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February 16, 2023
Health Policy Challenges Apparent in State of the Union Speech
President Biden delivered a provocative State of the Union address to a joint session of a deeply divided Congress on February 7. Loud protests erupted in the House of Representatives chamber when Biden vowed to stop proposals from some Republicans to sunset Medicare and Social Security, but he secured a public bipartisan commitment to protect those programs as Congress and the White House wrestle with federal spending and raising the federal debt limit.
The president called on lawmakers to “finish the job,” alternating between a condemnation of Republicans’ policies and calls to forge bipartisan deals including on health policies ranging from ending cancer, addressing the opioid epidemic, tackling the country’s mental health crisis, and supporting veterans. Nursing advocates were disappointed that he failed to acknowledge workforce shortages and the need to strengthen nursing education and clinical education. The administration is likely to have difficulty finding bipartisan support for proposals to permanently extend enhanced subsidies to lower premiums on Affordable Care Act health plans, close gaps in Medicaid coverage, or cap the cost of insulin.
White House, Congress Face Debt Limit Confrontation
The Congressional Budget Office predicted Wednesday that the federal government will officially hit the limit on its borrowing authority between July and September, ratcheting up the pressure on Congress and the White House to agree on a plan to raise the debt ceiling. The independent budget office warned that the actual date when the Treasury Department can no longer pay interest on its $31 trillion-plus debt will depend on the flow of federal dollars in and out of the government over the next few months.
After an initial White House meeting, President Biden and House Speaker Kevin McCarthy both expressed cautious optimism about talks to negotiate a deal to increase the nation’s debt limit and avert a potential economic catastrophe. But the two leaders agreed only to continue talks to bridge the gaping differences in their positions: House Republicans continue to demand billions of dollars in federal spending cuts and budget reforms in exchange for raising the debt ceiling, while the White House and congressional Democrats refuse to negotiate over cuts and press for a “clean” increase in borrowing authority to cover past federal spending. The debate over federal spending will heat up when the White House sends its fiscal 2024 budget proposal to Capitol Hill on March 9.
With Social Security and Medicare apparently off the negotiating table, Republicans could push for severe cuts in funding for a wide range of federal programs including Medicaid, nursing and health professionals education, and student loan repayment. Legislators have also raised the idea of demanding work requirements for Medicaid and nutrition programs and rescinding approved but unspent COVID-19 relief funds as part of a possible debt limit deal.
COVID-19 Federal Emergencies to End on May 11
Nearly three years after they were first declared in response to the spreading COVID-19 pandemic, President Biden informed Congress on January 30 that he will end the twin national emergency and public health emergency designations on May 11. The move will significantly restructure the federal response to the virus as an endemic public health threat that can be managed through agencies’ normal authorities.
Millions of people are at risk of losing health insurance through Medicaid as federal protections that kept people covered during the pandemic come to an end. Those protections were once tied to the public health emergency, but Congress decided in December to phase them out separately. States can start dropping people from Medicaid and Children’s Health Insurance Program coverage as early as April if they no longer meet eligibility requirements. The Department of Health and Human Services plans to open a 16-month special enrollment period that will allow people who lose their Medicaid coverage to enroll in an Affordable Care Act marketplace plan throughout the eligibility re-determination period.
The end of the public health emergency could have a significant impact on nursing practice since many of the federal and state waivers of rules restricting practice were tied to the emergency designation. Congress extended most telehealth flexibility through next year, but policies waiving physician supervision and certification requirements for hospital admissions, critical access hospitals, federally qualified health clinics and rural health clinics, and skilled nursing facility visits are likely to be lifted with the emergencies end – unless Congress intervenes to retain them. |
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