Legislative Update 11/29/21: Government Funding, Build Back Better Act, and Pediatric Mental Health

US capitol

This is the legislative update for November 29, 2021. View all updates here.

The November 29, 2021 legislative update includes highlights from both federal and state legislatures.

Federal Updates

Senate and House Focus On Funding Following Thanksgiving Break

The Senate returns today from Thanksgiving break. The House is back on Tuesday, November 30.

At the risk of being repetitive, this is shaping up to be the busiest December in years.

With only four days before government funding runs out on Friday, December 3, lawmakers returning to the Hill will be prioritizing this funding. Rumor has it that House leaders will introduce a stopgap funding bill (Translation: a temporary budget that will keep the government running and avoid a shutdown) on Tuesday, November 30 when they return from the Thanksgiving Holiday. The short-term funding measure is expected to run through mid-January. A floor vote is possible by Wednesday.

Senate Majority Leader Chuck Schumer will need an agreement with Senate Minority Leader Mitch McConnell to get the continuing resolution (CR) through the chamber by week’s end — but that isn’t expected to be a major problem. With 2022 being an election year, a government shutdown is highly unlikely.

Prior to finalizing any CR deal, there are some outstanding issues that have to be dealt with first, including:

  • Funding for unaccompanied children taken into US custody at the southern border
  • Money for Afghan refugees held overseas at American military bases

Congress must also pass a debt-ceiling limit bill by December 15 — otherwise, the US is at risk for defaulting on its debt. The vehicle to pass this re-authorization is unlikely the Build Back Better (BBB) Act, as it would add even more polarization to an already challenging effort.

The Build Back Better Act

Speaking of the Build Back Better Act, the bill would need to pass by December 31 under existing reconciliation rules (Translation: A bill can pass in the Senate with a simple majority of 51 votes or only 50 votes — and the Vice President acts as tiebreaker.)

There are a number of key provisions in the omnibus bill that will impact children and families:

  • 12-month continuous eligibility for children and new mothers enrolled in Medicaid
  • Permanent extension of Children’s Health Insurance Program (CHIP)
  • A $200 million boost to Children’s Hospital Graduate Medical Education (CHGME)
  • Another year with the child tax credit increase — a provision of the first COVID relief bill
    • Supporters increased the tax credit to $3,000 per child ages 6 to 17 years old and $3,600 per child 5 years old and under.
  • The nation’s first paid family leave program, allowing workers to take time off for childbirth, to care for a new child, or to deal with a serious health issue of a family member
    • The proposal began with 12 weeks of paid time off but is now pared down to four weeks.
  • Universal prekindergarten for all children who are 3 and 4 years old
  • Child-care subsidies for parents earning up to 150% of the state’s median income (about $115,000 nationally) to pay no more than 7% of their income on child care, with the poorest families getting free child care
    • Additionally, the bill includes a proposed tax credit for as much as half of a family’s spending on child care, up to $4,000 for one child or $8,000 for two or more children.
  • Expanding Medicaid in about a dozen states and providing subsidies that reduce the cost of plans in the Marketplace — Nebraska has already expanded
    • Congressional Budget Office (CBO) predicts the number of uninsured will reduce by nearly 4 million.

Last Thursday, House Minority Leader Kevin McCarthy (R-Calif.) held an eight-hour speech on the House floor — the longest in history — in opposition to the bill. The bill prevailed on a narrow partisan vote. The Senate will face an even more formidable pathway for passage, and it is taking the back seat to the other looming deadlines.

Supreme Court

On November 30, the Supreme Court will hear arguments seeking to reverse cuts to the 340B Drug Program.

The 340B Drug Pricing Program provides financial assistance to hospitals that serve vulnerable communities, in order to manage the rising costs of prescription drugs. The program requires pharmaceutical manufacturers that participate in Medicaid to sell outpatient drugs at discounted prices to healthcare organizations — including children’s hospitals — that provide care for many low-income and uninsured patients.

Learn more about the 340B Drug Pricing Program.

The American Hospital Association (AHA) and providers that participate in the program are asking the high court to reverse a nearly 30% cut in 340B reimbursements the Centers for Medicare and Medicaid Services (CMS) initiated during President Donald Trump’s administration and continued under President Joe Biden.

While these cuts have not been applied to children’s hospitals, this is a critical issue to monitor as we advocate to preserve the intentions of the 340B Drug Pricing Program.

State Updates

Upcoming Lunch and Learn with NCHEA

The Nebraska Child Health and Education Alliance (NCHEA) is hosting a virtual lunch and learn on Tuesday, December 8 at 12 p.m. (CST). The virtual event will call attention to pediatric mental health statistics, concerns, and solutions.

With a legislative session just around the corner, we are targeting all local, state, and federal lawmakers with a call to action to address the mental health crisis in children, including Children’s two proposals.

Liz Lyons is chair of the alliance comprised of healthcare providers, child advocates, and schools and will be moderating the event. Mike Vance will be the keynote address as he presents mental health data and solutions on behalf of Children’s.

Register for the event here.

Updates From The Behavioral Health Policy Forum

The Behavioral Health Education Center of Nebraska (BHECN) hosted a Behavioral Health Policy Forum Monday afternoon.

This forum featured sobering statistics on the mental health crisis in Nebraska and offered insight into the upcoming legislative session with Senator John Arch, chair of Health and Human Services (HHS) Committee and Senator Jen Day, member of the HHS and Education Committees.

BHECN was created by the Nebraska Legislature in 2009 to improve access to behavioral health across the state with a focus on generating a strong workforce. They are deeply involved with providers, behavioral health regions, and the Legislature — among others — to address the mental health crisis.

During the panel, Senator Arch described how often he hears about the social challenges our youth continue to face in school. He cited an inherent anxiety and depression children are facing, and he believes the Legislature will be committed to focusing on at least the impact on children with American Rescue Plan Act (ARPA) funds.

Senator Arch predicts the chairman of the Appropriations Committee John Stinner will work closely with him and his HHS Committee to prioritize funding efforts. He anticipates the release of the Governor’s budget recommendations between now and the Governor’s State of the State remarks in early January.

Additionally, Senator Arch said the committee will be focusing on the ongoing investigation of St. Francis Ministries which handles child welfare for the eastern service area (Omaha). The HHS Committee and St. Francis Oversight Committee are required to issue a report of their recommendations and findings by December 15.

Youth Rehabilitation and Treatment Centers of Nebraska

Meanwhile, it was just announced that the Department of Health and Human Services (DHHS) will debrief a report given to the HHS Committee related to the Youth Rehabilitation and Treatment Centers of Nebraska (YRTC) for Kearny and Geneva. This is scheduled for December 17 but has not yet been posted.

(Sources: CHA, AHA, Congress.gov, Nebraska Legislature, World-Herald, Peetz & Co.)


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