Congress Fails, Again

Plus, Paul Ryan's biggest regret By Yuval Rosenberg and Michael Rainey Congress Fails to Take Even Modest Steps to Fix Budget Process The federal budget process is a mess and it’s likely going to stay that way for the foreseeable future, as a special bipartisan committee set up to improve the budget process failed on Thursday to approve even modest reforms. Established by the Bipartisan Budget Act of 2018, the 16-member Joint Select Committee on Budget and Appropriations Process Reform has been meeting for months to fix a budget process that tends to veer from crisis to crisis. There are plenty of ideas for comprehensive reforms — examples include those offered by [Brian Riedl]( [Stan Collender]( the [Bipartisan Policy Center]( and the [Committee for a Responsible Federal Budget]( — but lawmakers were unable to agree on anything beyond the possibility of moving to a biennial budget timeframe, and even that simple proposal failed to move forward in the failed vote Thursday. Five Republicans and two Democrats on the committee voted yes, while three Republicans and two Democrats voted no, with four Democrats voting present. The rules required five yes votes from each side for the bill to advance. Politics played a role in the committee’s lack of progress. Co-chair Rep. Nita Lowey (D-NY) expressed concerns about the rules governing amendments to the bill as it moved through the Senate, and Sen. James Lankford (R-OK) said that the reforms didn’t go nearly far enough. “The failure of the Joint Select Committee to pass even modest reforms is disappointing and emblematic of our broken political system,” CRFB’s Maya MacGuineas [said]( Thursday. “It is discouraging that the JSC was unable to pass even the smallest of reforms. The possible looming government shutdown is a perfect example of why we need to fix the process.” What comes next: Zach Moller of the CRFB [tweeted]( “I’ve worked on the [Joint Special Committee] effort for the past 9-10 months and this is a disappointing ending for the JSC. But budget process reform is still desperately needed. There’s a new Congress in January and I hope the cause will have new champions.” G. William Hoagland of the Bipartisan Policy Center said the committee should keep at it in the next Congress: “If they do nothing else, leadership should authorize the committee to continue its work in the next Congress, otherwise the diligent, bipartisan work undertaken by members of this committee will have been for naught.” [Share this story →]( Farm Bill Deal Scraps Food Stamp Work Requirements Lawmakers say they have [reached a deal]( on the massive farm bill, which has been hung up for weeks over demands by President Trump and House Republicans for new work requirements for food stamp recipients. Negotiators have agreed to jettison those requirements for the Supplemental Nutrition Assistance Program (SNAP), which were included in the House version of the bill but not the Senate version. However, the White House has not yet signed off on the agreement and House conservatives may not support a bill that lacks work requirements. The Congressional Budget Office has not yet scored the bill, which is expected to cost nearly [$900 billion]( over 10 years. Do Your Health Insurance Premiums Keep Rising? Here’s One Likely Reason Why Competition in the health insurance market isn’t as healthy as it could be, a [new study]( by the American Medical Association finds. The key details: - 73 percent of metropolitan areas in the U.S. have highly concentrated insurance markets - In 91 percent of metropolitan areas, at least one insurer had an overall market share of 30 percent or more - In 46 percent of metropolitan areas, one insurer has a market share of 50 percent or more - Half of all states had commercial health insurance markets that were less competitive in 2017 than during the previous year - Anthem dominated 75 metropolitan markets, more than any other insurer, according to a tally by [Becker’s Hospital Review](. Health Care Service Corp. followed with leading market share in 40 metro areas, and UnitedHealth Group led in 27 metro areas. “High concentration levels in health insurance markets are largely the result of consolidation (i.e., mergers and acquisitions), which can lead to the exercise of market power and, in turn, harm to consumers and providers of care,” the report says. “It appears that consolidation has resulted in the possession and exercise of health insurer monopoly power—the ability to raise and maintain premiums above competitive levels—instead of the passing of any benefits obtained through to consumers.” One takeaway, the authors say, is that antitrust regulators should vigorously scrutinize proposed mergers between insurers. Axios’ Caitlin Owens [notes]( that one study published last year found that insurers with more market power can bargain for lower prices in markets where providers are highly concentrated. Whether those lower prices get passed onto consumers is another matter. “The policy dilemma that arises from our findings,” the 2017 study said, “is that there are no insurer market mechanisms that will pass a portion of these price reductions on to consumers in the form of lower premiums.” The Axios chart below breaks down the market share of the largest insurance provider in each state — and you can see the tables at the back of the [AMA study]( to find more details about your state or city. Chart of the Day: Number of Uninsured Children Rises for First Time in Years The number of children without health insurance [rose in 2017]( for the first time in almost a decade, with the biggest increases coming in states that did not expand Medicaid under the Affordable Care Act. “While not a big jump statistically — the share of uninsured kids rose to 5 percent in 2017 from 4.7 percent a year earlier — it is still striking,” Phil Galewitz of Kaiser Health News [said](. “The uninsured rate typically remains stable or drops during times of economic growth. In September, the U.S. unemployment rate hit its lowest level since 1969.” TGI(almost)F! Email your tips, comments and criticism to yrosenberg@thefiscaltimes.com. Connect with us on Twitter: [@yuvalrosenberg]( [@mdrainey]( and [@TheFiscalTimes](. If you were forwarded this email, [sign up here]( to get your own copy every weekday. Paul Ryan Says the Huge National Debt Is His Biggest Regret. He Presided Over a Big Increase. Outgoing House Speaker Paul Ryan said Thursday that the ballooning national debt is his biggest regret. In an interview with [The Washington Post]( Ryan named the debt and immigration as the two issues he wished the Republican-led Congress had been able to address. “Debt and immigration are the two big issues that, if we get right in this country, we will have a great 21st century,” he said, adding that “health care entitlements — aging of baby boomers, health care inflation — that is the driver of the debt that’s got to get dealt with.” At the same time, Ryan again defended the tax overhaul his party passed last year, which the Congressional Budget Office has projected will add a total of [$1.9 trillion]( to deficits through 2028. “I think history is going to be very good to this [Republican] majority,” Ryan said. “Why? The tax system was atrocious. … We really did have the worst tax system in the industrialized world and it was hollowing out American competitiveness. We have now put underneath the economy a far, far stronger foundation for a healthy economy and growth because of that. I was extremely worried about our national security posture, meaning our military, and we have now put underneath that a much stronger foundation.” But Business Insider’s Bob Bryan [notes]( that legislation passed under Ryan’s speakership has added substantially to deficits and debt, and is projected to continue to do so: “According to [the Committee for a Responsible Federal Budget]( 46% of the fiscal year 2019 deficit will be derived from legislation passed since Trump took office. Of that, $228 billion comes from the GOP tax law — which Ryan cited as one of his major accomplishments — and $188 billion comes from the bipartisan budget agreement.” [Share this story →]( Clipping the Wings of Trump’s Space Force? Pentagon officials have been scrambling to come up with a plan for the creation of the Space Force as a new, independent branch of the military. But Marcus Weisgerber of Defense One [says]( that the Trump administration is worried that the plan may not get through Congress next year, so defense officials are working on alternative plans. The four main options being considered reportedly are: 1. a space corps that is operated within the Air Force 2. a space corps that is controlled by the Air Force and also takes over space-related assets from the Army and Navy 3. an independent Space Force that takes over all space-related assets from the Air Force, Army and Navy 4. an independent Space Force that takes over all Pentagon space assets plus some parts of the intelligence community. Each option has different budgetary implications, though the total additional cost for each variation is unclear. Todd Harrison of the Center for Strategic and International Studies [said]( recently that different iterations of the Space Force could cost anywhere from $11 billion to $21.5 billion to operate each year, although only about $550 million of that would be new spending, with the rest coming from budget shifts within the Pentagon. News - ['We Got Gamed': Ryan's Dream of Budget Reform Goes Poof]( – Politico - [Fed Officials Express Caution About Pace of Future Hikes]( – Associated Press - [U.S. Consumer Spending Rises Strongly, Inflation Moderates]( – Reuters - [Democrats Taking Key Leadership Jobs Have Pocketed Millions from Pharma]( – Kaiser Health News - [Brady Proposing to Kill New Tax on Churches, Colleges, Other Nonprofits]( – Politico - [New Insurance Guidelines Would Undermine Rules of the Affordable Care Act]( – Washington Post - [U.S. Life Expectancy Declines Again, a Dismal Trend Not Seen Since World War I]( – Washington Post - [Dem Single-Payer Fight Set to Shift to Battle Over Medicare ‘Buy-in’]( – The Hill - [VA Vows to Make Veterans '100 Percent Whole' Over Underpaid Housing Benefits]( – The Hill - [CVS-Aetna Deal Closes with Vow to Change 'Consumer Health Experience']( – Forbes - [Democrats and Republicans Want to Tax Pollution — and Give the Money Back to You]( – Miami Herald - [Pentagon Moves Closer to Cutting Turkey's Role in the F-35 Program if It Buys S-400 SAMs]( – The Warzone - [Postal Service Clarifies Mission Is ‘Mail, Not Drugs' after 16 Workers Were Sent to Prison for Delivering Cocaine]( – Washington Post Views and Analysis - [What Would a Real Fiscal Policy Look Like?]( – Jared Bernstein, Washington Post - [Note to Trump: The Mueller Probe Costs Roughly $0.00 – Not $40 Million]( – Eric Levitz, New York - [Failed Tax-Cut Experiment in Kansas Should Guide National Leaders]( – Heather Boushey, The Hill - [This Could Be Trump's Last Stand on Border Wall]( – Jacqueline Alemany, Washington Post - [Trump Is Wrong About the General Motors Bailout]( – Steven Rattner, New York Times - [From Inconsequential to Illegal, All the Ways President Trump Has Suggested Cutting the Deficit]( – JM Rieger, Washington Post - [The All-Republican Government Will End as It Began Under Trump, in Disarray]( – John Harwood, CNBC - [Retirement Contributions May Be Another Way to Game Pass-Through Deduction]( – Brendan Duke, Center on Budget and Policy Priorities Copyright © 2018 The Fiscal Times, All rights reserved. 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