Policy Updates: Hill Happenings and Administration Activities

By Mike Weir February 20, 2018

Hill Happenings

Budget and Appropriations

In the coming weeks, the House and Senate Appropriations Committee leaders will allocate the new non-defense caps for FY2018 for each subcommittee. The Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Subcommittee members and staff will then work together to finalize FY2018 appropriations.

A side agreement among Congressional leaders allocates some of the new non-defense discretionary funding should be spent, earmarking money for infrastructure, the opioid epidemic, and other priorities. House Labor-HHS Chairman Tom Cole (R-OK-4) told reporters that the side agreement makes it more difficult to divide up the extra non-defense funding across the traditional 12 appropriations subcommittees because some priorities may be funded by more than one subcommittee if they fall under the jurisdiction of several subcommittees.

Appropriators have until March 23 to finalize the FY2018 appropriations levels. The Trump Administration provided Congress with a list of recommended changes they would make to FY2018 funding as a result of the two-year budget deal passed last week. Included was a partial restoration of cuts they previously proposed for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Appropriators are going to make a swift pivot to FY2019 as soon as FY2018 is finalized. An update on the FY2019 President’s Budget request is below.

House Appropriations Chair

A spokesman for Tom Graves (R-GA-14) announced Wednesday that the Congressman will join in the race for House Appropriations Committee (HAC) chair. Congressman Graves currently chairs the Financial Services Appropriations Subcommittee.

Four other senior members of HAC have already announced their intent to replace current chairman Rodney Frelinghuysen (R-NJ-11) when he retires at the end of his term. The current field of contenders includes: Congressman Robert Aderholt (R-AL-4), Kay Granger (R-TX-12), Mike Simpson (R-ID-2), and Tom Cole.

The Affordable Care Act

House Speaker Paul D. Ryan (R-WI-1) said Tuesday Republicans will continue with a piecemeal approach to repealing the Affordable Care Act (ACA). House Ways and Means Chairman Kevin Brady (R-TX-8) noted "there is strong interest" in overhauling the employer mandate among Ways and Means members, with the goal being to retroactively delay or repeal it.


More than 170 House Democrats asked Health and Human Services (HHS) Secretary Alex Azar to reject requests from states to require Medicaid beneficiaries to work. 

"Such actions to tie health coverage to work are motivated purely on the basis of ideology and mistaken assumptions about what Medicaid is and who it covers," the Democrats wrote to Secretary Azar. 


At a recent event, the U.S. Surgeon General offered advice for lawmakers on how to help support long-term recovery for people with an addiction, as Congress examines how to curb the opioid epidemic plaguing the country. Connecting people with support services, such as food and housing, pays off, Surgeon General Jerome Adams said. “We have to help law enforcement have a public health-informed approach to the way they tackle addiction, but we will never be able to remove law enforcement from the equation,” he said. “We’ve got to figure out ways to better partner with them.”

Administration Activities  

FY2019 President’s Budget Request

Last week, President Trump released his overall FY2019 Budget Request and the Health and Human Services FY2019 Budget in Brief, which detail topline budget requests. The Budget request calls for funding to fight the opioid epidemic, proposes strategies to address drug prices, requests Medicaid reforms and additional flexibility for Medicaid programs. The document, entitled “An American Budget,” proposes severe cuts to safety-net programs. The Budget also proposes eliminating parity between defense and non-defense discretionary spending and increasing defense spending at the expense of non-defense spending.

As the Budget request was written before the passage of the Bipartisan Budget Act, which increased spending levels for FY2019, the Office of Management and Budget released an addendum to the budget, detailing spending levels for the new funding. These addendum funding levels were included in the Budget in Brief and are included in program totals below. 

NASTAD put together this chart detailing available funding levels.

Opioid Epidemic

The Budget request includes $10 billion in new funding for the Department of Health and Human Services over five years. This funding will be targeted at increasing access to prevention and treatment, increasing availability of overdose-reducing drugs, increasing surveillance, improving research, and working on pain management.  Infectious diseases are not listed as a priority in this request, but NASTAD awaits more details.

Centers for Disease Control and Prevention (CDC)

The CDC has not yet released their Justification of Estimates for Appropriation Committees that present a detailed explanation of the President’s Budget Request for CDC. CDC released this chart detailing funding levels.

NCHHSTP New Demonstration Project

The Budget proposes a $40 million demonstration project on Infectious Disease Elimination, which will focus efforts in select states and jurisdictions at “high-risk for infectious disease, including those with high rates of opioid-related transmission. This new initiative will jointly support efforts to eliminate HIV transmission, viral hepatitis, sexually-transmitted infections, and tuberculosis.” It is unclear through what division this project will be funded. The White House released this fact sheet on the project, which does not include mention of hard reduction programs.

Health Resources and Services Administration (HRSA)

Ryan White Program

The HRSA Justification of Estimates for Appropriation Committees has not yet been released. The budget requests $2.26 billion for the Ryan White Program, a decrease of $59 million. The budget eliminates funding for Part F - Special Projects of National Significance (SPNS) and AIDS Education and Training Centers (AETCs).

The budget includes language about collaborating with Congress on a future Ryan White Program reauthorization:

The FY 2019 Budget also proposes to reauthorize the Ryan White HIV/AIDS Program to ensure that Federal funds are allocated to target populations experiencing high or increasing levels of HIV infections and diagnoses while continuing to support Americans already living with HIV across the Nation.

The proposed reauthorization will include data-driven programmatic changes and will simplify, modernize, and standardize certain statutory requirements and definitions to be consistent across the Ryan White Parts to reduce burden on recipients.

Congress is responsible for the reauthorization of programs and thus far there has not expressed interest in reauthorizing the Ryan White Program in 2018.

The Affordable Care Act

Idaho Governor C.L. "Butch" Otter is allowing insurers in his state to sell plans that don't fully comply with the ACA. On Wednesday, Blue Cross of Idaho became the first insurer to take Otter up on the offer, announcing it would sell five “Freedom Blue” plans that include limits on annual medical spending and charge higher premiums to people with preexisting medical conditions — all policies that are specifically prohibited under the ACA. On Wednesday, HHS Secretary Azar said he will uphold the ACA as long as it remains the law.

NASTAD in the News

His Health - Reducing the Risk of HIV for Black Men Who Have Sex with Men

“The National Alliance of State and Territorial AIDS Directors (NASTAD) partnered with the Health Resources and Service’s Administration’s HIV/AIDS Bureau to do something about the high rates of infection among black MSM. BLKHLTH interviewed Terrance Moore, Deputy Executive Director at NASTAD, to learn more about HIV in black men and the interactive online community, His Health.”

News Bulletin

How a Police Chief, a Governor and a Sociologist Would Spend $100 Billion to Solve the Opioid Crisis

“We asked 30 experts to think big, but realistically, about solutions. Imagine you had $100 billion to spend over five years — a little less than current federal domestic H.I.V./AIDS spending — to address the opioid crisis. Where would you put that money?”


NASTAD will host a webinar on March 5, 2018 from 3:00 PM to 4:00 PM EDT to discuss the latest updates on the appropriations process, other Administration updates, and NASTAD’s next steps.