The partial government shutdown is on its 31st day and there’s been little to no change in the landscape. Over the weekend, the President offered a proposal that was rejected by Democrats, leaving us about where we were last week. Just about all legislation that could pass Congress is on hold as this plays out, with federal workers expected to miss out on another paycheck this week. There’s no telling where this will end so long as both sides remain resolute. But the question remains if Democrats will not accept any proposal other than immediately re-opening the government, will Republicans concede or pressure Democrats to concede any ground.

The shutdown also slows down the regulatory process, creating a log jam of regulations in the pipeline. However, there are a number of regulations that must get out on time. Just last week CMS released the proposed 2020 Notice of Benefit and Payment Parameters, which sets the requirements for the 2020 ACA marketplaces. While much of this will play out off of Capitol Hill, the rule does seek a legislative fix to cost-sharing reductions payments, as well as an end to silver loading.

As for other happenings on Capitol Hill, we will get our first taste next week with hearings in the House and Senate. The Senate HELP Committee will focus in on Community Health Centers, which funding will need to be reauthorized before the end of the fiscal year. The House Energy & Commerce (E&C) Committee is expected to hold hearings on the Texas v. Azar decision as well as market stabilization efforts. And the House Oversight Committee is expected to hold a hearing on drug pricing. 

Medicaid Work Requirements

We can expect to see the E&C Committee examine Medicaid work requirements at some point this year as Arizona becomes the eighth state to incorporate work requirements into its Medicaid program. Arizona tried a number of creative workarounds, although some were rejected by CMS.

Arkansas is the only state where work requirements have taken effect, although New Hampshire and Kentucky are not far behind. The five other states – Arizona, Indiana, Maine, Michigan, and Wisconsin – will begin enforcing work requirements later in 2019 or soon after.