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The “Medicare Trigger” — How Does it Work in the House?

Title VIII of the Medicare Prescription Drug, Improvement, and Modernization Act (P.L. 108-173) requires an annual report to Congress regarding the financial condition of Medicare. Specifically, the Medicare Trustees’ Report is required to warn Congress when general revenues from the Treasury exceed 45% of Medicare’s spending. If this happens in 2 consecutive annual reports, which it did in 2007, this triggers a requirement that the President submit legislation to Congress responding to the warning. Congress will then consider the President’s proposal under expedited procedures similar to Fast Track Trade Authority and consideration of budget resolutions. The process works like this:
  1. The President is required to submit legislation responding to the Medicare funding warning 15 days after he submits his FY09 budget (President Bush submitted his proposal on February 15, 2008, which complied with the statutory requirement).
  2. The Majority and Minority Leaders of the House of Representatives then must introduce the President’s proposal within 3 legislative days. Under these procedures, the bill is to be titled, “A bill to respond to a Medicare funding warning”. The bill was introduced on February 25, 2008 as H.R. 5480.
  3. House Committees of referral (in this instance, Energy and Commerce, Judiciary and Ways and Means) have until June 30th to report a Medicare funding bill to the House. It is important to note that Committees of referral do not necessarily have to report the President’s bill, but rather any bill entitled, “A bill to respond to a Medicare funding warning.”
  4. The Chairman of the House Budget Committee needs to certify whether the legislation actually fixes the excess burden that Medicare is placing on the Treasury.
  5. If the House has not passed the Medicare funding fix by July 30th, a motion to discharge becomes privileged after 30 calendar days and 5 legislative days if the certified bill has been in committee for 30 calendar days. The motion must be made by a Member who supports the legislation and must be seconded by one-fifth of the total membership of the House, meaning that only 87 Members are needed rather than the 218 required for normal discharge procedures.  The motion to discharge is debatable for one hour, equally divided, and the vote may not be reconsidered. 
  6. Only one motion to discharge under these procedures may be adopted per session of Congress. 
  7. Once the motion to discharge is adopted the Speaker is required to begin consideration of the bill within 3 legislative days of the discharge. 
  8. The bill is considered in the Committee of the Whole and can be considered for a maximum of 15 hours, with 5 hours of general debate and 10 hours of debate on amendments, with each amendment being debatable for no more than 1 hour, equally divided.
  9. Members must receive certification from the Chairman of the Committee on the Budget that their amendments would eliminate the excess Medicare burden on the Treasury.
  10. A motion to recommit is available.
  11. The Committee of the Whole can rise on any particular day, but must resume consideration on the next legislative day.
  12. House passage of a certified Medicare funding bill in a previous session of Congress negates these expedited procedures. 

After passage in the House, the bill would be considered by the Senate under another set of expedited procedures.

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