On Nov. 30, the Senate began debate on its version of health care overhaul legislation, H.R. 3590, which aims to hold down insurance costs and increase coverage. The House passed its version, H.R. 3962, on Nov. 7. The Senate bill would expand Medicaid coverage and create state-run insurance exchanges in which a newly established public option would compete with private insurers. Most Americans would be required to obtain health insurance beginning in 2014, and tax credits would be provided to help individuals and families buy health insurance through the state exchanges. Republicans object to much of the bill and have proposed a number of motions and amendments. On Dec. 2, the Senate Democratic Caucus met to discuss strategies for moving the bill forward. One option they are reportedly considering may be moving to table Republican amendments and motions. Such a motion is not debatable and—unlike a cloture motion to end debate, which requires 60 votes—requires only a simple majority to succeed. On Dec. 3, the Senate adopted an amendment from Sen. Barbara Mikulski (D-Md.) by a vote of 61-39 that would eliminate co-payments and other cost-sharing requirements for many preventive health care services for women. It would also stop the U.S. Preventive Services Task Force’s most recent recommendations on breast cancer screening from being used for coverage determinations. Through a unanimous consent agreement, the amendment required a 60-vote threshold for adoption.
Democrats currently do not have the 60 votes necessary to end debate on the legislation. Leaders will have to put together a substitute version that can command the necessary votes before they force a cloture showdown. Such a substitute proposal would include an alternative to the provision allowing states to opt out of offering a public option. Senate Finance Committee Chairman Max Baucus (D-Mont.) said the Senate will have the necessary votes when it is time to file cloture. Baucus has said the Senate will not resort to reconciliation, a process that would insulate a health care bill from filibuster.
As the end of the current session becomes a factor in this year’s congressional debates, both parties and the White House have begun shifting their focus from the still-active health care debate to the issue of job creation. Democrats in both houses are setting their sights on a new jobs creation bill that could contain some of the same elements in the American Recovery and Reinvestment Act of 2009 and which would, they hope, reduce the unemployment level from its current level of 10.2 percent. Measures under discussion include $100 billion in emergency spending on extensions of unemployment insurance, Consolidated Omnibus Budget Reconciliation Act health care benefits, and Supplemental Nutrition Assistance Program benefits. Other provisions on the table include $60 billion for infrastructure projects, tax relief for small businesses, and direct jobs programs. House Speaker Nancy Pelosi (D-Calif.) has suggesting tapping unused Troubled Asset Relief Program funds to offset costs, diminishing the impact on the deficit. Additionally, Senators Dick Durbin (D-Ill.) and Byron Dorgan (D-N.D.) are working on a job bill that could be ready draft form before the Christmas recess. On the Republicans side, on Dec. 3, the same day that the White House hosted a job creation summit, House Minority Leader John A. Boehner (R-Ohio) led his own economic and job creation roundtable, stating that the current Democratic initiatives will “only make matters worse.” The sentiment was echoed by Sen. Lamar Alexander (R-Tenn.), who said the most important step toward creating jobs would be to defeat the Senate health care bill.
The press of other legislative business has resulted in little time left before Congress adjourns for the holidays, and there are still seven fiscal year 2010 spending bills that have not been approved. House Democrats are reportedly looking at an omnibus spending package that would include the seven bills, among them Labor-Health and Human Services-Education. The proposed omnibus could also contain a one-year “fix” to prevent a cut in physicians’ Medicare payments and the possible job creation measures now being examined. An omnibus could face even more daunting prospects in the Senate, which is still busy debating health care reform. Federal spending authority covered by the seven appropriations bills currently ends on Dec. 18, the expiration date of a continuing resolution passed last October.
On Nov. 23, the White House released an Executive Order aimed at reducing improper payments and eliminating waste in federal programs. The order is broken down into two main areas, transparency and public participation and agency accountability and coordination. Under transparency and public participation, there are detailed tasks assigned to the director of the Office of Management and Budget and the secretary of the Treasury in coordination with the Attorney General. Within 90 days of the date of the order, the director of the Office of Management and Budget must establish a workgroup consisting of federal, state, and local officials to make recommendations concerning the federal government’s measurement of access to programs by the targeted program beneficiaries. The working group will submit measurement recommendations, in consultation with the Council of Inspectors General on Integrity and Efficiency, within 180 days of the order. The secretary of the Treasury may publish the recommendations on an internet site designed to hold information on improper payments in high-priority programs. High-priority programs are defined as “federal programs in which the highest dollar value or majority of government-wide improper payments occur.” The director of the OMB will identify high-priority programs; coordinate with either the agency or executive department responsible for administering high-priority programs annual or semi-annual targets for reducing improper payments; and issue guidance, governmentwide, on the implementation of the order. The secretary of the Treasury will also publish on the Internet information on improper payments in high-priority programs within 180 days of the date of the order. This order follows a blog post on OMB’s web site; see This Week, Nov. 20. The order is posted at http://www.whitehouse.gov/the-press-office/executive-order-reducing-improper-payments.
On Dec. 1, APHSA and its affiliate, the National Association of State TANF Administrators, hosted an all-state conference call with the Administration for Children and Families, Office of Family Assistance, to discuss the status of the $5 billion Temporary Assistance for Needy Families Emergency Contingency Fund. David Hansell, the principal deputy assistant secretary for ACF, was among ACF staff on the call and highlighted that $1 billion of the ECF has been obligated with another $4 billion remaining. The ACF also noted the new publications now available on the Office of Family Assistance web site detailing the increased expenditures approved by the OFA in addition to the categories under which states have been approved. ACF staff also updated states on the new guidance that has been published on the OFA Frequently Asked Questions web page as well as a new document that details approved uses of non-recurrent short-term benefits that qualify for reimbursement under the ECF. More details are on OFA’s web site at http://www.acf.hhs.gov/programs/ofa/. For more information on this conference call, please contact Robert Ek, robert.ek@aphsa.org.
On Nov. 20, Kevin Concannon, U.S. Department of Agriculture undersecretary for Food, Nutrition and Consumer Services, sent a letter to all state human service commissioners expressing concern about some states’ ability to maintain proper management of the Supplemental Nutrition Assistance Program in the face of rising caseloads and diminished resources. The letter was particularly critical of some major projects that outsourced significant portions of the eligibility process to for-profit enterprises, noting that they “encountered severe problems in meeting critical performance standards and many eligible SNAP applicants have suffered as a result.” Concannon added that as a result, the USDA does “not regard these projects as successfully furthering the purpose of [SNAP and does] not support furtherance of such projects.” The letter urges states to adopt broad-based categorical eligibility as both a time-saver and a way to increase access to benefits. It also encourages states to use their Food and Nutrition Service regional office for technical assistance regarding successful models for improved performance as well as the Workload Reduction Matrix available on the FNS web site.
On Nov. 30, the Congressional Budget Office released a report measuring the economic output and employment impacts of the American Recovery and Reinvestment Act of 2009. Using employer reports, effects of similar previously enacted policies, and economic models, the CBO came up with a “more comprehensive” tabulation of ARRA’s influence on the economy during the third quarter of calendar year 2009. ARRA funding recipient reports indicated an increase or retention of 640,000 jobs. However, these reports only indicate jobs created or retained by employers directly receiving ARRA funds or their immediate subcontractors; it fails to account for any tertiary contracting done by the subcontractor. The CBO also noted the inability to know how many jobs would have been created or retained in the absence of economic legislation. The agency also said it is difficult to pinpoint any increase in jobs that would result from a boost to the economic capacity of individuals working in retained or newly created jobs, which would in turn create a higher demand for additional products and services.
Recipient reports were only mandated under certain appropriations that account for “only about one-quarter of the total amount spent by the government or conveyed through tax reductions in ARRA through September 2009.” On this basis, the CBO estimates that additional 600,000 to 1.6 million individuals were employed during the third quarter of 2009. CBO’s estimates also indicate that the country had a 1.2 percent to 3.2 percent higher real Gross Domestic Product than it would have in the absence of a stimulus and that ARRA curbed unemployment from anywhere from 0.3 percent to 0.9 percent. For the complete CBO report, see http://cbo.gov/ftpdocs/106xx/doc10682/11-30-ARRA.pdf.
This Week in Washington is published by the American Public Human Services Association each week Congress is in session and on other dates. Editors: Larry Goolsby and Frank Solomon. Writers: Jodie Anthony (health), Rashida Brown (child welfare), Ilana Cohen (health), Robert Ek (TANF, child support), Sue Hall (SNAP), Courteney Holden (child and family services), Katherine Klosek (budget and appropriations), Bertha Levin (child and family services), Ngozi Onunaku (child care), Nanette Relave (health), Henry Sallee (legislative affairs intern), Damon Terzaghi (health), Emily Wengrovius (legislative affairs), and Angela You (child and family services).
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