Axios Pro: Health Care Policy

November 28, 2023

Axios Pro Exclusive Content

Happy Tuesday, gang. Abortion policy isn't the only controversy hanging over the House Labor-HHS appropriations bill — and we've read through the text to come up with a list of poison pills that could sink the spending package.

  • Plus, there are hearings ahead this week on AI in health care and trust in the CDC.

1 big thing: The HHS bill's other poison pills

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, Victoria reports.

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 CDC and a $3.8 billion cut to the NIH.
  • 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 additionally 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.
  • And there's a set of much-discussed anti-abortion provisions, including Hyde Amendment language preventing taxpayer funding from being used for abortions.

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 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" studies that manipulate 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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