Not that that it was a ut happened in milwaukee is still progressing to this day, still thriving to this day, and landed back in, beautiful words. That was the outcome there. There may be people im sure there are people will break away briefly from this program to keep our over 40 your commitment to covering congress to retake your life now to the floor of the u. S. Senate where lawmakers are holding what we believe will be a brief session today. No votes are expected. The appropriation for the department of health and Human Services. The food and Drug Administration is an agriculture appropriations bill ive never been quite been times. Will do the American History to tv. If theres not some resolution either continuing resolution maybe they come to some kind of a deal on these spending bills thin piece of the department of health and Human Services will cease to function until they figure out how to find them here the department of health and Human Services is one of the departments where most things continue even in the absence of appropriations because so much of the spin is what we call mandatory spending and thats not affected by the appropriation deadline. What is in the health and Human Services budget just remind folks were trying to understand these 12 big bills that move through and what pieces their interest in watching for. The big pieces in the hhs appropriations National Institutes of health, centers for Disease Control and prevention, all of the Mental Health organizations, organizations, parts of it that actually provide medical care through Community Health centers and other places. There are a lot of what we call Discretionary Spending that runs through that bill and it would be impacted if congress doesnt come to some sort of Funding Agreement at the end of september, this might be a good time to do one on one between major spending and Discretionary Spending and how that plays out amid the budget battles that happen every year. Mandatory Spending Continues unless Congress Changes it. Im like the appropriations that has to be proved every year or funding stops, mandatory programs go until congress affirmatively stops the funding. Medicare, medicaid, Social Security, the obamacare subsidies, most of the chip program, Childrens Health insurance program. Those are all mandatory and those would continue even if there is a spending impasse which it looks conceivable there will be a trend is congress trying to affirmatively stop funding for any of these mandatory programs . Guest not in the next two months. Which is not to say they may not end up there at some point but right now there is no, were talking mostly, the fight currently is about the spending bills mostly and also about some of these authorizations for some of these spending programs that are going to expire at the end of september. The important difference though is if the authorizations are not finished at the end of september doesnt mean funding stops for those programs are, in fact, my favorite little factoid that federal Family PlanningProgram Title x has not been reauthorized since 1984. Its continued to get funding. Congress has tried any number of times but never managed to agree since the 1980s now that program should be authorized. Host can we do 101 on authorization verse appropriations . Guest the description people like to use it as authorization to putting money in the Checking Account at appropriation for spending the money from the Checking Account. The authorization sets the outline for what things should be, what federal funds should be spent for what types of things. Policy is supposed to go in the authorization bill thats why they often get bogged down because there are fights about policy. The spending for ts are supposed to be just for the money but there are ways to put policy writers into the spending bills and that is what comes up the works when the spending bills dont get done in time. Host what our policy writers that you are attracting that could be coming up the works in the next few months . Guest the most famous of a an issue this year is the Hyde Amendment which is been in the hhs bill since 1980s with the late henry hyde republican if illinois famous antiabortion member of congress and it bars most federal funding for abortion. Over the years that is been admitted sometimes to allow exceptions for rape and incest, sometimes not. There have been various iterations of that that basically that bill had carried the Hyde Amendment since the 1970s because neither side has had the votes to change it there been efforts to make a stronger or weaker, even take it out and basically you would need 60 votes in the senate to do that and there is never been 60 votes on either side of this issue. Host another policy issue we talked about is efforts to stop federal funding for transgender care. Where does that stand right now . Guest thats one of the big writers of this year. Just as they are height and limit type amendments, language in several different appropriation bills, not just on hhs, there are gender affirming bands in several different appropriation bills because you can see how some of the speg bills go to other departments but there giving healthcare adjacent services or Actual Health care kind of services that are sometimes funded through the defense bill or Veterans Affairs bill that have their own healthcare program. There are things being attached to somebodys other bills here its not just the hhs bill, and how big is the hhs bill . Guest i havent looked in, meaning many billions of dollars but it is a small segment of hhs suspended because so much of hhs spending particularly medicare and medicaid is mandatory. Host the defense spending is the biggest Discretionary Spending part of the bill. What are the healthcare issue in the defense bill your tracking at tff health news . Guest we are tracking this for not just the spending bill but this change in policy by the Biden Administration to allow Service Women and family members who are stationed in states where abortion is barred, therey would be allowed to pay for the travel and time off for women to go to another state to get that care and obviously senator Tommy Tuberville is famously holding up pretty military motion need to come to the senate i sorta expect it to get tied up in the Defense Authorization bill that just got through the house and the the senate. I imagine it will type the defense spending bill. Host where does that stand right now . What is your read on that standoff and if they can come to agreement. Guest i dont know where that will end up here this is an issue because this is the first year we had abortion banned in many states. That had not been an issue here itd been issue with some overseas spending about servicewomen in countries where abortion was banned. That had been fought over for many years so this is obviously going to affect many more people who will be seeking those services because there are now so many states where members of the military and people dont have any choice about where they are sent. Host a lot going on on the healthcare front in the next two months on capitol hill when Congress Returns ahead of the september 30 deadline at the end of the fiscal year. Julie rovner here of Kff Health News to help us break it all down. A good time for your calls if you have questions on federal health care policy, republicans, so i was putting the light regionally. Easter central time zones it is 2027488000 here if youre in a mountain or specific time zones 2027488001. She is with us until the end of the program the next half hour this morning chocolate and start calling in. For what the health view assuming that it picked up that podcast at what is going to fight if they had over there . Guest i have basically many about a dozen and a half female Health Reporters from around d. C. , in some cases around the country and we get together every thursday and talk about the weeks weeks hy news. Its fine and it is a good listener. Host what are you going to be talked about this week . Guest a lot of what were talking about, or congress to answer many of these Health Issues that either need to get done or in some cases congress would like for them to get done spiritually to talk about this. Theres a lot of effort on drug prices, a number of congressional committees in both the house and senate are working on this issue. Its something they would like to get finished before the session of congress is done. Host if viewers want to pick up what the health compared to the go traffic anywhere they get the podcast. Host this is me looking up numbers, 127. 3 billion was what hhs asked for on its discretionary side in fiscal 2023 but then 1. 7 trillion in mandatory spending. Bring that back and explain what the much smaller number is and with a much bigger number is. Guest the bigger number is mostly medicare and medicaid. The discretionary part, the biggest piece of the disclosure park against the National Institutes of health, the centers for Disease Control and prevention, the fda which is in the hhs budget request because the fda as part of the department of health and Human Services but gets funded through the agriculture appropriation, the food part of the food and Drug Administration that would be part of that. Host in reading the steps we just topped line for hhs ngc 2. 95 trillion in fiscal 2023 in spending and you see the number and gets a project to break it down by mandatory discretionary. Guest right spirit valerie is in saginaw, michigan, you are on with julie rovner. Good morning, good morning. I hope im ontopic but i think its almost criminal to expect women to cheat themselves desperate keep themselves in Good Condition to fight for our country when we are taking the right to get paid for travel, not for the abortion but for travel. To be reimbursed for their travel. And i would like to know how much money is being diverted out of medicare into Medicare Advantage, if she knows anything about that . Because that is a program that needs investigating. It has nothing to do with medicaid. It is private Insurance Companies. Can you answer that, please . Guest two different issues there obviously that was a good description of the fight going on in the military over abortion and other Reproductive Healthcare that may be difficult to get there is not just abortion. A lot of the states with abortion bans come theres other kinds of healthcare women can get because doctors have left the state or because their pregnancies that e pregnancies that are going wrong and its difficult the doctors dont know whether they can be prosecuted for care other than abortion. So that is a big issue. As we mentioned being fought out in several different venues and corridors. The Medicare Advantage issue, the call is correct as a private alternative to medicare. Not to medicate the theres manage caitlin medicaid but it is just a medicare is increasingly popular because people who are joining medicare are increasingly used to being in managed care plans and Medicare Advantage often offers extra benefits to people, things like vision care and dental care and so a lot of people want to join it although it is and we at Kff Health News have investigated this a lot. There is some wastage. Companies are making profits off of basical a government program. They are not just giving extra benefits to the beneficiaries. They are also keeping some for themselves. Host about how many people or how big is Medicare Advantage versus medicare . Guest almost half. Its great right up towards half. Its a big deal in terms of how much you spent. There the big fight in the early 2000, actually in the late 1990s because there was so much overpayment going on congress cut it back as part of the big balanced budget act and the plants all started leaving because he could make any money. The republicans a 2003 with that that addictive Prescription Drug bill started to give them enticements but again they started overpaying for him so theres been this overpayment underpayment trying to get the payment right really over the last 25, 30 years, is that hello Medicare Advantage has been around for three more than that. Since 1980s, why did they create in the 80s . Guest because republicans created in the 1980s there was the hope managed care could provide better care at a lower cost. That is still the hope of managed care and in some cases it cant in some cases it hasns entered the idea was we should try, let these companies see if they can take, originally they were paid 95 of what patients would have spent in the regular Medicare Program the company said we can take that 95 and make the care so efficient that we can actually make a profit answered medicare money. That hasnt always happen but that was the origin of the program. Host independents kentucky, sandra. Good morning, good morning. I dont know if she knows about this but i would like to ask you about prescription costs, if there is anything been done or are they doing anything at all in congress about prescription costs because i am on xarelto because that blood clots in my legs im 78 years old, and its costing me over 400 for xarelto which is a blood defender to keep from getting blood clots. I dont make that much pension or Social Security so its very costly for me its not just me. Im sure its a lot of people in my same shoes. They always talk a good story but and never do anything about it. Thank you. Guest the caller is exactly correct. This is a big issue Prescription Drug prices when you go out and ask the public what are the most interested in having policymakers address, always near the top when you talk about healthcare. Weve seen action this year as a vision from a number of committees mostly looking at that pbm system, pharmacy benefit managers but they were created as he said they could negotiate with Drug Companies and get a better deal for the Insurance Companies but thats how they started but everything that the pbms do is basically opaque that nobody knows how they operate, how much money they keep, whether sometimes they are actually encouraging the Insurance Companies to buy more expensive drugs because they get a bigger cut of that than less expensive drugs theres a lot of pbm transparency legislation that is bipartisan thats moving through the house and senate. One of the Things Congress would like to get done when they come back in the fall weather they will, even though its a bipartisan issue drug prices are bipartisan if you come pbm reform is a bipartisan issue. Theres pieces that the pbm industry doesnt like in the drug industry may not like advair are still very powerful. May be these things will make a cross of insight is not a sure thing. Host we did we start having pbms, the pharmacy benefit managers and why was it created . Guest in the 19, i think the making 90s. We were first aware in the 1990s and again as i said they came in to say to Insurance Companies we can negotiate separately with the Drug Companies, get you a better deal. Very much like Medicare Advantage with the pbm said we can make money off of our cut and save you money and it is a winwin for everybody and it has always been that way. Host what did you think when the pbm executives on capitol hill earlier this year and are sitting alongside some of these a drug Company Execs and which with the fingers were being pointed . Guest always at each other its a big problem and its over somebody elses, somebody elses fault all of these problems. Host who did the members agree with . Guest the members were maybe a bit confused but it is hard to tell and thats part of why they are working on transparency legislation because its really hard to figure out some of these business relationships pick what we seen over the years is the Insurance Companies have bought the pbms so the pbms are no longer independent. Many of them belong to Insurance Companies picked up the largest ones belong to Insurance Companies but now they are captive and it really is hard to know whats going on and i think members of congress in both parties are very frustrated about this because they are getting calls like we just heard of people have drugs they have to take to stay healthy come to stay alive in som