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HHS bill's poison pills extend beyond abortion

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Nov 28, 2023

Illustration: Caresse Haaser, Rebecca Zisser / Axios

While anti-abortion provisions loom large in House Republicans' Labor-HHS bill, poison pills dealing with public health funding, gender-affirming care, family planning and gun violence could just as easily sink the package.

Why it matters: Always among the toughest spending bills to pass, the House FY2024 package is loaded with contentious policy riders that are certain to be rejected by the Senate, which advanced a bipartisan HHS funding bill out of the Appropriations Committee in July.

Driving the news: The House narrowly approved the rule for debating Labor-HHS before the Thanksgiving break, then punted it past the holiday after conservative hardliners scotched a procedural vote on a different spending bill.

  • The House bill has gone through multiple revisions since appropriators advanced it along party lines in July. Many of the added policies could further divide an already fractious GOP caucus.
  • The Labor-HHS package as it stands calls for a 12% overall budget cut for the Health and Human Services Department, an 18% reduction for the Centers for Disease Control and a $3.8 billion cut to the National Institutes of Health.
  • There's also a 9% cut to the Ryan White HIV/AIDS program, and an elimination of funding for former President Trump's "Ending the HIV Epidemic" initiative.
  • The bill would also eliminate federal Title X grants to family planning clinics including Planned Parenthood — a long-held conservative priority that would eat into contraceptives, pregnancy tests, infertility services and STI tests.

The package also would cut funding for programs on maternal health, STI research, chronic disease prevention and public health preparedness.

  • Gender-affirming medical care is also targeted with a proposed federal funding ban that would prevent Medicaid and Medicare from covering surgical procedures or hormone therapies.

What they're saying: The cuts for health agencies may be particularly hard for moderate Republicans in competitive districts to swallow, despite continuing scrutiny of the CDC stemming from the COVID response.

  • "I don't recall a time when members have been asked to vote for such deep reductions on this bill," Jim Dyer, a senior adviser at Baker Donelson and former longtime staff director for House Appropriations Republicans, previously told Axios.
  • "This bill [Labor-H] is a hard bill anyway, but when you knock it down 40% or whatever, you're going to have a lot of difficulty with moderates," Dyer added.
  • Rep. Tom Cole, vice chair of the Appropriations Committee, recently told Politico that if the Labor-HHS bill had been put on the floor before Thanksgiving it would have "lost a lot of votes" among Republicans. "The cuts are really big. It's hard to move," he said.

The bill is loaded with other policy riders that reflect conservative priorities but are likely to draw pushback, including:

  • Language blocking funds to implement a proposed HHS rule that builds on the Affordable Care Act to bar discrimination in certain government health programs on the basis of race, color, national origin, sex, age or disability.
  • A provision blocking HHS from declaring a public health emergency that would result in gun control or restricting a "citizen's Second Amendment right." No funds in the bill could also be used to promote gun control.
  • Language that would block federal funding for the World Health Organization, to implement vaccine or mask mandates, or to enforce President Biden's nursing home staffing rule.

Don't forget: The bill also has a set of anti-abortion provisions, starting with Hyde Amendment language preventing taxpayer funding from being used for abortions.

  • Funding for any post-graduate medical training programs requiring abortion training would also be deleted, if there isn't an "opt-in" option.
  • And it would prevent funds from being spent on two Biden executive orders designed to maintain access to reproductive health services.
  • These are likely to test Republicans' willingness to continue pressing on an issue that's proven to be a consistent loser for them at the polls.

The intrigue: There are provisions the GOP could still rally around, such as a section that would strike U.S. funding for research in China and "gain-of-function" research that manipulates dangerous pathogens.

What we're watching: Whether Speaker Mike Johnson pushes ahead and brings the bill to the floor or picks a legislative route that's less likely to air out his caucus' differences.

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