The House Energy & Commerce Committee officially announced late Monday it will hold a long-awaited markup Wednesday to extend telehealth provisions for two years, and a day earlier the full House will vote Tuesday on two smaller virtual care measures under a streamlined suspension process. Lawmakers are racing against the clock to pass legislation that would extend pandemic telehealth flexibilities beyond the end of the year after stakeholders have repeatedly signaled a lapse in virtual health services would cut off thousands of patients from necessary care.

The E&C markup on Wednesday (Sept. 18) at 10 a.m. will include the Telehealth Modernization Act of 2024, among other health bills, which would extend pandemic-era telehealth flexibilities for two years.

A day earlier, two telehealth bills are set to be voted on under suspension on the House floor after passing out of E&C committee in June.

The Telehealth Enhancement for Mental Health Act of 2024 would establish a Medicare modifier for telemental health services and require HHS to provide guidance on facilitating telemental health services for patients with limited English proficiency and that are visually or hearing impaired.

HHS also would be required to provide communication regarding interstate licensure requirements and providers would be mandated to include whether they offer telehealth services in their provider directories. The mental health bill likely won’t have a budgetary impact.

Supporting Patient Education and Knowledge (SPEAK) Act of 2023 will also be on the floor Tuesday. The bill would require HHS to establish a task force to improve access to health care information technology for non-English speakers. The agency would be mandated to release best practices on integrating interpreters during a telemedicine appointment and provide mobile health vendors with guidance on how to serve patients with LEP.

But the bigger news for stakeholders is E&C’s official announcement late Monday that it will vote on a two-year extension of Medicare telehealth flexibilities.

“The Energy and Commerce Committee is continuing its work to deliver solutions and make life better for the American people. At this week’s markup, we will consider more than a dozen bills, including legislation to repeal harmful regulations that are jeopardizing America’s economic and energy security, extend telehealth services for seniors, and continue to incentivize important innovation for pediatric rare diseases,” said Chair Cathy McMorris Rodgers (R-WA).

The Telehealth Modernization Act passed out of the E&C health subcommittee in May. In June, the full E&C abruptly canceled its scheduled markup of privacy and telehealth bills amid partisan squabbles over the private right of action provision in the proposed national privacy legislation.

The Congressional Budget Office (CBO) gave the two-year telehealth extension bill a $4 billion price tag, sources told Inside Health Policy in July, but at that point was still collecting additional research to adjust the final score. Sources said the bill’s cost could reach $4.3 billion.

CBO has been looking for more information on telehealth payment rates, substitution effects and downstream spending to reduce uncertainty in its models to more accurately score the cost of telehealth extension legislation.

Southwestern Health Resources, a 31-hospital joint venture based in Farmers Branch, Texas, laid off 129 employees. The layoffs occurred on Sept. 10 and affected some managerial and director positions.  

Modesto, Calif.-based Stanislaus Surgical Hospital will suspend operations indefinitely and lay off all 160 employees. The layoffs, anticipated before Sept. 15, will affect various positions, including registered nurses, nursing assistants, supervisors, physical therapy assistants, midlevel providers, imaging technicians and admissions and office staff, according to The Modesto Bee.

Oakland, Calif.-based Kaiser Permanente will close its last skilled nursing facility in the U.S., the Kaiser Permanente Post Acute Care Center in San Leandro, Calif. The closure, which began in June, will affect 249 jobs.

August

Dallas-based Steward Health Care will lay off 944 employees in Ohio due to hospital closures. The layoffs will affect workers at Trumbull Regional Medical Center and Hillside Rehabilitation Hospital, both in Warren, Ohio, which are expected to close on or around Sept. 20. Employees at Steward’s Northside Regional Medical Center, a breast health center affiliated with Trumbull, will also be affected.

Presque Isle, Maine-based Northern Light AR Gould Hospital, part of Brewer, Maine-based Northern Light Health, is laying off an undisclosed number of layoffs. Management positions are affected, but inpatient nursing positions are not, according to an Aug. 15 statement shared with Becker’s.

Houston-based Texas Children’s Hospital is laying off 5% of its workforce, or roughly 1,000 employees. The layoffs include front-line healthcare workers and those in leadership positions, The Houston Chronicle reported Aug. 6. 

Dallas-based Steward Health Care plans to lay off 1,243 employees due to the closure of two of its hospitals: Dorchester, Mass.-based Carney Hospital and Ayer, Mass.-based Nashoba Valley Medical Center. Steward will lay off 753 employees at Carney Hospital and 490 employees at Nashoba Valley Medical Center, effective Aug. 31, according to WARN notices filed by the system.

Beaver, Pa.-based Heritage Valley Health System laid off several workers and is closing multiple facilities. The workforce and service cuts were made for financial reasons as the system continues to evaluate a potential partner, president and CEO Norman Mitry said in a July 31 letter to employees, according to Beaver County Radio.

July

Ann & Robert H. Lurie Children’s Hospital in Chicago laid off a “very small” number of employees following a comprehensive budget review, the hospital confirmed in a July 27 statement shared with Becker’s. The hospital declined to confirm the number of affected positions.

Chicago-based CommonSpirit plans to lay off employees at hospitals in Oregon and Tennessee. CHI Mercy Health-Mercy Medical Center and Centennial Medical Group in Roseburg, Ore., is eliminating 18 jobs, mostly in leadership support, according to local news outlet KLCC. Additionally, Chattanooga, Tenn.-based CHI Memorial Hospital is laying off workers and reassigning others to address financial challenges, according to the Times Free Press. 

Howard Brown Health, a federally qualified health center that serves the LGBTQ+ community in the Chicago area, is laying off 43 employees, or 7% of its workforce. The layoffs include management, administrative and other staff positions, according to a July 1 Howard Brown news release. They are effective Aug. 30.

Oakland, Calif.-based Kaiser Permanente laid off 51 IT workers in Pleasanton, Calif. Affected positions do not provide direct patient medical care, according to the health system.

June

Winston-Salem, N.C.-based Novant Health is laying off 81 IT workers as it transitions additional digital products and services to Deloitte Digital. The layoffs are slated to take effect Aug. 25, according to a notice filed with the state.

Middletown, N.Y.-based Garnet Health laid off 26 employees, or about 1% of its workforce. The layoffs amount to about $4.6 million in salaries and benefits costs and affect staff in management, union and non-union positions.

West Monroe, La.-based Glenwood Regional Medical Center, part of Dallas-based Steward Health Care, laid off 23 employees. Affected roles included leadership, a spokesperson for the hospital said in a statement shared with Becker’s. 

Cleveland-based University Hospitals is reducing its leadership structure by more than 10% as part of more than 300 layoffs. COO Paul Hinchey, MD, told Becker’s C-suite level leaders and vice presidents were included in the cuts. 

Portland-based Oregon Health & Science University told staff June 6 that it plans to lay off at least 500 employees, citing financial issues. The news follows the institution and Portland-based Legacy Health signing a binding, definitive agreement to come together as one health system under OHSU Health. 

May

The All of Us Research Program, a collaboration of the University of Arizona in Tucson and Phoenix-based Banner Health, plans to lay off 45 workers due to reduced federal research funding, according to an Arizona WARN notice filed May 28. The program, launched in 2018, is part of HHS’ National Institutes of Health.

Burlington, Mass.-based Tufts Medicine will lay off 174 employees due to industry challenges, the health system confirmed in a May 21 statement shared with Becker’s. The layoffs, which have varying effective dates, will primarily affect administrative and non-direct patient care roles. Some leadership roles were affected, a spokesperson told Becker’s. 

Doral, Fla.-based Sanitas Medical Center laid off 56 employees between May 17 and May 20. Some of the affected roles included nine care coordinators, one care educator, and two case managers, according to a May 20 WARN notice accessed by Becker’s.

Select Specialty Hospital in Longview, Texas, will close on or about June 30, affecting 94 employees, Becker’s has confirmed. The hospital, operated by Mechanicsburg, Pa.-based Select Medical, is a 32-bed, critical illness recovery facility.

White Rock Medical Center in Dallas laid off nearly 35% of its staff. The hospital temporarily stopped taking patients transported by emergency medical services due to the layoffs, The Dallas Morning News reported. It has since resumed accepting those patients.

Oakland-based Kaiser Foundation Hospitals is laying off 76 workers in California. The layoffs primarily affect employees in IT and marketing, according to regulatory documents filed with the state May 1.

April

Pittsburgh-based UPMC will lay off approximately 1,000 employees. The layoffs, which represent more than 1% of the health system’s 100,000 workforce will primarily affect nonclinical, administrative and non-member-facing employees. 

Union Springs, Ala.-based Bullock County Hospital laid off 95 employees beginning April 9, according to regulatory documents filed with the state. The layoffs occurred as Bullock seeks to become a rural emergency hospital and is ending psychiatric services as part of the shift, AL.com reported April 25.

Jackson Health System reduced compensation programs for senior leaders; laid off fewer than 25 people, including one hospital CEO; and froze many vacant positions, especially in support and nonclinical areas, a spokesperson for the Miami-based organization confirmed to Becker’s. President and CEO Carlos Migoya shared these efforts in a message to staff, citing financial challenges.

Coos Bay, Ore.-based Bay Area Hospital plans to conduct layoffs as it outsources its revenue cycle management operations, a spokesperson for the hospital confirmed to Becker’s. The transition will affect 27 positions.

Manchester, N.H.-based Catholic Medical Center plans to cut 142 positions, including 54 layoffs. An April 18 letter to employees from CMC president and CEO Alex Walker, obtained by Becker’s, said cuts would occur through the 54 staff eliminations, open position cuts, reduced hours, planned departures, and resource redeployment in satellite locations for CMC.

Marshfield (Wis.) Clinic Health System will lay off furloughed staff, effective in early May. The health system furloughed about 3% of its workforce in January, affecting positions mostly in non-patient-seeing departments, including leadership roles. 

Norwalk, Ohio-based Fisher-Titus Medical Center laid off some workers in nonclinical roles and reduced hours for others. Seven employees, about 0.5% of the health system’s workforce, were laid off  April 1. Work hours were reduced for another 10 positions, a hospital spokesperson told Becker’s.

March

Robbinsdale, Minn.-based North Memorial Health is laying off 103 employees in clinical and nonclinical roles, citing financial challenges. The layoffs affect several services across the two-hospital system. 

AHMC’s San Gabriel (Calif.) Valley Medical Center is laying off 62 workers, according to regulatory documents filed with the state March 13. The layoffs take effect May 13.

Miami-based North Shore Medical Center, part of Steward Health Care, started conducting layoffs as part of cuts to some of its programs amid the Dallas-based health system’s continued financial struggles. Around 152 workers represented by 1199SEIU were laid off, a union spokesperson confirmed. However that number could be higher as their members do not represent every employee at NSMC, the spokesperson said.

Oakland, Calif.-based Kaiser Foundation Hospitals is laying off more than 70 employees. The layoffs primarily affect those in IT roles.

February

Lion Star, the group that operates Nacogdoches (Texas) Memorial Hospital, is closing four of its clinics on March 22, which will result in fewer than 50 layoffs, a Lion Star spokesperson confirmed to Becker’s. No additional layoffs are planned.

Little Rock-based Arkansas Heart Hospital has laid off fewer than 50 employees since the beginning of 2024, citing low reimbursement rates. The layoffs affected lower-paying positions, Bruce Murphy, MD, CEO of the hospital, said, according to Arkansas Business.

Cincinnati-based Mercy Health will lay off some call center positions. The system attributed the move to its partnership with a third party to operate its enterprise contact center for primary care scheduling.

Ridgecrest (Calif.) Regional Hospital announced more layoffs to avoid closure. It is laying off 31 more employees, including seven licensed vocational nurses and four registered nurses, two months after it announced plans to lay off nearly 30 others and suspend its labor and delivery unit, Bakersfield.com reported Feb. 15.

Medford, Ore.-based Asante health system laid off about 3% of its workforce. The layoffs primarily affected administrative and support roles and were necessary to offset “financial headwinds” over the past several years, according to a report from NBC affiliate KOBI-TV, which is based on an internal memo sent to staff Feb. 9. 

Oakdale, Calif.-based Oak Valley Hospital District is scaling back services and laying off workers to improve its finances. The hospital said in a Feb. 2 statement shared with Becker’s that it will close its five-bed intensive care unit, discontinue its family support network department and lay off 28 employees, including those in senior management and supervisor positions. 

Chicago-based Rush University System for Health laid off an undisclosed number of workers in administrative and leadership positions, citing “financial headwinds affecting healthcare providers nationwide.” No additional information was provided about the layoffs, including the number of affected employees.

University of Chicago Medical Center laid off about 180 employees, or less than 2% of its roughly 13,000-person workforce. The majority of affected positions are not direct patient facing, the organization said in a statement shared with Becker’s.

Fountain Valley, Calif.-based MemorialCare laid off 72 workers due to restructuring efforts at its Long Beach (Calif.) Medical Center and Long Beach, Calif.-based Miller Children’s and Women’s Hospital. The layoffs include 13 positions at Long Beach Medical Center’s outpatient retail pharmacy, which is closing Feb. 2, a spokesperson for MemorialCare said in a statement shared with Becker’s.

January

George Washington University Hospital in Washington, D.C., part of King of Prussia, Pa.-based Universal Health Services, is laying off “less than 3%” of its employees. The move is attributed to restructuring efforts.

Amarillo-based Northwest Texas Healthcare System, also part of Universal Health Services, announced plans to lay off a “limited number of positions.” The move is attributed to restructuring efforts. 

Lehigh Valley Health Network is cutting its chiropractic services and laying off 10 chiropractors. The layoffs are effective April 12 and due to restructuring. The Allentown, Pa.-based health system has 10 chiropractic locations, according to its website. 

Central Maine Healthcare is laying off 45 employees as part of management reorganization. The Lewiston-based system, which also ended urgent care services at its Maine Urgent Care on Sabattus Street in Lewiston on Jan. 12, has 3,100 employees total.

University of Vermont Health Network, based in Burlington, is cutting 130 open positions. The move is part of the health system’s efforts to reduce expenses by $20 million.

Med-Trans, a medical transport provider based in Lewisville, Texas, closed its UF Health ShandsCair base serving Gainesville, Fla.-based UF Health Shands Hospital on Jan. 10 due to decreased transportation demands. The move also resulted in layoffs, a spokesperson for UF Health, the hospital’s parent company, told Becker’s in a statement. 

RWJBarnabas Health, based in West Orange, N.J., is laying off 79 employees, according to documents filed with the state on Jan. 8. The layoffs are effective March 31 and April 5. A spokesperson for the health system told Becker’s that 74 of the positions were “time-limited information technology training job functions.” The other layoffs were due to closure of an urgent care center.

Cigna Health & Life Insurance Co. defeated a $100 million lawsuit by hospitals that said they were underpaid for out-of-network medical services, when a New Jersey federal judge said the complaint didn’t point to specific language in Cigna’s health plans.

The hospitals, which are owned by New Jersey-based CarePoint Health Systems Inc., said Cigna had an intentional and unlawful pattern of underpaying them for emergency and elective services, with more than $100 million owed on at least 4,708 discrete claims. Judge Jamel K. Semper of the US District Court for the District of New Jersey dismissed the hospitals’ claims for benefits under the Employee Retirement Income Security Act in an unpublished order issued Thursday. He said they “do not point to, describe, or quote any language from the actual Cigna Plans that they claim entitle them to reimbursement.”

• Semper also dismissed the hospitals’ claims for fiduciary breach and declined to exercise jurisdiction over their claims under New Jersey law
• A different federal judge dismissed an earlier-filed complaint in the case last year

Delia Halpin was being treated for a lung infection at Hackensack University Medical Center over three days in July when doctors came to her room with a suggestion: You can go home if you’d like.

Halpin, 80, wasn’t being discharged. She was returning to her Maywood house with a load of medical equipment, a tablet to let her keep in touch with doctors, and a team of nurses who would visit every day until she recovered.

“No one wants to be in the hospital,” she said. “It was great to be home, be around family, be around the things you’re comfortable with.”

Halpin is among the first wave of patients who received care under Hackensack’s new “Hospital from Home” program — but she is far from the last.

Born out of the COVID-19 pandemic, this new way of providing care is expected to spread quickly among New Jersey hospitals thanks to a new law that greatly expanded the number of patients eligible for these services by requiring all private health insurers to cover them.

“You’re going to see care continue to shift to home in a big way over the next few years,” said Kristin Bloom, an assistant vice president overseeing Virtua Health’s Hospital at Home program in South Jersey. “You can’t ignore the benefits and the outcomes that you see.

“The health care industry will not be able to sleep on this,” she said.

Health care providers have been looking at alternative ways to care for patients as they deal with a current staffing crisis and an expected tsunami of older patients who will likely require greater care in the years and decades to come. The number of New Jerseyans over 60 is expected to increase by 1 million this decade when those in the tail end of the baby boomer generation become senior citizens.

Patients with early-stage infection, chronic heart or lung disease

Each hospital has its own protocols, but typically a patient is identified for hospital-at-home programs almost immediately when they are brought into the emergency room, or a few days after they are admitted. A number of boxes need to be checked before a patient is able to participate. Are they well enough to be treated at home? Do they live in a stable home? Do they live with a caretaker?

The most common ailments among those sent home at Hackensack and Virtua are early-stage infections or pneumonia, along with those whose chronic heart disease or chronic lung disease has flared up, doctors said.

Patients arrive at home with a monitor that transmits all their vital signs in real time to a command center staffed mostly by nurses. Other common equipment includes IV pumps, oxygen tanks and a tablet for telehealth sessions. Nurses come at least once a day to check on the patient.

“If we can bypass any brick-and-mortar care, we will going forward,” said Dr. Jason Korcak, an internist who oversees the program at Hackensack. “In-hospital treatment is necessary for many people who come through our doors, but at the end of the day you’re still in a hospital. The missing piece is the comfort of their own bed or family by their side day and night.”

COVID sparked ‘Hospitals Without Walls’ program to free up beds

Receiving care at home is nothing new. It harks back to a time when the neighborhood doctor made house calls carrying a black leather bag. And it has evolved in recent years mostly to long-term elder care at home, hospice care, and visiting nurses and physical therapists checking in on people recently discharged from a hospital.

But providing full acute services at home wasn’t done extensively until the pandemic. In the spring of 2020, as COVID spread like wildfire in New Jersey and the rest of the Northeast, the federal government launched the “Hospitals Without Walls” program to free up beds and reduce the spread of coronavirus in hospitals.

Most patients have been seniors, since Medicare was the only insurer to cover the costs — until recently. A few notable hospital networks across the U.S. have begun using it extensively, including Mount Sinai Health System in New York and Massachusetts General Hospital.

About a dozen New Jersey hospitals have been approved by federal regulators to provide home services that were covered almost exclusively by Medicare.

‘Hospital at Home Act’ requires medical coverage

But last year, Gov. Phil Murphy gave a jolt to these programs when he signed the “Hospital at Home Act” into law. It ordered private insurance companies, NJ FamilyCare and Medicaid programs to provide coverage for hospital services delivered at home “on the same basis as when services are delivered within the facilities of a hospital.”

The patient pool has expanded greatly now that insurance coverage is no longer limited to those 65 years and above.

Doctors say they have seen benefits for patients in and out of hospitals. Patients sleep much better at home. The risk for infections usually associated with hospital goes down. “It’s virtually nonexistent,” said Dr. Diego Ortega, lead physician for Virtua’s Hospital at Home program.

Meanwhile, more hospital beds are available for the sickest patients, and demand for care goes down at a time when staffing is a major problem at medical centers.

“It frees up a lot of capacity, especially during the flu and respiratory illness season,” Ortega said. “It also frees up staff. Doctors and nurses can now spend more time with the sickest patients inside the brick-and-mortar hospital.”

Not every case works out. About two or three of the 50 Hackensack patients who have received care at home since late April have had to go back to the hospital after taking a turn for the worse, said Korcak, the internist. Virtua Health, which has treated 1,100 patients at home since 2022, has had a 4% readmission rate this year, Bloom said.

Truck arrived with oxygen machine, tanks, IV equipment, monitors

Among those who stayed at home was Delia Halpin. She had the sort of living arrangement that the staff at Hackensack liked to see before allowing a patient to go home. Her husband and an adult son lived at home with her and were capable of lending a hand in her care.

Her house was big enough that a spot could be carved out in the living room where she could rest instead of having to climb stairs.

A truck arrived at her home with an oxygen machine and tanks, along with intravenous equipment, health monitors and a tablet to connect to doctors and nurses around the clock. 

In the mornings she would contact a nurse on the terminal and go over her vital signs. A nurse would come in later in the day and examine her, including scanning her kidneys to see if they were functioning correctly. She received virtual visits from her doctor. “I always felt safe because I knew someone was near,” she said.

About a week later, Halpin was “discharged.” Workers took away the medical equipment, and she was given an itinerary of follow-up visits, medication and preventive tips as if she were being wheeled out of the hospital.  

Halpin said she recovered much faster than she would have in the hospital.

“I’m not the most active person, but I don’t want to just lie in a hospital bed for days doing nothing,” she said. “I was at home. I could get up if needed. It was where I wanted to be.”

NJ hospital systems approved for home care

• Holy Name Medical Center.
• Cooper University Hospital.
• Virtua Health.
• Hackensack Meridian’s JFK University Medical Center, Hackensack University Medical Center and Jersey Shore University Medical Center.
• Salem Medical Center.
• Jefferson Health.
• Carewell Health.
• Inspira Health.

If Johnson & Johnson moves forward with its plan to undermine the 340B Drug Pricing Program by unilaterally imposing a rebate model rather than the longstanding upfront discount model, the Health Resources and Services Administration should take “immediate enforcement action,” including assessing civil monetary penalties on J&J for intentionally overcharging 340B hospitals, the AHA said Aug. 28 in a letter to HRSA. 

“J&J is yet again engaging in 340B vigilantism,” AHA’s General Counsel Chad Golder wrote. “J&J’s adoption of this rebate model is yet another example of a drug company seeking to squeeze every possible penny from the hospitals and health systems that care for America’s underserved patients.” 

On Aug. 23, J&J announced that it would be upending its approach to 340B pricing for two of its most popular products, Stelara and Xarelto. Historically, J&J offered upfront discounts to 340B hospitals when they purchased these drugs. Starting on Oct. 15, however, J&J will require all disproportionate share hospitals participating in the 340B Drug Pricing Program to purchase these drugs at full price and apply for a rebate from J&J. Under the new program, these hospitals will be required to submit certain data to J&J when they purchase the drugs at full price. After J&J verifies the drug’s 340B status, it will send disproportionate share hospitals a rebate for the difference between the amount paid and the discounted 340B price.

AHA said that J&J’s new policy is a fundamental shift in how the 340B program has operated for over 30 years and “could jeopardize patients’ access to these drugs.” In addition, disproportionate share hospitals, which already operate on the thinnest of margins, will be forced to develop pricey administrative mechanisms to make and track rebate requests. 

“And J&J will essentially transform itself into the ultimate arbiter of whether a rebate should be approved and paid, with the likely consequence of J&J denying rebates to hospitals that they appropriately owe,” AHA said. “While J&J may contend that this new policy is needed to improve program transparency, Congress did not permit drug companies to take the law into their own hands. … This new rebate policy — like the drug companies’ contract pharmacy policies that preceded it — is a money-making scheme dressed up as a program integrity measure.”

Congress returns Sept. 9 for a three-week sprint, during which lawmakers will face key legislative deadlines and work to push their political messages before departing again for campaign season.

Political pressure and considerations could complicate how Congress addresses must-pass items.

The legislative dash will also be a prime time for lawmakers to push messages that aid their parties ahead of the November election.

Here are six items to watch in Congress this September.

Government funding 

Government funding for fiscal 2024 expires Sept. 30, and virtually no one expects Congress will come to an agreement on funding for 2025 by that deadline. The Senate has passed zero regular funding bills, and while the House has passed partisan versions of more than half of the 12 regular funding bills, intraparty squabbling has stopped others from passing on the House floor.

Attention is now turning to what the terms will be for a continuing resolution (CR) to fund the government at current levels to avoid a government shutdown and buy Congress more time.

One consideration is the length of a continuing resolution. Hard-line conservatives in the House Freedom Caucus are pushing for a stopgap to extend into 2025, with the thought that doing so could avoid a massive end-of-year omnibus negotiated primarily by party leaders. That could also give Republicans a chance of getting more influence over funding levels if they win the House, Senate, and White House.

Other Republicans prefer starting 2025 with a clean slate, arguing that even if former President Trump wins, he will not want to be distracted by a funding fight in his first months back in office.

Speaker Mike Johnson is rolling out the House GOP’s strategy for a high-stakes government funding fight, teeing up a showdown with Senate Democrats ahead of the Oct. 1 shutdown deadline.

House Republicans on Friday unveiled a stopgap funding bill, also known as a continuing resolution, that will fund the government at largely current levels through March 28. The funding measure includes a GOP proposal to require proof of citizenship to vote in federal elections — a measure that former President Donald Trump insisted on but is a non-starter for Senate Democrats.

The stopgap also includes $10 billion to boost FEMA’s disaster aid fund, depleted after hurricanes in Texas and Florida, along with West Coast wildfires and severe storms across the Midwest and Northeast. Republicans also included nearly $2 billion for Navy submarines, a total requested by the White House.

The speaker called the bill rollout “a critically important step” for House Republicans, saying in a statement that Congress “has a responsibility” to both fund the government and “ensure that only American citizens can decide American elections.”

Johnson wants to put the bill on the floor on Wednesday in an effort to squeeze Democrats on non-citizen voting, which is already banned in federal elections but is still a top Republican focus heading into peak campaign season. But the GOP spending plan is all but doomed in the Democratic-controlled Senate.

“If Speaker Johnson drives House Republicans down this highly partisan path, the odds of a shutdown go way up, and Americans will know that the responsibility of a shutdown will be on the House Republicans’ hands,” Senate Majority Leader Chuck Schumer and Appropriations Chair Patty Murray (D-Wash.) said in a joint statement.

OMB Director Shalanda Young added that Republicans are “wasting time” and that “there is a clear, bipartisan path to responsibly fund the government.”

But it’s not yet certain that Johnson has the votes to even get it through the House given skepticism from multiple corners of his own conference.

A small bloc of conservative members are skeptical of any CR, even if it’s loaded up with partisan wins. One person familiar with the House GOP’s internal dynamics estimated that camp has roughly five members — smaller than last year, when a similar headache thwarted then-Speaker Kevin McCarthy’s funding plan, but still large enough to cause headaches for GOP leadership.

Johnson is also facing questions from a coalition of centrists, battleground members and governing-minded Republicans, who believe they will eventually need to cut a deal with Democrats and pass a clean spending extension by Oct. 1. Though those members are signaling they could go along with Johnson’s plans for now, they don’t want to see the government shut down over the GOP’s voting fight.

But Johnson’s right flank demanded that he attach the non-citizen voting bill and argued that Republicans should kick the funding deadline into March, when they hope Trump will be back in office and give them more leverage in any spending negotiations. Trump, for his part, has floated that Republicans should shut down the government unless they get the citizenship voting bill attached.

Notably, the stopgap bill does not include a farm bill extension, despite House GOP leaders raising interest in recent days about attaching a one-year extension. House Republicans have been privately discussing the matter for several weeks now.

But key agriculture lawmakers, including Republicans, only want to negotiate a farm bill extension after the election. That means lawmakers will need to pass a short-term extension — or break the current deadlock on a new $1.5 trillion reauthorization — before the end of the year.

Separately from the stopgap, House Republicans hope to swiftly pass a $3 billion bill that would address the beginnings of a $15 billion veterans funding shortfall, which also includes provisions demanding answers from the Biden administration on how the Department of Veterans Affairs racked up the budget gap.

Abortion continues to play a key role in the lead-up to November’s elections, the Lykos CEO resigns following the Food and Drug Administration’s rejection of the company’s MDMA-assisted therapy application, mpox vaccines hit the ground in the Congo and a push to expand methadone access runs into a roadblock.

Eyes on abortion

Abortion access remains a central campaign issue. My colleague, Alice Miranda Ollstein, details the experience of one doctor who had to travel from her conservative state to Delaware for abortion training — and had to pull together several grants and scholarships to the cover $8,000 for a flight, hotel, rental car, medical licensing fees, malpractice insurance and background check. The training wasn’t required, but she felt it was a “moral imperative” — as many doctors who make the trip do.

Meanwhile, pressure from anti-abortion groups is also ramping up for Donald Trump’s campaign. The Republican presidential nominee said he would vote against an abortion ballot measure in his home state of Florida after signaling that he might not. But anti-abortion activists — worried by Trump’s “leave-it-to-the-states” position — weren’t placated. They’re now calling for a promise from Trump to staff his administration with abortion opponents if he wins, Alice reports.

Another setback for Lykos

Lykos Therapeutics is still recovering from an FDA decision to reject its application to offer the psychedelic drug MDMA as a treatment for post-traumatic stress disorder. Now, it’s also dealing with a major transition.

CEO Amy Emerson is leaving, POLITICO’s Erin Shumaker reports. Emerson’s departure comes after the company cut 75 percent of its staff and Rick Doblin, who led the push for MDMA-assisted therapy, left its board.

The fight against mpox

After months of delay over bureaucratic issues, 99,000 mpox vaccines have arrived in the Democratic Republic of the Congo to help stem the outbreak of the virus’ deadly Ib variant — different from the clade 2b variant that led to the 2022 outbreak in the U.S.

The vaccines come after the variant has recently spread outside of the African continent, including to Europe, your host reports with POLITICO’s Carmen Paun. And it could still be weeks until the vaccines are deployed.

The methadone fight

Expanding methadone access to allow the medication to be dispensed outside of clinics has garnered bipartisan support in the Senate, Carmen reports. But some, including many directors at methadone clinics and enough Republicans to stall the bill, fear expanded access would actually worsen the opioid crisis because of the drug’s potential for abuse.

Earlier this week, as Vice President Kamala Harris took to the campaign trail to roll out a new set of economic policy proposals, her Republican vice presidential opponent, Sen. JD Vance, took to the internet to criticize them.

“As Kamala Harris talks a big game about standing up for workers, remember that her administration wanted to fire hundreds of thousands of people for refusing the COVID shot,” Vance posted on social media. “It’s all fake.”

Vance’s take-down may sound fairly routine, but one word stands out: “Fake.” Like his running mate Donald Trump and Trump’s many surrogates, Vance has embraced that four-letter word as a catch-all political epithet, used to describe everything from the news media to unfavorable polls to Kamala Harris’ entire personality.

But Vance’s use of the term to describe Harris’ economic proposals gets at something deeper than Trump’s verbal tic. To those in the know on the right, Vance’s repeated use of the word “fake” points toward a broader critique of America’s economic order. It’s one that has gained purchase among the small clique of conservative writers and activists surrounding Vance — a group often known as the “New Right.” And if Trump wins in November, the critique that underlies Vance’s use of the word could play a critical role in shaping the economic policy of a potential Trump-Vance administration.

So, what does Vance really mean by “fake”? In the eyes of many on the New Right, the United States has not one but two economies — a “real economy” grounded in productive industries like manufacturing and transportation, and a “fake economy,” based on non-productive industries like finance and consulting, where productivity is measured in terms of intangible economic growth rather than the production of tangible goods and services.

As Vance put it during a speech in Byron Center, Michigan in mid-August, “I like to talk about the ‘real’ versus the ‘fake’ economy. The ‘real’ economy is for the people who build things with their hands, who get it to our stores, who transport it from one place to another.” The “fake” economy, by contrast, is all the economic activity that shows up in GDP measurements but that doesn’t “put people to work making real products for American families” as Vance put it in his speech at the Republican National Convention.

As Vance and his New Right allies see it, the “fake economy” has gradually swallowed up the “real economy” as the spread of globalization and the financialization of economic markets have shifted the focus of U.S. economic policy from producing goods and services to growing financial assets and ensuring returns on investments. This shift, in turn, has had profound consequences for the United States: In addition to blowing up the trade deficit and making the U.S. reliant on foreign imports for basic goods, the rise of the “fake economy” has concentrated economic power in the hands of asset-owning elites and harmed working-class communities — like the southwestern Ohio steel town that Vance grew up in — that depend on the “real economy” for their economic livelihood. As Vance said while running for an Ohio Senate seat in 2022, “You’re going to have a fiscal problem in this country so long as we have a fake economy where we rely on countries that hate us to make our stuff.”

To be sure, Vance’s casual reliance on calling things “fake” as a shorthand for this broader critique can result in some bizarre soundbites — like the time last year when Vance declared that “economics is fake” because his 40-year-old refrigerator kept lettuce fresher than a newer fridge that he had just purchased.

But some iterations of Vance’s argument have even gained acceptance across the political spectrum. During last year’s legislative fight over U.S. aid for Ukraine, for instance, Vance repeatedly argued that the relative strength of the American economy — measured purely in terms of GDP — did not reflect its actual military strength in a match-up with Russia. That point garnered significant agreement at this year’s Munich Security Conference, where even supporters of U.S. aid to Ukraine acknowledged that U.S. economic power doesn’t mean it has the industrial capacity to support an extended war with Russia.

In other settings, Vance has embraced the critique — shared by many mainstream economists — that economic indicators like GDP are not meaningful measures of a society’s economic health. “One of the [animating] forces in my politics is I have a deep skepticism of how we measure things and whether it’s actually captured reality,” Vance told POLITICO Magazine earlier this year.

On the campaign trail, though, Vance has been vague about how he and Trump plan to restrain the growth of the “fake” economy and resuscitate the “real” one. So far, he has largely paid lip service to Trump’s economic agenda, which pairs sweeping immigration restrictions, aggressive tariffs and deregulation of American energy markets with broad-based tax-breaks that would benefit big businesses and high-earners. The closest that Vance has come to laying out a blueprint for the stimulating the “real economy” came during a talk he gave at the right-leaning economic think tank American Compass in 2023, where he talked in broad strokes about shifting economic policy to “make working on real things pay more money than it does right now … [and] make working on fake things pay less.”

But until he lays out a more substantial plan for growing the “real” economy, Vance will have to contend with a familiar criticism: that his economic populism is as fake as the economy he decries.

There are more than 100,000 people awaiting an organ with a new person added to the list every eight minutes, according to HHS.

A congressional committee will review the overhauling of the U.S. transplant system a year after it was ordered in law.

The House Energy and Commerce Oversight and Investigations Subcommittee will hold a hearing on Sept. 11, focusing on how successfully the federal government has implemented the law to reform the system.

Years of bipartisan congressional inquiry uncovered mismanagement in the organ transplant system, which has been run by a single nonprofit contractor since the 1980s.

Last September, President Joe Biden signed a law to decentralize the organ transplant network, restructuring the system into manageable parts. That allowed different entities to oversee certain functions of the system, and the appointment of a new board of directors. Just last week, the Biden administration awarded its first contract to a nonprofit to oversee the election of a new board of directors.

There are more than 100,000 people awaiting an organ with a new person added to the list every eight minutes, according to HHS. As POLITICO has reported, the reform has hit snags in recent months as members of Congress, the federal government and providers have sparred over oversight. Some of the questions revolved around how big a role the federal government should have and whether people who were involved in the previous setup should continue to work in the new one.

“Unfortunately, for years the organ transplant system has been hampered by inefficiencies, mismanagement, and risks to patient safety,” Committee Chair Cathy McMorris Rodgers (R-Wash.) and subcommittee chair Morgan Griffith (R-Va.) said in a statement. “This hearing will provide an opportunity to hear from experts and stakeholders about how the law is being implemented and what challenges remain.”

Witnesses have not been announced.

At the beginning of the post-Labor Day homestretch, the race is incredibly tight — Harris leads in national polls by between 2 and 4 percentage points, on average. The election, of course, is not decided by a national vote. The outcome will be determined in seven battleground states — Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania and Wisconsin. And there, the contest is exceptionally close as well.

Harris holds a narrow lead in six of the seven battlegrounds — all but North Carolina, according to FiveThirtyEight polling averages in those states. But the margin between the candidates is so slim that it’s under one percentage point in more than half of those states. At the moment at least, this is a margin of error contest wrapped in a photo-finish inside a dead heat.

For Democrats, the outlook is better than at any other point in the 2024 campaign. Before dropping out, Biden trailed in every battleground state. Even his own campaign conceded that his path back to the White House had narrowed to a harrowing ride through the Rust Belt, with no room for error. Today, Harris has two plausible routes, one through the Rust Belt and another through the Sun Belt. She’s even in striking distance of winning North Carolina, which would all but doom Trump’s chances.

Republicans also have reason for hope. Their nominee for president has weathered 88 alleged criminal offenses across four criminal cases and has been found guilty of 34. He still owes hundreds of millions of dollars in civil penalties to E. Jean Carroll and New York state. Despite all that, he remains essentially tied in the polls.

The GOP base remains wildly enthusiastic about voting for Trump. While Democratic enthusiasm has spiked in the aftermath of Harris’ ascension to the party nomination, Republican enthusiasm for Trump has kept pace — and even shows signs of improvement. According to an early August Pew Research Center survey, 72 percent of Trump supporters said they are extremely motivated to vote, up from 63 percent in July. In that same poll, 70 percent of Harris supporters said they are extremely motivated to vote.

Trump supporters have another reason to believe: polls have underestimated the level of support for Trump in both the 2016 and 2020 elections.

It’s been a campaign that has already witnessed a lifetime’s worth of October Surprises — indictments, convictions, an assassination attempt, a catastrophic debate performance, the withdrawal of a president from a reelection bid — and yet there are still some potentially catalytic moments to come.

A presidential debate between Trump and Harris is slated to take place just one week from today, on Sept. 10, hosted by ABC News. The two camps remain held up on the rules — including whether the microphones will be hot. Boiled down to its essence, the mic fight is a Harris campaign bet that an unmuted Trump is an unmoored Trump, easily baited into a spectacular act of self-immolation.

Throughout the campaign thus far, Harris has stayed relentlessly on message while Trump has swung wildly at her identity; that’s a distinction that the vice president’s campaign is hoping they can show the American public in miniature next week.

A week after the showdown before a national audience, the first of three significant economic moments will arrive — occasions that could go a long way toward determining how Americans feel about the economy, and bolstering or undermining the candidates’ arguments.

On Sept. 17-18, the Federal Reserve is set to hold its September meeting, where Chair Jerome Powell is expected to recommend an interest rate cut. A 25 basis point cut is likely already priced in, but if Powell recommends a larger cut of 50 basis points — unlikely but not out of the question — it could spur optimism in the market about inflation, but also could mean that the Fed sees the labor market as particularly weak.

In October and early November, we’ll get final, pre-election looks at both the state of inflation and the strength of the job market, which will color the closing arguments in an election where inflation and the economy are the number one issue for many voters. On Oct. 10, the final Consumer Price Index — the most important measure of inflation — before the election will be released. Then, three weeks later on Nov. 1, just four days before voters go to the polls, the final jobs report will be released. Harris is trying to sell voters on an economy where inflation is under control and the job market remains robust. But if one of these indicators suggests otherwise right before Nov. 5, Republicans will have a key data point to leverage in their case against Biden-Harris economic policies.

Polls suggest Harris is closing the gap on Trump regarding how much voters trust each candidate to handle the economy. But as she claims more credit for the policies of the Biden administration, these three dates become essential as voters build their impression of how she might handle economic issues as president.

With just over two months to go, the race looks tighter than any in recent memory. And while the polls rarely change dramatically between Labor Day and Election Day, the fact that the contest is so close means that even a small atmospheric change could decide who will be the next president.

As Eli and ALEX ISENSTADT wrote Tuesday morning, KAMALA HARRIS’ team believes she is the underdog in a race against DONALD TRUMP, a former president seeking the office for a third straight time. But they also believe several dynamics in the revamped race are working in her favor.

DAVID PLOUFFE, the campaign manager on BARACK OBAMA’s 2008 bid, is now Harris’ senior adviser for path to 270 and strategy. He spoke to West Wing Playbook about how he and the vice president’s team see the 63 days ahead. This conversation has been edited for clarity.

How do you see these final nine weeks setting up?

I think the most important thing in the pursuit of 270 electoral votes is that Kamala Harris has multiple credible pathways to win. She has shown growing strength, which is important. You see both candidates have a pretty high vote share, so there’s a small but important number of undecided voters, and this is a campaign that’s well positioned to reach them.

Because of the enthusiasm she’s generated?

Right now, I think more voters than not see her as kind of a breath of fresh air. She’s handled herself exceedingly well in this hot spotlight. You know, at the end of the day, I think we were convinced there’s enough voters in each battleground state that, all things being equal, would rather Donald Trump not return for a second time.

We have a market of voters out there who want to know more about her, who are open to voting for [her] and we’ve got, I think, a campaign and a candidate who can meet those voters where they are.

How does that enthusiasm translate to her campaign, operationally?

I can’t overstate it — it makes impossible things possible. So say we want to go talk to [several] thousand voters today in Pittsburgh’s Allegheny County or in [Wisconsin’s] Dane County, or in Wake County, down in North Carolina, and the campaign can do that. Some people give dollars, and that’s amazing. People will share social media content, and that’s super important, because it creates kind of an army of people out there sharing good content. Those people reach other voters.

The debate is coming up in a week. How critical is that, especially given that it’ll be her chance to make a first impression with so many people watching?

Presidential debates do matter. … I would assume that the audience for this will be larger than the one in June. You have a lot of people going to vote who may not watch the debate, but they’ll see clips, of course. It’s a big moment. It’s not the only moment. I think a successful campaign does not over-rely on any one moment.

And don’t forget: No one in American history will have done more general election presidential debates than Donald Trump. This will be his seventh. Kamala Harris rightly says she’s an underdog in this race. I think she’ll be an underdog in this debate.

But if she does well, you see this is a real chance to solidify and expand her support?

Where the race stands today is there’s still a bunch of voters out there that want to know more about Kamala Harris, that will learn more about her, that are curious about her, and that’s a big advantage. I don’t think people pay enough attention to that, people who are watching this race: These candidates aren’t similar in terms of their ability to grow.

Campaign chair Jen O’Malley Dillon wrote a memo this weekend touting, among other advantages, your superior organization. How does that factor in at the end of the day?

Basically the presidential campaign is seven gubernatorial races and one congressional race. Yes, television ads are important. And yes, national coverage is important. But you’ve got to think about it that way, which is, you want to be in as many corners of the state as you can, communities large, medium and small.

You want surrogates in those places; you want as good a ground operation as a state-based candidate would have. I mean, to me, that’s the standard you need to set … Can you run just an incredibly intensive presidential campaign as if you were running a dead heat battleground state governor’s campaign? And I think we can.

And you need to do that in these seven key states you’re talking about. That, essentially, is where this race will be won or lost.

Yes. You’ve got seven states and the congressional district in Nebraska. And you’ve got different ways to win them.

I mean, a month, 40 days ago, the Trump campaign was spending as much time talking about New Jersey and New Mexico as North Carolina. … That ridiculous notion that he was going to expand the map has now been laid to rest.

The list, known as “anomalies,” details funding exceptions the White House is seeking amid otherwise stagnant budgets under a continuing resolution.

The administration is pushing for an extra $15.4 billion to help the Social Security Administration deal with staffing and customer service issues, as well as $12 billion in mandatory funding to address a major looming shortfall for veterans medical care. The White House also seeks $7.7 billion to ensure that women, infants and children can continue receiving federal food assistance through WIC, nearly $2 billion for Navy shipbuilding and $2.4 billion to help manage federal student aid operations and more.

What’s next: The list of “anomalies” essentially kicks off the debate over what federal programs will receive a boost beyond the static spending levels in a stopgap.

Once they return next week, lawmakers will have just three weeks to pass a continuing resolution that staves off a shutdown on Oct. 1, likely with a number of other priorities in the mix, such as disaster aid and money to rebuild the Francis Scott Key Bridge in Baltimore.

House conservatives are pushing for a funding patch through March, with a standalone citizenship voting bill known as the SAVE Act attached, hoping for maximum leverage to influence the appropriations process next year if former President Donald Trump wins a second term. Democrats have already rejected that plan, preferring to fund the government before the end of the calendar year.

First up is a visual from our Data & Graphics team looking at new priorities outlined in the Democratic Party’s platform during the DNC last month. The party’s platform highlighted economic growth along with investments from the bipartisan infrastructure law and the Inflation Reduction Act, and proposed expanding protections for workers and unions.

The platform also touched on tax policy, social spending on things like Medicaid expansion and rural health care, border security and immigration, foreign policy, criminal justice, energy policy and more. Data reporter Taylor Miller Thomas has everything you need to know in one handy graphic.

Next, health care reporter Sophie Gardner teamed up with data reporter Madi Alexander to take a look at what health care legislation and rules the administration and lawmakers hope to tackle before the new Congress gets sworn in early next year. Federal health agencies still have a few critical rules to finalize and propose — like the 2025 physician fee schedule and the DEA’s telemedicine rule — by the end of the 2024. There are also two key health care-related bills that could still become law: the Kids Online Safety and Privacy Act and the Improving Seniors’ Timely Accesss to Care Act.

And last but certainly not least, our Legislative Compass team just published a Pro Bill Analysis on Senate Majority Leader Chuck Schumer‘s No Kings Act (S. 4973), which would essentially reverse the Supreme Court’s decision on presidential immunity. SCOTUS ruled in July that Donald Trump had immunity from criminal prosecution for certain actions he took as president while attempting to subvert the 2020 election.

Shortly after the decision was announced, Schumer indicated that Democrats were planning to move forward with a measure to classify Trump’s acts as “unofficial,” and therefore not immune from prosecution. Check out Jordan William’s coverage of the No Kings Act here.