Editor’s note: The blog will shift in the days ahead to more episodic publishing.
Members of Congress raced at the year’s end to avoid the consequences of a brutal snowstorm battering huge swaths of the country. Before hitting the holiday exits, lawmakers approved a whopping $1.7 trillion bill to fund the federal government through the fiscal year and until next fall, spending giants sums on guns over butter.
Those who drill down on military budgets will be better positioned to determine the wisdom of the $858 billion appropriation by Congress for the Pentagon. The 4,000-plus pages that detail the measure’s allocations included $772 billion for domestic spending, including, of note for those focused on health care, items such as:
- Changes related to regulation of the infant formula supply
- Extension of regulations to allow telehealth services
- Ensuring a steady, clear funding for a federal health program for Native Americans
- New authorities for how the Food and Drug Administration (FDA) regulates and tracks cosmetics
- Shifts in a much-disputed FDA mechanism, purportedly to speed helpful, innovative drugs to market
- And supposed improvements to the nation’s response to future pandemics
Policy experts also pointed out, though, that in health care terms, Congress also:
- Tackled issues related to Medicaid and who will be covered by the government program targeted to help the poor, working poor, children, the disabled, and the mentally ill. As the New York Times reported:
“The legislation includes a number of proposals that could greatly affect Medicaid eligibility, maintaining pandemic-era policies that protected children, mothers, and low-income Americans. But the bill’s passage could mean that millions of people who have been enrolled because of pandemic policies may lose access to the program next spring. Under current law, states are required to keep all Medicaid beneficiaries enrolled as the public health emergency continues, most likely until the spring or summer. Lawmakers are proposing that states be allowed to remove some program recipients beginning April 1, regardless of when the emergency declaration is lifted … The bill has profound implications for children, roughly half of whom are enrolled in Medicaid or the federal Children’s Health Insurance Program. It requires the programs to keep children enrolled for at least a year, regardless of any changes to the family’s income.”
- Declined to restore the much-praised child tax credit. This policy initiative, costing what some analysts estimated would have been $12 billion annually, died in the Senate and before the House took up the appropriation bill. Child advocacy groups, including the nonpartisan Annie E. Casey Foundation had reported, based on U.S. Census data, that the measure during its short life as part of coronavirus pandemic relief, had worked. Remarkably. “The nation’s child poverty rate dropped by half in 2021, from an estimated 10% in 2020 to a historic low of 5%.”
- Refused to fund the Biden Administration’s requests for further sums to battle the pandemic, especially with programs to develop vaccines and vaccinate more people with the latest booster targeting the Omicron variants. Public health officials have noted that this winter the country is battling a raging “triple-demic,” with hospitals jammed with cases of an early, especially virulent seasonal flu, the RSV respiratory illness, and a resurgent coronavirus. Republicans have called further efforts against the coronavirus unnecessary and demanded that the administration account in detail for federal funds spent over the months of the campaigning against the disease.
In the House, many members voted by proxy, having departed the District of Columbia, Maryland, and Virginia region in hopes of getting home before a frigid storm battered much of the nation. Final voting on the last bill of this session of this Congress also occurred on a Friday before Christmas. News organizations dedicated to reporting on health care had announced, holiday closures. Lawmakers interrupted their budget negotiating for a rare joint session of Congress featuring an address by the valiant leader of Ukraine.
Expect surprises to emerge about this appropriations bill, which is the latest example of how the Congress, deeply divided along partisan lines, barely functions, as critics say.
They note that what once was a deliberative body too often deadlocks in party-line ways, leading to deadline decision making and non-transparent, late-night dickering — not full airing of proposals’ pros and cons, as might better occur in congressional hearings and thoughtful investigations. Congress now jams as many of its concerns into disjointed and giant bills that members concede they too often lack time to read fully and to understand.
Journalists sought, in advance, to call attention to various, noteworthy aspects of the appropriation bill, into which lawmakers seemed to drop and add a myriad, divergent concerns with alacrity. Fueling the fiscal frenzy, of course, was the imminent political changes in the House. There, Republicans will take control with a fractious, slim majority — and with extreme elements of the party empowered and threatening to upend any order, including from their own partisan leadership.
Senate Republicans made clear, according to news reports, that they preferred to hold their nose and negotiate with Democratic counterparts, rather that even attempting to work with GOP members in the House. Traditional Republicans emphasized that they wanted to boost military spending, big time, which they did — as well as playing to their partisan base with a rollback of the coronavirus vaccine requirement for service members.
The difficulties in dealing with the GOP far-right showed clearly during the visit by Volodymyr Zelenskyy and congressional consideration of further U.S. funding of Ukraine’s war with Russia. Republican extremists boycotted the Ukrainian president’s speech or showed their disdain for him by ignoring him while sitting in congressional chambers. Zelenskyy, in the meantime, won multiple standing ovations and huge public praise. The extreme GOP objection to U.S. Ukrainian spending has baffled nonpartisan, independent foreign policy analysts, one of whom wrote of the, yes, billions expended, amounting to a minuscule part in one year of the gigantic, sustained American defense budget:
“[W]with no boots on the ground and little risk to U.S. lives … [t]he Ukrainian armed forces have already killed or wounded upwards of 100,000 Russian troops, half its original fighting force; there have been almost 8,000 confirmed losses of armored vehicles including thousands of tanks, thousands of APCs, artillery pieces, hundreds of fixed and rotary wing aircraft, and numerous naval vessels. U.S. spending of 5.6% of its defense budget to destroy nearly half of Russia’s conventional military capability seems like an absolutely incredible investment …”
Looking ahead to international and domestic policy making out of Washington, D.C., analysts are warning the public to buckle up for likely great turbulence. Is this any way to run a country?
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Health care in the richest nation in the world cannot be a privilege for the wealthy few. It must be a right for all. We can do this, in part, by battling nihilistic of cynical takes on what this country can or cannot do for its people. We can practice a reciprocal altruism, particularly with health coverage that shares the bankrupting burdens of ungodly expensive expansive and expensive medical services among a larger group of folks, rather than crushing individuals or families.
To protect our functioning democracy, we need our politicians to steer to the middle ground, declining to advocate for extremes that end up dividing us and excluding people from benefits that can be shared by all. Civil, temperate discussions are necessary in this process, along with a reliance of facts and evidence — not wild theories.
We have much work to do to ensure that our health care is all that we want and deserve.
