after the House passed the measure 256-164 last week. Section 702 of the Foreign Intelligence Surveillance Act allows the National Security Agency to intercept calls or emails from suspected foreign terrorists outside the U.S. Majority Leader Mitch McConnell filed for cloture on the measure with a procedural vote planned for Tuesday.

 

CHIP

The Children’s Health Insurance Program would get a six-year extension under legislation Energy and Commerce Committee Chairman Greg Walden (R-OR) wants to bring to the House floor the week of January 15. House Majority Leader McCarthy did not specifically mention the children’s health program when he listed floor votes for this week but said the chamber may consider extension of programs.

The Congressional Budget Office (CBO) has told lawmakers that extending CHIP for 10 years rather than a proposed five years would reduce the federal deficit by $6 billion. A five-year extension is estimated to cost around $800 million, according to the CBO.

Sen. Orrin Hatch (R-UT) told reporters the CBO score makes it much easier to renew CHIP and makes it a tempting must-pass vehicle for other priorities. “It also means everyone wants to hang everything on it now,” said Hatch, chairman of the Finance Committee.

Sen. Ron Wyden(D-OR), the ranking Democrat on Finance, is negotiating to extend CHIP for longer than six years. He said he also wants the measure to include community health centers.

Georgetown University researchers have concluded that 11 states will exhaust their funds in February and be forced to tap into a federal reserve of funds. Almost half of all states and the District of Columbia face running out of funds at the end of February.

Medicaid, Opioids

The Senate Homeland Security and Governmental Affairs Committee will convene a hearing Wednesday, January 17, on Medicaid and the nationwide opioids epidemic. Chairman Ron Johnson (R-WI.) plans to release a report saying Medicaid expansion may have led to increased abuse of opioids.

Chairman Johnson began making this claim last year as Republicans sought to repeal the Affordable Care Act — which expanded Medicaid coverage. Researchers dispute that Medicaid has caused or fueled the opioid epidemic.

The House Ways and Means Oversight Subcommittee meets Wednesday, January 17, to discuss efforts by the Centers for Medicare and Medicaid Services to use data to identify participants in Medicare Part D who are potential risks for abusing opioids. Lawmakers also plan to examine the extent of the opioid epidemic and tools CMS has available to prevent individuals from receiving unnecessary opioids.

The Senate Health, Education, Labor and Pensions Committee on Wednesday, January 17, is scheduled to hear from Food and Drug Administration Commissioner Scott Gottlieb, Centers For Disease Control And Prevention Director Brenda Fitzgerald and HHS Assistant Secretary for Preparedness and Response Robert Kadlec on the U.S.’s preparedness and response capabilities to 21st century public health threats.

Immigration Push

For weeks, House Speaker Paul Ryan (R-WI) has said any deal to shield 700,000 young undocumented people from deportation must be bipartisan. Members of the GOP conference, however, appear to have another idea entirely.

House Republicans are pressing Speaker Ryan for a vote on a partisan immigration bill that has little chance of passing the Senate. They want floor action on legislation by House Judiciary Chairman Bob Goodlatte (R-VA), which goes well beyond what the White House has said should be in a deal codifying the Obama-era Deferred Action for Childhood Arrivals (DACA) program into law — and which is unlikely to garner a single Democratic vote.

Speaker Ryan and his top lieutenants have not committed to a vote on the Goodlatte bill, which GOP leaders worry could undermine bipartisan negotiations. And they’re not even sure the text could garner the 218 GOP votes needed for passage in the House. Still, he’s risking a backlash from conservatives if he does not put it forward for a vote.

Supporters of the Goodlatte bill have pointed out that it also had input from Homeland Security Committee Chairman Michael McCaul (R-TX), House Freedom Caucus conservative Raul Labrador (R-ID) and centrist Martha McSally (R-AZ). Backers say leadership should not ignore a bill with such broad buy-in from GOP heavy-hitters.

The debate about the House strategy comes as a bipartisan group of senators has reached a deal to create a path to citizenship for the so-called Dreamers, after Trump decided last year to end the DACA program and demand a legislative solution instead. Trump, however, has panned the agreement as a “step backwards” and accused Democrats of hindering talks.

Immigration is also a particularly thorny issue for Ryan. House Republicans drove out ex-Speaker John Boehner (R-OH) in part over immigration. Now conservatives are worried Ryan will foist on their conference a bipartisan Senate deal that their base would consider “amnesty” for people who came to the U.S. illegally.

President Trump’s flirtation with the Goodlatte proposal complicates things for Ryan. He gave a shout-out to the bill during on-camera negotiations with Democrats— one the authors took as an endorsement from the White House.

Sources close to leadership, however, dispute that notion. They say the proposal goes beyond the four areas the White House has said an immigration deal must address: a legislative replacement for the DACA program, border security funding, changes to the way people can bring family members to the U.S. and other visa program adjustments.

The Goodlatte bill meets all those requirements but also would crack down on sanctuary cities, tweak policies governing child migrants and asylum seekers, and require companies to verify the legal status of their workers.

The latter provision, known as E-verify, would put centrist House Republicans in swing districts in a difficult position. Some hail from heavily Hispanic districts where E-verify would disrupt agriculture businesses.

But even if House moderates backed the Goodlatte bill, it’s unlikely to get enough support in the Senate, where Republicans have a slim majority and need 60 votes to pass immigration legislation. Some centrists in the House say it’s pointless to take such a controversial vote.

 

Water Infrastructure Needs and Challenges Hearing

The Senate Committee on Environment and Public Works held a hearing last week to examine the needs and challenges facing water infrastructure, particularly the challenges faced by the Bureau of Reclamation and the Army Corps of Engineers in tackling these issues with current budget restrictions. Chairman John Barrasso (R-WY) addressed public safety concerns, such as ice jams created from flooding in Wyoming. Many communities depend on Army Corps of Engineers projects, and the Corps must work together with the Bureau of Reclamation to face the challenges presented. Ranking Member Senator Carper (D-DE) addressed the costs imposed from extreme weather which totaled $300 billion dollars in 2017. Additionally, over 70% of Army Corps of Engineering projects have shifted to maintenance leaving the Corps’ infrastructure at risk of exceeding its lifespan.

Witnesses focused their testimonies on the Water Resources Development Act (WRDA). A witness from the National Association of Counties addressed how communities would benefit from additional WRDA projects. For example, how counties must face the safety concerns associated with lacking water infrastructure and their dependence on limited tax dollars to do so. For example, Toulumne County in California is working to provide an adequate water resource to 50,000 residents where the only water source is an old wooden flume. Damage to the flume would take 500 days to repair and devastate the county. A link to the testimony from the National Association of Counties can be found here.

A witness from Congressional Research Service highlighted past WRDA projects and how current Corps projects have authorized funding, but have yet to be funded. Approximately $100 billion in authorized Corps projects are eligible for construction appropriations. IN recent years, Congress has funded emergency projects with supplemental funding. A link to the Congressional Research Service testimony can be found here.

The Committee is continuing to shine a spotlight on this issue with another hearing scheduled for January 17.  A panel of federal experts is expected to participate but a witness list has not yet been provided.

 

In the Administration

Medicaid Policy Changes

The Trump administration’s decision to move forward with allowing states to implement Medicaid work requirements is drawing swift backlash from Democrats and advocates who warn the eligibility changes are illegal.

Medicaid officials guided states Thursday, January 11 on cutting unemployed people from the safety-net health insurance program and pledged to back efforts to boost community engagement, calling them “anchored in historic CMS principles that emphasize work to promote health and well-being.”

Critics deem that the change in agency policy, a strong departure from the Obama administration’s flat rejection of work requirements, violates the mission and statute of Medicaid and harshly jeopardizes health care for the poor and needy, critics contended. Further, it hearkens back to the “days of work houses for the poor” among those who can’t find work, Families USA said in a statement.

The National Health Law Program said the move is “on wobbly legal ground” and called for the Centers for Medicare & Medicaid Services to re-open or extend public comment periods on all pending Section 1115 waiver applications that would add the eligibility requirements.

Seven states—Arkansas, Indiana, Kentucky, Maine, New Hampshire, Utah, and Wisconsin—are seeking the change to restrict Medicaid coverage only to those who work or are actively studying or volunteering, according to the Kaiser Family Foundation. The Trump administration has yet to approve any of the waiver requests, but the guidance is likely the first step toward that.

The CMS in the past year has also repeatedly backed increased flexibility for states to control their Medicaid programs, as GOP leaders sought to tackle the program’s growing $550 billion price tag.

Legal Challenges

Families USA noted it is working closely with NHeLP, which represents low-income and underserved people, to support legal challenges to the Medicaid requirements in federal court.

In a separate letter, the legal group said the decision “ignores the wealth of literature regarding the negative health consequences of work requirements… It appears that CMS has decided on a policy position first and then cherry-picked a small number of studies in an effort to justify this drastic shift in agency policy.”

Critics contend those who can work already are.

The advocates added that work requirements reflect prejudice against the poor and put actual lives on the line. They also cautioned that the mandate could harm poor beneficaries’ health, limiting the ability to look for a job and having a counterproductive effect.

The CMS said in its guidance that it would not approve the policy for children, pregnant women, seniors, and the disabled. Adults getting some substance use disorder treatments could also be exempt.

The CMS letter to states noted that state Section 1115 waivers including the work requirements would need to be budget neutral and that states will not be allowed to collect on savings from a decline in enrollment under the change. Further, states won’t be allowed to use Medicaid funding to pay for work support services that will be required under the waivers such as job training, child care assistance, and transportation.

“Medicaid is not about funding work programs; it’s about funding health insurance,” she said. “Essentially the federal government admits this is totally outside the purpose of Medicaid.”

Democrats Slam Trump Administration

Several prominent Democrats also weighed in to slam the Trump administration on safety-net work requirements.

Lawmakers spent much of 2017 in a divisive political battle over Obamacare that included failed debates over whether to overhaul Medicaid and its spending. And that has shown little sign of abating in 2018, with GOP leaders signaling that entitlement reform could be a priority this year.

House Minority Leader Nancy Pelosi (D-CA) in a statement called the move a “shameful violation” of Medicaid’s intent, noting that it would especially hurt women who are caretakers or chronically ill.

Republican advocates backed the Trump administration’s decision despite the opposition.

The CMS, in its letter to state Medicaid directors, stressed work and community engagement as a determinant of health alongside other social and economic factors. The agency noted living longer had been linked to higher wages and unemployment associated with poorer physical and mental health.

Separately, Americans for Prosperity lauded the move, citing an “unsustainable” growing price tag of the Obamacare Medicaid expansion and the need to protect the program’s future for the most needy.

 

Debt Ceiling Restructure

Treasury Secretary Steven Mnuchin on Friday said he and President Trump are mulling how to change the method through which the U.S. government caps the federal debt.

Sec. Mnuchin said it was “ridiculous” that lawmakers needed to regularly raise the legal limit on how much debt the U.S. government can hold or risk triggering a global crisis.

The Treasury Department secretary said he and President Trump are discussing ways to make sure all spending appropriated and authorized by Congress would not be affected by the federal debt.

The U.S. federal debt exceeded $20 trillion last year and is currently over the federal debt limit. The Treasury Department will likely be able to stave off a potential default on U.S. debt by diverting and delaying internal payments until March.

A failure to raise the debt ceiling past that point could risk financial turmoil, though credit analysts say a temporary breach of the debt ceiling won’t destabilize the economy.

Republicans have long insisted on attaching spending cuts to any bill to raise the debt ceiling, while Democrats have called such measures unnecessary.

President Trump has floated eliminating the debt ceiling altogether, which some Democrats have supported. GOP lawmakers are largely opposed to the idea.

White House scrambles after false missile warning in Hawaii

The erroneous alert triggered reminders inside the administration about long-delayed plans to prepare for a domestic missile attack.

A false warning of a missile threat in Hawaii sent White House aides scrambling Saturday, frantically phoning agencies to determine a response and triggering worries about their preparedness almost a year into the Trump administration.

President Donald Trump’s Cabinet has yet to test formal plans for how to respond to a domestic missile attack, according to a senior administration official. John Kelly, while serving as secretary of Homeland Security through last July, planned to conduct the exercise. But he left his post to become White House chief of staff before it was conducted, and acting Secretary Elaine Duke never carried it out.

The White House press office did not respond to a request for comment about the exercises.

Saturday morning Hawaii time, people in the state received an emergency alert notification about an incoming missile that read, “BALLISTIC MISSILE THREAT INBOUND TO HAWAII. SEEK IMMEDIATE SHELTER. THIS IS NOT A DRILL.” The state’s governor, Democrat David Ige, attributed the error to a “wrong button” pressed during a shift change — but it took a full 38 minutes for the state to advise residents of the error.

The administration official said there was no military response around the president during the incident — as would be expected during an actual missile attack — because there was no actual threat detected by the military. National security adviser H.R. McMaster later briefed the president on the events, and President Trump tasked him with overseeing the administration’s response.