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Budget Season Begins Again In Washington

On January 3, a new Congress (the 113th) was sworn in, and any unfinished work by the previous Congress was left on the table. Unfortunately, one of the many things left undone was reauthorization of the Children’s Hospital Graduate Medical Education (CHGME) program. This means that CHGME continues to be an “unauthorized” program, but at the same time continues to be funded. Wait, you’re thinking – how can Congress provide money to an unauthorized program?

On January 3, a new Congress (the 113th) was sworn in, and any unfinished work by the previous Congress was left on the table. Unfortunately, one of the many things left undone was reauthorization of the Children’s Hospital Graduate Medical Education (CHGME) program. This means that CHGME continues to be an “unauthorized” program, but at the same time continues to be funded. Wait, you’re thinking – how can Congress provide money to an unauthorized program?

A brief explanation - the term “authorization” is used to describe two types of laws. One is an “organic,” or “enabling,” statute, which creates a federal agency, establishes a federal program, or allows a particular federal expenditure within a program. The second type of authorization is a specific provision that authorizes the appropriation of funds (generally allowing for “discretionary spending” – funding Congress chooses to provide, as opposed to “entitlement spending,” which Congress MUST provide) to carry out the program or function established in the enabling statute. Simply put, one creates a federal program; the other ensures Congress can fund it. But once the first authorization is completed – ie, the program is created – the second one needn’t necessarily exist to continue to fund the program. Congress can weigh the merits of a program whose authorization has expired and choose to fund it based on its quality.

Applying the above to CHGME, the “enabling” statute to create CHGME was passed in 1999. The program was reauthorized (the second type of authorization above) in 2000, then again in 2006. The authorization expired in 2011, but Congress continued appropriating money because of the proven quality of the program. (This happens every year with literally hundreds of federal programs – the Congressional Budget Office releases a report of these “unauthorized” programs every January.)

Despite the lack of authorization, Congress funded CHGME –which has enjoyed broad bipartisan support since its inception - at $265 million last year. The President, on the other hand, has not been so kind to the program, recommending last year that only $88 million be provided to the program (which was at least a step up from 2011, when he recommended no funding for the program at all). We have been fortunate that Congress has not taken the President’s advice. At least not yet.

The process starts anew now – the President will release his budget at some point in February (though some reports say it will be later than usual). The President’s budget recommends to Congress how much money the federal government should spend and what they should spend it on, and how much it should take in as tax revenues. But his budget is only a recommendation – federal spending is ultimately decided by Congress (though the President must sign off on it).

The President knows that, despite temporarily avoiding the fiscal cliff, cuts must be made. And they can only be made in certain areas – those “entitlement programs” mentioned above must be funded, and they take up all but 10-15 percent of the overall budget. If you’re the President and you’re trying to show fiscal responsibility, you try to trim as much of that portion of the budget as you can, which is why he has attempted to cut or eliminate CHGME funding in the past. That’s why concerned advocates for children’s health like you need to let the President know not to make the same mistake three times in a row. Take just a few minutes to send a message to the White House and urge President Obama to maintain funding for CHGME and support the program in his budget blueprint. The health of our children is worth far more than .0085 percent of the budget, yet that’s all we’re asking.

And we will need to work once again this year to get CHGME reauthorized. Even though the program can be funded in its current state, it’s always better when a program has Congress’ official seal of approval.


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