How Might the Budget Debates Affect Children's Health Care?

It’s July in Washington, DC, when congressional committees begin meeting to decide how much funding each government program will get next year. This is always a contentious process, but this year is shaping up to have more July fireworks than usual.

It’s July in Washington, DC, when congressional committees begin meeting to decide how much funding each government program will get next year. This is always a contentious process, but this year is shaping up to have more July fireworks than usual.

The process got off to a strange start in March when House Budget Committee chair Paul Ryan (R-WI) introduced his budget proposal before the President introduced his. A highly unusual move, but not unexpected; the President’s budget is usually released in February, but this year wasn’t released until April (largely because of continuing questions about sequestration; another issue altogether which, for the sake of keeping you awake, we’ll avoid here).

The Ryan budget passed the House, which is controlled by Republicans, but hasn’t been taken up in the Senate, which is controlled by Democrats. Instead, Senate Democrats release their first budget proposal in four years which, of course, has no chance of being passed by the House. Thus began the stalemate; one which has happened nearly every year in which different parties control each house of Congress. To avoid a government shutdown, both parties usually come together in the fall to iron out a compromise to keep government programs running at the previous years’ funding levels – this is called a “continuing resolution.”

This year, however, seems to have its own unique set of issues, and they could have an effect on programs that help ensure kids’ access to doctors, such as the Children’s Hospital Graduate Medical Education (CHGME)—a  program that funds training for pediatricians. For background, we need to get a little into the weeds of the congressional budget process.

Normally, House and Senate appropriators get together to determine how much money they are able to spend on government programs. In technical terms this level of funding is called a “302(a) allocation.” The appropriations committee in each body then determines how much money to give to each of 12 appropriations subcommittees, each of which decides funding for a different sector of the government. (For example, there is an appropriations subcommittee on Labor, Health & Human Services, and Education, which determines funding levels for most education and health programs, including the National Institutes of Health and CHGME.) The funding level for each subcommittee is called a “302(b) allocation.”

This year, the House and Senate never met to decide on a 302(a) level; thus each body is working with a considerably different budget number. The House is working with a level of $967 billion, and the Senate with a level of $1.058 trillion. This sizable gap is the source of the friction between the two bodies of Congress (and, as we’ll see in a minute, the President).

Because it’s highly unlikely the House and Senate will be able to reconcile these differences, it will mean a showdown in the fall, when Congress will once again attempt to forge a continuing resolution to keep the government running. Only this year, they’ll also have to contend with the sequestration budget cuts (sorry, I said we wouldn’t mention those but it couldn’t be avoided) as well as the starting period for open enrollment in the Affordable Care Act’s health care exchanges – the funding for which congressional Republicans are highly unlikely to approve. The President is currently traversing the country and urging Congress to work out these differences to avoid a government shutdown.

Now let’s talk about how this affects CHGME. The Senate Labor-HHS-Education Appropriations subcommittee met on July 11 and approved a funding level of $267.3 million for the program. It’s not as much as the $317.5 million that is needed to meet children’s growing need for pediatricians and pediatric specialists, but it’s much better than the President’s proposed level of $88 million. (It’s also the same amount that Congress ultimately approved last year for the program,though the sequestration meant the FINAL amount for the program was approximately 5 percent less.) 

That’s the good news. The bad news is, because of the considerably smaller 302(b) allocation, the House Labor-HHS-Education subcommittee is working with nearly $43 billion LESS funding than its Senate counterpart.  That means it will need to make substantial cuts to many programs to come up with a bill that fits within the overall spending cap. While nothing has been completed, it’s possible that CHGME funding could be reduced as a result of this huge disparity. There are already signs the House subcommittee is having trouble settling the issue, as a meeting to discuss the bill scheduled for July 25 was cancelled and has yet to be rescheduled.

That means there’s still time to contact your legislators and tell them to support CHGME. Cuts to this program would hamper important training programs for pediatric specialists, who are already in short supply in many parts of the country.

We’ll keep you posted as the budget process moves forward.

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