One of the biggest issues that the Congress faces this month is what to do about the National Defense Authorization Act. Before both houses of Congress left prior to the election, they had actively considered defense spending bills, but those plans did not match. In order for a spending bill to become law, the Congress must negotiate and resolve its differences and pass matching bills. There has been every expectation that there would be an agreement on spending before the end of the calendar year.

As the Congress deliberates over its “lame duck” session, defense spending is considered a “must do.”

Buried among the existing defense spending is one program designed to help current members of the military. The program provides funding for post high school education, including college or occupational training.

One of the big selling points to enticing individuals to volunteer for military service is the possibility to get a college education or other ways to enhance their careers.

The United States employs about 1.3 million people in active military service. All of these individuals are volunteers and that’s the way it’s been since the 1970s.

Being in the military can be dangerous – after all, armed forces are trained to go to war. While the government provides military personnel with basic services – health care, housing, among them – the pay is shockingly low. The lowest ranking soldier with the least amount of time in the service makes about $2,000 per month.

To offset that meager pay, the Defense Department offers financial assistance to those who seek a college degree or some other form of career enhancement.

Yet tuition benefits for active military members are far below the average rate of tuition in the U.S. Active military members are reimbursed only $250 per credit hour up to an annual cap of $4,500. While the average cost of four-year public college tuition and fees increased 140% over the past twenty years, the active military tuition reimbursement rate has not changed since 2002. Today, the average cost of one credit hour at public four-year institutions is $406, and it is nearly four times that amount at private schools.

Many colleges and universities cannot afford to honor the $250 reimbursement rate, so given the modest salaries of active military and the low tuition reimbursement rate, members of the armed forces have increasingly limited choices of schools to attend.

There are relatively simple solutions to this problem. First, the Department of Defense receives about $800 million annually for tuition reimbursement. However, it only uses about $600 million for that purpose. The remainder of the funds goes toward training and other activities. If the Department of Defense actually used all the money it receives for tuition assistance for that purpose, then it could increase the tuition reimbursement rate to $300-350 per credit hour.

The second step in the solution is for Congress to allocate more resources for active military tuition.

It might seem as though $800 million is a lot of money. It is – until it is put into broader context. The 2024 Department of Defense budget is nearly $850 billion. If Congress added $500 million to the Department of Defense budget stipulating that it must be used for tuition reimbursement, it would allow the active-duty tuition reimbursement rate to increase to at least the average cost of a credit hour at public universities.

It is clear that the DOD already has a gigantic budget. There can be no doubt that the Department should use its clout to boost the reimbursement rate. Since the U.S. has a completely voluntary armed forces, it’s in the national interest to attract capable and dedicated individuals who want to serve. A small investment in the benefit that drives many to enlist would go a long way to ensure that the nation’s military is adequately staffed. Let’s not just thank military personnel for their service, let’s show them we’re grateful. Whether the Congress shares that sentiment, time will soon tell.

The U.S. Congress returned last week to try to wrap up its work before the newly elected Congress is sworn in next month.  This return – known as the “lame-duck” session – has important topics on its to-do list.  Among the most critical items is to try to agree on funding for the federal government – at least through the winter – providing more disaster aid, approving a defense policy bill, confirming judges, and hopefully, taking on some important health care measures.

The term “lame-duck” session of Congress refers to the period when the Congress meets after its successor is elected, but before the successor’s term begins.  And that period is now.

The most important action for the lame-duck is for Congress to approve continued government funding, since lawmakers only have until December 20^th before the existing funding runs out.  Passing a budget was not the first item to be tackled, however.  The U.S. Senate leadership agreed to a deal to allow confirmation of some of President Biden’s judicial nominees.  

Top issues are replenishing the Federal Emergency Management Agency’s disaster relief fund and agreeing on funding of the defense department, with other potential topics including measures that impact health policy.

While it remains to be seen how much legislative activity occurs during the lame-duck, one of the possibilities is a measure known as “site neutral” health care payments. 

Last month, nearly 60 organizations joined the call to urge Congress to pass legislation that would require that hospital and non-hospital Medicare pricing be the same.  

Here is the background:  The amount charged for medical procedures or services can depend as much on where they are performed as on the type of procedure or service provided.  All else being equal, a procedure in a hospital is much more expensive than that same procedure done in a freestanding facility like a physician’s office or a clinic. The higher cost is meant to support a hospital’s more complex infrastructure, staffing and other expenses. 

However, these higher prices are being charged for services provided at non-hospital locations, which often operate at less expense.  That’s in large part because hospitals are buying up private practices, clinics, imaging centers and labs, using them effectively as a “cash cow” to charge more.   Once acquired, these facilities often begin using the hospital billing code to charge hospital prices for services that were previously less expensive.  When acquired by a hospital, physician practices charge about 14 percent more than when they were independent. That means patients and insurers begin to pay more for the same service. The only difference is that the non-hospital facility is owned by a hospital and begins to use the hospital billing code. And over half of physicians now work for hospitals and health systems. 

As a result, patients, Medicare, and employer-based insurance companies are paying much higher prices for care than they otherwise would.  For example, Medicare pays twice as much for procedures done in hospital-owned facilities as they would in independent physician’s offices. Don’t forget that for many patients, high deductibles and co-insurance policies mean that they may face a financial hit as well. 

The “site neutral” legislation that would be considered in the lame-duck requires that Medicare procedures and services are delivered at the same price regardless of the location, whether it’s a hospital, doctor’s office, imaging center or clinic.  This would save significant money for consumers, employers and taxpayers.  Decreased Medicare spending as a result of “site neutral” policies could save taxpayers $150 billion.

Those savings drove the House of Representatives to approve legislation that contained a “site neutral” provision.  In the U.S. Senate, Republican Senator Cassidy and Democratic Senator Hassan have released a legislative framework for “site neutral” payment policy.  Their proposal could be the vehicle for action during the lame-duck.

Of course, whatever happens during the lame-duck will have to be the product of bipartisan compromise.  Given the existing narrow Democratic Senate majority, which is soon to be replaced by a Republican one, the parties will have to agree to get anything done at all.

Yet, the bipartisan nature of the Cassidy/Hassan plan, coupled with the apparent support in the House, indicates “site neutral” legislation has a chance.  The prospects for success hinge on whether it’s a priority of current Senate Majority Leader Schumer.  Here’s hoping he’s able to get it done.

Americans are hearing about how states can change their laws to insulate themselves from actions expected from the incoming Trump Administration and the new Congress. New Yorkers hear the same. Policies impacting the environment will be a key battleground.

Of course, no one really knows what will happen when the new Administration and the new Congress convene next month, but it is expected that programs that protect the environment will be under a great deal of stress, if not on the chopping block. In the meantime, what can states do?

Here in New York, the state will soon approve new regulations to protect the environment – rules designed to protect wetlands.

The rules are the product of legislation approved in the 2022 New York State budget. The 2022 agreement amended the New York State Freshwater Wetlands Act. Prior to the changes, the state’s wetlands had to be included on official state maps before they could be protected by the Department of Environmental Conservation (DEC). However, those maps were not updated on an ongoing basis, which allowed for the filling, dredging, draining of and building upon many unmapped wetlands. 

The amendments to the Freshwater Wetlands Act eliminated this requirement and will allow DEC to require permits for activities that impact wetlands larger than 12.4 acres beginning in 2025, and then wetlands that are larger than 7.4 acres in 2028. Wetlands are of tremendous importance, providing myriad, significant benefits, such as reducing flooding, providing critical habitat for wildlife, sequestering carbon, increasing climate resilience, and maintaining clean drinking water. 

The law also protects smaller wetlands of “unusual importance,” defined to mean changes over wetlands that are, among other things, located in a watershed that has experienced significant flooding in the past, is expected to face significant flooding due to climate change, or contains the habitat of an endangered or threatened species.

The rationale for state protection of wetlands, which include swamps, marshes, bogs, fens, and wet clay meadows, is that these areas provide critical ecosystem services for communities across the state. Wetlands protect drinking water by naturally filtering out heavy metals, toxic contaminants, and other pollutants.  Additionally, wetlands offer flood protection, with one million gallons of water being stored for every one acre of wetland, while also mitigating shoreline erosion.

Wetlands act like sponges; slowing down and soaking up water that might otherwise cause devastating floods. Wetlands also hold water in place until drier conditions prevail and then release it downstream. In this way, they protect not just against floods but against drought, too. Wetlands are also “carbon sinks”; they hold carbon dioxide thereby reducing the amount of heat-trapping pollution in the air.

According to the U.S. Environmental Protection Agency, over 60 percent of New York’s wetlands have been lost due to human development. In recent years, pressures have significantly increased from sprawling human development, the proliferation of invasive species, extreme weather, and continued threats from pollution. With weaknesses in existing federal freshwater wetlands protections, it is up to states to protect these critical resources before more wetlands are lost. Given the Trump Administration’s previous record of weakening wetlands protections, the prudent thing is to expect more of the same in the new one.

That’s where the new state law and its implementation matter.

Estimates are that the new law, once implemented, will be the equivalent of adding one million acres of wetland under the state’s protection. But before the new law goes into effect, the DEC must allow public comment and then finalize regulations to implement it. The state’s public comment period for the wetlands regulations closed on September 19, 2024. Opponents, including those who like to develop wetlands, are pushing to weaken the regulations. Environmentalists, on the other hand, are arguing that the proposed regulations are not strong enough. Protecting wetlands – particularly in an era of climate change – is of critical importance.

It’s now up to the DEC to decide how these regulations turn out. There’s an enormous amount at stake. Getting the regulations right will help bolster the resiliency of wetlands and will help to curb the worst impacts of climate change.

Wetlands provide a wide range of important benefits for humans and wildlife. Wetlands serve as natural filters and sponges, purifying surface waters and recharging groundwater supplies. Yet, wetlands are disappearing at an alarming rate, due to development pressures. The loss of wetlands not only destroys important habitat for plants and wildlife, but it also jeopardizes water quality and removes natural flood controls. The destruction of wetlands puts human health and property at risk.

When it comes to protecting the state’s wetlands, the DEC should do all it can to ensure that those areas are protected for decades to come.