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The House and Senate are back today with two workweeks before a government shutdown if both chambers don't pass the same version of a continuing resolution to extend funding beyond September 30. Work continued into the weekend among the various factions of the House Republican Conference toward a CR that includes the bulk of a House GOP border security bill (H.R. 2) in a bid to appease conservatives, who have cited the issue as a demand for a short-term spending bill. House Speaker Kevin McCarthy (R-CA) can only lose 4 votes with the Friday retirement of Rep. Chris Stewart (R-UT). The party ratio is 221R-212D.

The Washington Post last night reported that members of the Main Street Caucus and Freedom Caucus, including Reps. Scott Perry (R-PA) and Chip Roy (R-TX), announced agreement on a border-focused CR that would extend government funding through October 31 and impose an 8% cut to all federal agencies except Defense and Veterans Affairs. "While the deal is expected to appease a significant amount of conservatives, including several in the House Freedom Caucus, Republican leaders now face the difficult task of ensuring the bill passes through their razor-thin margins," the report said. "Given the conservative provisions included in the proposal, Democrats are not expected to help pass the bill."

The potential for the proposal to be a major breakthrough eroded through the evening, as more than a dozen conservatives expressed opposition. Politico reported that a House vote on the measure could happen on Thursday and "McCarthy and Majority Whip Tom Emmer (R-Minn.) have some time to tweak the proposal and bring the holdouts around. Perhaps the argument that worked during the debt-limit fight could change some minds again: The point isn't to get this proposal signed into law, but to give Republicans as strong a negotiating hand as possible. But, remember, this is a group that felt burned by the deal McCarthy ultimately negotiated to end the default crisis, and they're not going to be inclined to allow him much room to maneuver again."

Senate Democrats most certainly won't accept the strict migration curbs and nondefense spending cuts in the proposal, but the House passing a bill would set up a potential back-and-forth negotiation with the Senate and avoid, as Speaker McCarthy warned last week, the upper chamber imposing whatever short-term funding they choose on the House as the clock ticks toward a shutdown. Additional border security funding has been pushed by senators including Kyrsten Sinema (I-AZ) and Mark Kelly (D-AZ). It has been observed by some that Democrats, especially in the House, may be less willing to compromise generally following Speaker McCarthy's opening of an impeachment inquiry against President Biden. Of course, on the other side of a practical path toward government funding is the threat of a shutdown and, for Speaker McCarthy, the prospect that conservatives try to remove him from the position through a motion to vacate the chair, which he defiantly challenged members on last week.

Punchbowl News this morning: "If the leadership can't pass this CR, then what's their plan? The government may shut down anyway, despite McCarthy's exhortations that it would boost Biden. But if House Republicans can't pass something on their own, McCarthy may be forced to choose between staying on as speaker or avoiding a shutdown."

On Fox Sunday Morning Futures, Speaker McCarthy alluded to the focus on border security, saying, "some people say you should shut down. But think about this. I have been through shutdowns, and I have never seen somebody win a shutdown, because, when you shut down, you give all your power to the administration. How are you going to win your arguments to secure the border if the border agents don't get paid? … Finish the appropriation work to show that we do, give us a short time period to get that done, and make the case to the American public. Everybody wants this border secure. We will win that argument."

Disaster funds sought by the Administration in a supplemental spending request have bipartisan support but are apparently excluded from the House Republican CR proposal along with Ukraine funding. The Post earlier reported that, if the House can pass a CR, the Senate would likely strike the border language and add in the Ukraine funding. "McCarthy might be able to win some slight concessions for enhanced border security, given that the Biden administration has already included some funds for fighting fentanyl and other drugs crossing over from Mexico in its emergency disaster spending request," the report said. "That type of bill — temporary government funding, disaster recovery funds, some border security and Ukraine defense money — likely would command large bipartisan majority votes in the House and Senate."

Health — A WCEY article in Medical Economics this week addresses the benefits of enhanced primary care.

Congress — The Senate returns on Monday, September 18, at 3:00 p.m. and has scheduled a judicial nomination vote for 5:30 p.m. The chamber is expected to continue consideration of the minibus appropriations package on Military Construction/VA, Agriculture, and Transportation-HUD. The House is also back on Monday and leaders will try to secure sufficient votes to consider the Department of Defense appropriations bill on Wednesday, along with trying to vote on a government funding patch on Thursday.

On September 18, the House is expected to take up a tri-committee health care package, the Lower Costs, More Transparency Act, along with Veterans' Affairs bills. The Lower Costs, More Transparency Act contains provisions to reauthorize expiring health care programs, ban certain PBM practices and add new PBM transparency requirements, add new Medicare billing requirements for off-campus hospital outpatient departments, extend site-neutral payments to Medicare drug administration services, and more.

There is a Senate Finance Subcommittee on Health Care hearing set for Tuesday, September 19 at 10:00 a.m. on "Aging in Place: The Vital Role of Home Health in Access to Care."

The House Ways & Means Committee has scheduled a hearing Tuesday, September 19 at 10 a.m. on "Reduced Care for Patients: Fallout from Flawed Implementation of Surprise Medical Billing Protections."

The Committee has also scheduled a Trade Subcommittee hearing on "Reforming the Generalized System of Preferences to Safeguard U.S. Supply Chains and Combat China" for Wednesday, September 20 at 2 p.m.

The Senate Health, Education, Labor & Pensions Committee will hold a markup on "S. 1573, S. 2415, S. 1624, S._, Bipartisan Primary Care and Health Workforce Act on Thursday, September 21 at 10 a.m.

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