Election years can sometimes lead Members of Congress to focus on winning votes at home and avoiding tough votes in the nation’s capital or delaying action until after the election what should be addressed today. Getting major policy changes through Congress can be challenging even in good times, but there may still be opportunities for small but important bipartisan victories this year. The 118th Congress is on track to be one of the least productive in decades.
The current divided Congress, with the Democrats in the majority in the Senate (with the help of two Independents) and the House led by a small Republican majority, compromise is tough to find, but necessary for passage of most bills. As we saw recently, even when a compromise was reached in the Senate on a bipartisan supplemental appropriations foreign aid bill, which included border security, election year politics took over, and the bill was defeated. The Senate voted early on Tuesday, February 13 to pass the supplemental appropriations bill without the border security provisions (70-29). Its fate in the House remains unknown. The Senate bill’s fate in the House remains unknown. House Republicans have subsequently crafted a smaller bill that included military aid, some border security provisions, but no humanitarian aid. The sides are far apart.
The Fiscal Year 2024 budget and appropriations battles linger on even though the fiscal year began on October 1, 2023. Here is how we got this far this slowly: a Biden/McCarthy debt limit deal paid our bills, supposedly set the FY 2024 funding levels, and sent Speaker McCarthy packing; new Speaker of the House Johnson’s idea to split the appropriations bills into two packages kept the government going through the holidays and kept his conservatives at bay; facing another potential government shutdown, another double deal until March 1st and 8th between Majority Leader Schumer and Speaker Johnson with a few minor concessions brings us up to where we are to date. This leaves Speaker Johnson stuck somewhere between his unhappy conservatives who want bigger spending cuts, and a government shutdown would likely be blamed on the Republicans.
The stars of this entire process to date have been Senate Appropriations Chair Patty Murray (D-WA) and Vice-Chair Susan Collins (R-ME) who worked out 12 compromise bills many months ago. Just recently, Senator Murray and House Appropriations Chair Kay Granger (R-TX-12), concluded a deal that lays out the totals for the dozen spending bills so that the Appropriations Subcommittees of the Senate and House can work over the coming days to determine specific spending for hundreds of federal programs (e.g., NIH/NIA, VA, Older Americans Act, CMS) that will total more than $1.7 trillion. Those discussions will influence programs and services for millions with serious illness and their caregivers.
C-TAC’s Legislative Agenda
What does this mean for C-TAC’s federal serious illness legislative agenda – payment model reform, advance care planning, community-based supports and services, and hospice quality and modernization, with an overlay of health equity in each?
- Payment model reform – The genesis of much of C-TAC’s work was its development of a Medicare payment model that would reward patient-centered comprehensive, high-quality care provided to individuals with serious illness and support their family caregivers. This work continues but we have not been pushing Congress as much over the few years as we have been educating and working with CMS and CMMI to address the needs of those with serious illness in all of their model work. Recent activities have been very positive with the release of the Guiding an Improved Dementia Experience (GUIDE) model, which includes expanded support for caregivers, as well. Congress is unlikely this year to take up any of the bills that have called on CMMI to create new models, including a palliative care model.
- Advance care planning – Our goal in this Congress is to secure passage of a bill to expand the coverage for and use of advance care planning (ACP) to help ensure that patients’ (and their caregivers) care preferences are understood and followed. C-TAC is hopeful that new versions of the Improving Access to Advance Care Planning Act (H.R.8840/S.4873) will be introduced in the near future and be ready for committee mark-up when larger legislative vehicles become available. The bills, sponsored by Rep. Blumenauer (H.R. 8840) and Senator Warner (S. 4873), remove Medicare copays for all ACP counseling, authorize Licensed Clinical Social Workers to use the two ACP billing codes to pay for ACP, and provide for additional provider education on these codes.
- Community-based supports and services – This space is getting exciting given the upcoming work to reauthorize the Older Americans Act, which C-TAC strongly supports. We will have a number of proposals to strengthen the aging network’s ability to assist those with serious illness and their caregivers. We will also work to secure additional funding streams to the aging and disability networks who care for serious illness individuals.
- Hospice – C-TAC believes that the Medicare hospice program remains a major success in our health care system. We support efforts to address program integrity, and we are looking at avenues to strengthen consumer protections. We are also supporting work to modernize the program based in part on our principles for the hospice program. We believe that modernization should address the limitations of the six-month prognosis rule, allow concurrent care coverage, and cover upstream palliative care services and supports and services.
C-TAC will continue to look for opportunities to advocate for our agenda throughout this election year and until Congress adjourns.
