Congress

Previewing Congress’s Terrible, Horrible, No Good, Very Bad September

by Matt Gontarchick

Lawmakers are facing a September like no other.  With only a dozen or days scheduled to be in person in DC, Members of Congress must address a $3.5 trillion “human infrastructure” package, a $1 trillion bipartisan infrastructure bill, last month’s expiration of the debt ceiling, and appropriations for Fiscal Year (FY) 2022.  Each of these major bills carries several steps of their own, including committee hearings, markups, and behind-the-scenes negotiation.  How will lawmakers on Capitol Hill make it through such a complicated month?

Calendar At-A-Glance

Here’s how the calendar sets up.

Okay, Let’s Break it Down

Reconciliation

So, the House committees are meeting to mark-up the $3.5 trillion human infrastructure bill, also known as the reconciliation bill.  Speaker Nancy Pelosi (D-CA) has expressed a desire to pass the entire reconciliation bill by October 1, punting her version over to the Senate.

But what about the Senate?  The Senate is out till September 13. Even though their version of the reconciliation bill is due September 15, the Senate has yet to schedule any committee hearings.  Remember too that the Senate committees are a 50:50 split, meaning it’s harder to pass partisan legislation like this out of committee.  This all leads us to believe that the Senate may only release concepts or principles around what will be included in the legislation to meet the deadline.

We expect that when the House passes their bill, the Senate substitute the bill with their own changes. The Senate floor process includes debate and likely another all-night vote-a-rama session.  With any changes the Senate makes to the bill, the House will have to vote again, meaning the reconciliation bill has a way to go before it reaches President Biden’s desk.

Bipartisan Infrastructure Bill

Speaker Pelosi issued a September 27 deadline for the House to vote on the bill as the Senate approved it by a 69-30 vote on August 10.  If the bill doesn’t get passed in time, the House will have to vote to extend the Highway Trust Fund, which is estimated to become insolvent by October 1.

Debt Ceiling

Oh yeah, and Congress will need to raise or suspend the debt ceiling to avoid the US from defaulting on its loans. Usually, lawmakers generally agree in a bipartisan manner to increase the debt limit, but Republicans have publicly stated they will not support raising the debt limit and could force Democrats to raise the debt limit in a partisan way and without any Republican support.  

Appropriations

Even though the House has passed 9 out of 12 appropriations bills, the work has just begun in the Senate.  This signals the likelihood that Congress will need to pass a continuing resolution before September 30th to keep the government funded past September. 

How Will Things Play Out?

Between a packed schedule, partisan differences in key legislation, and divisions among some Democrats, September is shaping up to be an unpredictable month for Congress.  Below are some key items to watch for.

Will the House pass the bipartisan infrastructure bill by September 27?

Speaker Pelosi announced the September 27 deadline per an agreement with a group of moderate House Democrats who didn’t want to vote on the $3.5 trillion reconciliation bill without voting on the bipartisan infrastructure bill first.  Many moderate Democrats are holding firm on this agreement to pass this bill, even if the Senate is not finished with their reconciliation bill. Therefore, the divide between moderates and progressives on how to move forward with the legislation could create more problems for the Speaker. 

Will Sinema and Manchin demand a lower dollar amount for reconciliation?

However, the main question that is still on everyone’s mind is will the Democrats unanimously support $3.5 trillion in new spending as moderates in both chambers have concerns around this high price tag.

Even though Senate Democrats unanimously approved the budget resolution, two key moderate Democrats have signaled an unwillingness to approve $3.5 trillion in new spending, thus raising doubts about the bill’s future.  In a statement issued after the budget resolution’s passage, Sen. Joe Manchin (D-WV) expressed “serious concerns about the grave consequences” facing Americans if Congress decides to spend an additional $3.5 trillion.  On August 23, a spokesperson for Sen. Kyrsten Sinema (D-AZ) said the Senator would simply not back a $3.5 trillion bill. As the next couple of weeks unfold, all eyes will be on both Senators as the negotiations are ongoing around the reconciliation bill.

September Is Only the Beginning

With September as thorny as it is, Q4 is shaping up to be the biggest legislative fall in a number of years.  And just when they figure out these massive domestic policy issues, 2022 will be just around the corner, and with it a quick transition to campaign season for the midterm elections.

Telehealth

The Government’s Ambitions Plans to Grow Broadband Access

by Matt Gontarchick

A major barrier to widespread telehealth adoption in the United States is lack of access to broadband internet.  While telehealth utilization has surged since the start of the COVID-19 pandemic, telehealth’s potential for growth is limited by lack of high-speed internet connections for both patients and providers.

However, not all Americans have access to broadband.  A 2019 Federal Communications Commission (FCC) report found 21.3 million Americans, or 6.5% of the population, currently lack access to broadband.  Furthermore, a 2021 survey by BroadbandNow found 42 million Americans are unable to afford broadband without any assistance.  According to the Office of the National Coordinator for Health Information Technology, broadband service provides a higher-level speed of data transmission, which is particular important for live videoconferencing with health care practitioners.  Additionally, broadband allows health care providers to meaningfully use patient information, such as electronic health records, to improve patient outcomes. 

Fortunately, the federal government has taken some steps to boost broadband access. To help patients afford broadband access, the Consolidated Omnibus Appropriations Act, 2021 (P.L. 116-260) provided $3.5 billion to the FCC to establish a program to help low-income Americans get or stay connected to broadband.  The program is required to provide a $50 subsidy for qualified households who must include at least one individual who is eligible for the Lifeline Program, the Supplemental Nutrition Assistance Program, or a Pell Grant.

Providing direct government subsidies to individuals to access broadband looks likely to be part of an upcoming legislative effort to address the nation’s infrastructure needs.  The American Jobs Plan, the Biden Administration’s highly anticipated $2 trillion infrastructure proposal, high-speed broadband to every American, including the 35% of rural Americans who lack high-speed broadband.  Among the ways the Administration plans to achieve this include:

  • Providing individual subsidies to cover internet costs in the short-term and reducing costs through widespread adoption in the long-term.
  • Prioritizing support for broadband networks owned or operated by local governments, non-profits, and cooperatives.
  • Promoting transparency and competition among internet providers and requiring providers to publicly disclose prices their charge.

Direct subsidies are also included in the Leading Infrastructure for Tomorrow’s (LIFT) American Act.  Co-sponsored by all 32 Democrats on the House Energy and Commerce Committee, this proposal will provide a basis for House Democrats’ action on energy and broadband in the Congressional infrastructure bill.  The bill would grow high-speed internet access by:

  • Authorizing an additional $6 billion for the FCC program that provides a discount of up to $50 off the cost of monthly broadband service for eligible households. 
  • Providing $80 billion to develop secure broadband nationwide by funding connections to underserved rural, suburban, and urban communities.
  • Allocating $5 billion in federal funding for low-interest financing of broadband deployment.

While health care providers are already advocating for making permanent some of the Medicare and Medicaid flexibilities for telehealth enacted into law as the result of the coronavirus pandemic, they should be keen to keep an eye out for additional discussion and debate on broadband access.  Both the government’s recent actions to expand broadband and Democratic proposals to boost broadband even further suggest a strong desire to build out an infrastructure that will allow telehealth to flourish in a post-pandemic world.