Federal Issues - Budget and Appropriations 

Updated 4/20/2011

• House Passes FY12 Budget Resolution
  On 4/15/11, the U.S. House of Representatives passed a $1.019 trillion fiscal year (FY) 2012 budget resolution along party lines, 235-193, with no Democrats backing the bill and only four Republicans opposing it. The legislation, which is below the $1.121 trillion discretionary request included in the president’s FY12 budget request, was approved following the rejection of a number of alternative budget resolutions. Sponsored by House Budget Chairman Paul D. Ryan (R-WI), the spending measure also calls for an overhaul of Medicare and sets forth budgetary levels through FY21. The U.S. Senate’s Budget Committee is expected to release its FY12 budget resolution in May.

• On 2/14/11, President Obama proposed his administration’s fiscal year (FY) 2012 budget that would provide $3.7 trillion in discretionary spending, not including military operations. President Obama is proposing a five-year “freeze” on spending for non-security programs, limiting it to levels as provided in fiscal 2010. Some agencies and programs will see spending increases under the plan, while others are frozen or cut.
  
  The President’s budget proposes $79.9 billion in discretionary spending for the Department of Health and Human Services (HHS), a slight increase over FY10.  The administration increased the health professions programs - Title VII funding increased by $19 million (76%) to $449.5 million - the Training for Primary Care Medicine and Dentistry Program was level funded at $140 million, a 259 percent increase over FY2010; and the Centers of Excellence and Health Careers Opportunity Program were level funded at $25 million and $22 million, unchanged from fiscal 2010.  The National Health Service Corps benefited from an increase in funding with the President allocating a total of $418 million (+$249 million) through both the ACA and budgetary expansions; Community Health Centers received $2.1 million in additional funding to total $4.3 billion dollars distributed over 2011 and 2012; and the National Institutes of Health received a $745 million increase to $32 billion with the National Center for Complementary and Alternative Medicine receiving $131 million, a $2.16 million increase.  In order to maintain a $5,550 maximum Pell award, the FY2012 budget cuts Pell “year-round” grants and eliminates subsidized Stafford loans, which currently provide students with non-accruing interest loans. At the same time, $2.5 billion is budgeted for Perkins loans.  In addition, the President requested $10 million for the Teaching Health Center Development Grants; $78 million, an increase of $17 million from FY10, for the Office of the National Coordinator for Health Information Technology as well as a 2 year patch through 2014 to the Medicare sustainable growth rate (SGR), the formula that determines physician payment on the Medicare fee schedule.

• President Signs Payroll Tax, Includes Temporary SGR Fix
  On 12/ 23/11, President Obama signed into law the Temporary Payroll Tax Cut Continuation Act of 2011 (PL 112-078) which extends the SGR, along with the payroll tax holiday and unemployment compensation through 2/29/12. The two-month SGR extension freezes Medicare physician payment rates at 2011 levels and avoids a 27.4 percent cut, which would have gone into effect 1/1/12.  The president signed the measure after the House and Senate approved it by unanimous consent 12/23/11.  The law provides only temporary relief for physicians as they are now faced with another looming deadline in which their Medicare payments could be reduced.
  
  A House-Senate bipartisan conference committee has been established to negotiate a package that would extend the payroll tax cut, including the physician payment provision, through the end of 2012.  The committee is scheduled to begin its work this month.  House Ways and Means Committee Chairman Dave Camp (R-MI) will chair the committee.  On the Senate side, conferees appointed include, Sens. Kyl (R-AZ), Crapo (R-ID), and Barrasso (R-WY.), Finance Committee Chairman Baucus (D-MT.), Cardin (D-MD.), Reed (D-RI), and Casey (D-PA).  On the House side, Reps. Levin (D-MI.), Becerra (D-CA), Van Hollen (D-MD), Waxman (D-CA), Schwartz (D-PA), Brady (R-TX), Ellmers (R-NC), Hayworth (R-NY), Price (R-GA.), Reed (R-NY), Upton (R-MI), and Walden (R-OR).

• President Signs Stopgap Bill into Law to Avoid Shutdown
  On 10/4/11, President Obama signed into law a stopgap bill which funds the federal government through November 18. Earlier that day, the U.S. House of Representatives approved the bill, by a vote of 352-66. This was the second measure the House voted on – the first vote took place on 9/29/11, funding the government through 10/4/11, giving the chamber time to vote the following week on the longer-term measure.

• On 2/1/10, President Obama proposed his administration’s fiscal year 2011 budget that would provide $1.16 trillion in discretionary spending, not including military operations in Iraq and Afghanistan.  President Obama is proposing a three-year “freeze” on spending for non-security programs, limiting it to the $446.3 billion provided in fiscal 2010. However, some agencies and programs will still see spending increases under the plan, while others are frozen or cut.

• The President’s budget proposes $911 billion for the Department of Health and Human Services (HHS), a $51 billion increase over FY10.  The administration increased the health professions programs by $33 million to $995 million - the Training for Primary Care Medicine and Dentistry Program was level funded at $54 million; and the Centers of Excellence and Health Careers Opportunity Program were level funded at $25 million and $22 million.  The National Health Service Corps benefited from an increase in funding with the President allocating $169 million (+$27 million); Community Health Centers received a $290 million increase to $2.48 billion dollars; and NIH received a $1 billion increase to $32.2 billion with NCCAM receiving $132 million, a $3 million increase.  The budget also includes $371 billion for physician payment over the next 10 years, an estimate based on past Congressional actions.

• President Signs Continuing Resolution for Remainder of FY11
  On 4/15/11, President Obama signed into law a continuing resolution (CR), H.R. 1473, to fund the government for the remainder of fiscal year (FY) 2011.  The legislation, which includes cuts of approximately $40 billion from current spending levels, passed the U.S. House of Representatives 260-167.  Shortly thereafter, the U.S. Senate passed the bill 81-19.  This spending measure, which is the eighth CR passed in the current FY to continue federal funding, reduces funding for community health care centers by $600 million to $1.6 billion and includes some additional cuts to health-related programs.

• President Signs Stopgap Measure to Avert Government Shutdown
  On 4/9/11, the President signed into law a one-week continuing resolution (CR), narrowly averting a government shutdown on April 9th.  The CR will extend federal funding through April 15th, allowing time for a spending measure to be drafted for the remainder of FY11.  The spending measure is expected to be taken up this week.  The legislation, which includes cuts of an additional $2 billion from current spending levels but continues funding for most federal programs at FY 2010 levels, was cleared by the U.S. Senate on 4/9/11 and approved by the U.S. House of Representatives shortly after.  This spending measure is the seventh CR passed in the current fiscal year to continue federal funding.

• President Signs Three-Week Continuing Resolution
  On 3/18/11, the President signed into law a three-week continuing resolution (CR) to avert an impending government shutdown on March 18.  The CR will extend federal funding through April 8.  The legislation, which includes cuts of an additional $6 billion from current spending levels but continues funding for most federal programs at FY 2010 levels, was cleared by the U.S. Senate on 3/17/11 and approved by the U.S. House of Representatives a couple of days prior.  This spending measure is the sixth CR passed in the current fiscal year to continue federal funding due to Congress’ failure to pass the 12 regular appropriations bills for FY 2011.
  

• Senate Rejects Two Spending Measures to Continue Funding for Federal Government
  On 3/9/11, the U.S. Senate rejected two proposals to fund the government through the rest of the fiscal year.  The Senate first defeated H.R. 1, which was passed by the Republican-controlled House of Representatives, by a vote of 44-56.  This bill would have cut more than $60 billion from current government spending.  Then the Senate rejected a substitute amendment, cutting $4.7 billion, offered by Senate Appropriations Chairman Daniel K. Inouye (D-HI) by a vote of 42-58.  Each measure required 60 votes to pass.  The current continuing resolution extending federal funding for FY 2011 will expire on March 18.

• Congress Passes Two-Week Continuing Resolution
  On 3/2/11, the President signed into law a two-week continuing resolution (CR) to avert an impending government shutdown on March 4 which will extend federal funding through March 18.  The legislation, which includes cuts of more than $4 billion from current spending levels but continues funding for most federal programs at FY 2010 levels, was cleared by the U.S. Senate earlier in the day and approved by the U.S. House of Representatives on 3/1/11.  This spending measure is the fifth CR passed in the current fiscal year to continue federal funding due to Congress’ failure to pass the 12 regular appropriations bills for FY 2011. 

• House Approves FY11 Spending Measure
  On 2/19/11, the U.S. House of Representatives approved a measure, by a vote of 235-189, to fund the federal government for the rest of the current fiscal year, cutting more than $60 billion in spending from FY 2010 levels for numerous federal programs and agencies. The bill also prohibits some federal spending for implementation for the health care reform law. In addition, the measure includes an amendment that would temporarily bar the U.S. Education Department from enforcing a rule, which would prohibit the department from using federal funds to enforce its proposed "gainful employment rule" in the 2011 fiscal year, which ends September 30. There were over 500 amendments offered, in which the House voted on nearly 70 amendments and rejected just over 50. The Senate is expected to consider the measure the first week of March. Funding for the federal government is scheduled to end on March 4.

• President Proposes Five-Year Spending Freeze
  On 1/25/11, President Obama, during his State of the Union address, proposed a five-year freeze on non-security discretionary spending, which he said would save more than $400 billion over 10 years.  The President vowed to protect major provisions of the health reform law; however, he stated support for minor changes, such as revoking a provision imposing a tax reporting requirement on businesses.  The President is expected to unveil his FY 2012 budget during the week of February 14.

• House Passes Measure Reducing Non-Security Spending
  On 1/25/11, the U.S. House of Representatives passed a measure, by a vote of 256-165, directing  Budget Chairman Paul Ryan (R-WI) to set a discretionary spending cap for FY 2011 that assumes non-security spending at fiscal year 2008 levels or below.  House Republicans were joined in supporting the measure by 17 Democrats.  The current continuing resolution expires March 4.

• Congress Passes Continuing Resolution through March 4
  On 12/22/10, the House of Representatives approved, by a vote of 193-165, a continuing resolution (CR) allowing continued government operations at current levels for most programs through 3/4/11.  The Senate approved the measure 79-16 before it passed the House.  It was the fourth CR passed in the current fiscal year to continue federal funding at FY 2010 levels due to Congress’ failure to pass the 12 regular appropriations bills for FY 2011.  The most recent CR does not include increases for most programs under the U.S. Department of Health and Human Services.

• President Obama Signs Temporary SGR Fix
  On 12/15/10, President Obama signed into law the Medicare and Medicaid Extenders (H.R. 4994) bill delaying a 25% cut in Medicare reimbursement for physicians for one year, which was scheduled to take effect on January 1, 2011. The measure passed the Senate on December 8 and the House of Representatives on December 9.  The act is paid for by modifying policy in the health care affordability tax credit in the health reform law.

• On 9/29/10, the House of Representatives approved, by a vote of 228-194, a continuing resolution (CR) allowing continued government operations at current levels for most programs through 12/3/10.  The Senate approved the measure 69-30, several hours before it passed the House.  The CR was necessary because Congress had not approved the 12 regular appropriations bills for FY 2011, which began on 10/1/10.  Congress failed to address the impending Pell grant shortfall by denying White House requests to add funding in the CR for the Pell grant program, which helps low-income college students pay for school.

• On 7/29/10, the Senate Appropriations Committee approved its fiscal year (FY) 2011 Labor-HHS-Education appropriations bill by a vote of 18-12.  The bill includes funding increases for both Title VII and Title VIII programs, with Title VII receiving $356 million and Title VIII receiving $292 million.  Health professions programs received funding increases, including  $90 million, an increase of $51 million for primary care training activities; approximately $48 million for oral health care training, an increase of $15.1 million; and a total of $57.9 million, an increase of $20 million, for public health workforce training.  The bill also provides $32 billion for the National Institutes of Health, $5.1 million to fund a newly authorized Rural Physician Pipeline program to create opportunities for primary care physicians to train in rural areas, and maintains funding for the Agency for Healthcare Research and Quality at the FY 2010 level.  On 7/15/10, the House of Representatives Appropriations Subcommittee on Labor-HHS-Education approved its spending bill; however, the House has taken no further action on the bill.