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July 18 — Wrangling over money for Zika, mental health and a biomedical innovation initiative will top the health-care agenda when Congress returns in September.
The Senate left town last week for a seven-week recess after once again failing to pass a $1.1 billion spending package to fund the fight against the Zika virus. Another vote is scheduled on lawmakers' first day back.
The window for trying to rise above the partisan gridlock and pass anything will be narrow—lawmakers will still need to find a way to fund the government, which is likely to eat into the time that could be spent on other priorities. Once lawmakers return, they will have only eight legislative weeks left in the 114th Congress, including a lame-duck session.
Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) is also looking at September to pass the 21st Century Cures initiative, which aims to speed the federal approval processes for innovative medical products. The House approves its version of Cures (H.R. 6) just over a year ago, but Alexander has said he won't move forward until funding issues are worked out.
The hope isn't as bright for potential passage of a mental health reform bill in the Senate. The House overcame years of delays and overwhelmingly passed its own version (H.R. 2646) earlier this month. However, the Senate bill is being held up over gun language, and the disagreements could drag well beyond September. Democrats, especially the bill's main sponsor, Sen. Chris Murphy (D-Conn.), don't want the bill to contain language they fear would make it easier for mentally ill people to get guns. If the stalemate continues, there's real concern it could derail what was supposed to be promising, bipartisan legislation.
A $1.1 billion funding package (H.R. 2577) to combat the spread of the Zika virus failed to advance in the Senate July 14 after Democrats blocked the measure (136 HCDR, 7/15/16). It was the second time Democrats have blocked the measure, which was anticipated after the Senate tried and failed to pass the spending plan June 28. The funding was part of a conference report that included the Military Construction and Veterans Affairs fiscal 2017 spending bill.
Following the first failed vote, lawmakers spent the better part of two weeks pointing fingers at one another. That's not expected to change over the summer as the risk grows for domestic cases of the mosquito-borne virus. Senate Democrats decried the inclusion of “poison pill” riders in the House-passed measure, including new restrictions on Planned Parenthood funding to clinics in Puerto Rico and cuts to the Affordable Care Act. They also objected to budget offsets in the plan.
In February, the Obama administration requested $1.9 billion in emergency funding—that isn't offset—to combat the spread of Zika. Republicans in the House countered that the administration needs to shift existing funds that were being used to fight Ebola, and said any new money needs to be offset. Officials have said funding for projects like vaccine trials will run out without new money. Democrats had called for Senate Majority Leader Mitch McConnell (R-Ky.) and other Republicans to return to the negotiating table, but McConnell had insisted the conference report can't be amended
A third vote in the Senate on the spending package is already scheduled for Sept. 6.
Hopes are dimming for a mental health reform bill to pass the Senate. Despite the House decisively passing Rep. Tim Murphy's (R-Pa.) Helping Families in Mental Health Crisis Act (H.R. 2646) 422-2, momentum in the Senate on a parallel effort (S. 2680) has been stalled by a disagreement over guns. Advocates are still holding out hope lawmakers can act this year.
Sen. John Cornyn (R-Texas) has floated an amendment based on his legislation (S. 2002), which addresses the link between mental health and the criminal justice system. Democrats have objected to a provision in Cornyn's bill about background checks that they say would make it easier for mentally ill people to get guns. They also worry any language about guns would make Democrats offer gun control amendments, which would immediately doom the bill.
Neither Sens. Murphy nor Bill Cassidy (R-La.)—the mental health bill's primary sponsors—have said they are interested in having a debate about guns on the Senate floor, especially in an election year.
“I still believe this bill has to be about fixing the mental health system, not about changing gun laws,” Murphy told Bloomberg BNA in an interview just before the summer recess. “Right now Sen. Cornyn has a different view. We are not going to be doing a mental health bill in the Senate if there’s gun policy attached to it.”
The underlying bill authorizes block grants to states for topics like mental health services, as well as for the prevention and treatment of substance abuse disorders, although the exact amount will be subject to appropriations. It also seeks to improve coordination of mental health services across government agencies, and seeks to strengthen “parity” laws that require insurance companies to cover mental health services the same as physical health services.
Like the House legislation, the Senate bill has little to no mandatory funding elements—the House bill would actually save money. Both Cassidy and Murphy told Bloomberg BNA they weren't concerned the lack of mandatory funding would hold up the bill if it got to the floor.
“I think that if we show there’s bicameral, bipartisan support on mental health, the money is one of those issues that somehow manages to take care of itself,” Cassidy said.
A lone bright spot this fall could be a biomedical innovation bill. Alexander is hoping the Senate will vote on its companion to the House's 21st Century Cures bill, despite procedural obstacles.
“This could be the most important legislation Congress passes this year, and there’s no excuse for not finishing our work in September,” Alexander said in a recent statement. The main holdups in moving to a floor vote, Alexander has said, are the complexity of the proposals in the bills as well as disagreements about how to pay for the legislative package. Senate HELP Democrats have insisted on mandatory funding for the National Institutes of Health; Alexander said he's open to an innovation surge fund that would pay for specific projects such as the White House's precision medicine and cancer moonshot initiatives.
Alexander's commitment to September is good news for Houses Energy and Commerce Committee Chairman Fred Upton (R-Mich.), who told Bloomberg BNA July 13 he has a new plan to pay for the bill that would bring the National Institutes of Health funding “pretty close” to what Democrats want. Upton wouldn't give specifics, and likely won't announce anything until September. But he said the offsets would no longer tap the strategic petroleum reserves, as they were used to fund other pieces of legislation.
In other words, there's still plenty of optimism about getting the bill passed, even though there aren't many new details.
The House overwhelmingly passed its Cures bill (H.R. 6) almost exactly a year ago, giving a major legislative victory to Upton (133 HCDR, 7/13/15).
Alexander has said he wants to resolve the funding disagreements so the committee can offer those bills on the Senate floor, alongside a mechanism for how to pay for them. Even if it passes, the Senate would still have to work out the differences between its version and the House bill.
To contact the reporter on this story: Nathaniel Weixel in Washington at firstname.lastname@example.org
To contact the editor responsible for this story: Brian Broderick at email@example.com
Text of the Zika conference report is at http://docs.house.gov/billsthisweek/20160620/CRPT-114HRPT-HR2577.pdf.
Copyright © 2016 The Bureau of National Affairs, Inc. All Rights Reserved.
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