President Trump addressed a joint session of Congress on Tuesday night. While this type of speech is equivalent to the President’s State of the Union address, it is not officially called the “State of the Union” during a president’s first year in office. Notably, healthcare was mentioned only once, with President Trump vowing to prioritize efforts to reverse rising childhood cancer rates.
Senate confirmations were held for Jay Bhattacharya, MD, President Trump’s nominee to lead the National Institutes of Health (NIH), and Marty Makary, MD, his nominee to head the Food and Drug Administration (FDA). The Senate HELP Committee will vote on their nominations and hold a hearing for David Weldon, MD, President Trump’s nominee to lead the CDC on March 13th.
Government Funding Set to Expire in One Week
The federal government’s funding is set to expire a week from today. The government's fiscal year ends on September 30th. Congress is supposed to pass appropriations legislation prior to this deadline to fund the government for the upcoming fiscal year. However, it has become increasingly common to rely on short-term “Continuing Resolutions” (CRs) to extend funding at existing levels while negotiations on appropriations legislation continue. Since September 30, 2024, the U.S. government has been operating under a series of CRs, with the latest—agreed upon in December—set to expire at 11:59 PM EST on Friday, March 14.
The federal government will shut down if Congress fails to extend funding beyond this deadline. Congress will not pass appropriations legislation by this deadline which means another CR is needed.
Congress has some big decisions to make over the next week. Not only must Congress decide on how long to extend funding for, it must also decide which other policies that are not related to spending to include in the CR. Below are possible outcomes we are tracking:
Option 1: Agree to another Short-Term CR
A short-term CR would likely last just a few weeks and buy Congress time to agree on FY2025 appropriations bills even though only six months remain in the fiscal year.
A short-term CR is currently believed to be backed by leading Senate Democrat appropriators who prefer to prioritize appropriations legislation
Option 2: Agree to a CR through September 30, 2025
A CR taking the federal government to the conclusion of the current fiscal year is seen as the most likely outcome. This would bypass the FY2025 appropriations bills and fund the government at FY2024 levels for the remainder of the fiscal year. Notably, Congress has started the FY2026 appropriations process in parallel to addressing the current funding deadline
Most Republicans from both chambers seem to prefer this option. However, some Republican defense hawks oppose operating under a CR for the rest of the fiscal year because many Department of Defense activities are constrained under a CR.
Separate from the duration of the CR, a key question is whether the CR will be “clean” or if it will include policy riders. A CR with policy riders would provide the best opportunity to advance healthcare-related measures.
For example, a CR is viewed as the most practical legislative vehicle for a “Doc Payment Fix.”
Doctors’ Medicare reimbursements were cut by 2.83% to start the new year. A CR is also seen as the easiest way to extend pandemic-era telehealth provisions, which are also set to expire next Friday. While this situation remains fluid, based on our conversations with Congressional offices this week, there is confidence among key “doc fix” champions that the CR will address these cuts.
All this being said, it’s important to remember that President Trump’s voice carries a lot of weight on Capitol Hill. He strongly supports a “clean” CR. Thus, if Congress ultimately follows his lead, healthcare matters may not be included and will have to be addressed some other way.
Option 3: Agree on FY2025 Appropriations Packages
While it is important to consider this possibility, the chances of passing FY2025 appropriations bills are becoming much lower. House and Senate Appropriations Committees have already begun shifting their focus to FY2026 appropriations, thus making a CR a far more likely outcome at this point in the game.
Option 4: Let the Government Shutdown
If Congressional leaders cannot agree on a path forward and no action is ultimately taken, the government will shut down. A government shutdown would be very disruptive but would not impact Medicare payments to clinicians.
A CR needs 60 votes to pass in the Senate which means it needs support from Democrats to pass. It only needs a simple majority to pass in the House but Republicans control the Chamber with a very slim majority.
Government Funding Bills vs Government Budget
Considering the government funding matter, it’s easy to confuse federal funding with a congressional budget. These are two completely different processes that are sometimes conflated as the same thing.
In short, Congressional budgets establish top-line spending figures for different policy categories. The Appropriations process (and Continuing Resolutions) are the legislative mechanism that actually provides funding to the federal government.
Both the House and Senate recently passed respective budget resolutions. Unlike government funding, Congress is not required to pass a budget resolution. However, the House and Senate must pass identical budget resolutions for the budget reconciliation process to begin. This process is crucial for advancing President Trump’s legislative agenda, as budget reconciliation allows the majority party to pass spending-related legislation with a simple majority in the Senate instead of the 60-vote threshold for most other types of legislation. Congress is expected to focus its energy on advancing the budget reconciliation process after addressing the federal funding deadline.
In conclusion, Congress certainly has their hands full in the coming weeks as they aim to make progress on both a government funding solution as well as moving towards a budget reconciliation legislative package.