After a brief shutdown lasting just a few hours, Congress passed a major budget deal in the wee hours of the morning of Friday, Feb. 9, and sent the measure to the White House for the president's signature, which came later in the morning.
Following passage of the Bipartisan Budget Act of 2018, large healthcare organizations began parsing through the details to see how the plan, which fully funds many government programs for two years and further extends CHIP funding, might impact providers and patients.
A few quick takes:
- CHIP is now funded for 10 years (six-year funding passed in last continuing resolution plus additional four years in this one).
- Funds federally supported health centers for two years.
- Provides $6 billion to address the opioid epidemic.
- Permanently repeals Medicare coverage caps on outpatient therapy including physical therapy and speech pathology.
- Delays DSH cuts for two years.
- Disbands the Medicare Independent Payment Advisory Board.
- Provides more than $850 million in funding for National Health Service Corps. and Teaching Health Center GME program.
- Provides $2 billion in research funding to the NIH.
- Provides $4 billion to shore up VA hospitals and clinics.
- Provides funding for diabetes programming, expands telemedicine funding, and extends the Maternal, Infant and Early Childhood Home Visiting Program for 5 years.
- Lessens Medicare payment cuts for physicians.
Following is reaction from stakeholders:
Statement from Rick Pollack, President & CEO of the American Hospital Association:
"Today's continuing resolution includes many important provisions that benefit the patients and communities America's hospitals and health systems are privileged to serve each day. Importantly, this bill delays for two years cuts to Medicaid Disproportionate Share Hospital payments, which are critical to hospitals and health systems that care for our nation's most vulnerable populations--children, the poor, the disabled and the elderly. This delay will help ensure that hospitals can continue to deliver high-quality care for their patients. We also are encouraged that the bill extends critical rural programs--including the Medicare-dependent Hospital program, the enhanced Low-volume Adjustment program, and the ambulance add-on payment program -- that help keep vital care and service in rural America.
"Additionally, we're pleased that the bill extends funding for the Children's Health Insurance Program (CHIP) for an additional four years, yielding a decade of certainty for children's health coverage. With opioid addiction devastating families and communities across America, much-needed new funding to fight this epidemic is included in this package. We applaud the provisions in the bill that repeal the Medicare payment caps for outpatient therapy services, give hospitals more flexibility on meaningful use and increase the availability of telehealth services. The bill also supports chronic care management, including policies that advance team-based care, expand innovation and technology, empower individuals and care givers in care delivery and allow patients to receive more care in their homes. Finally, the bill repeals the independent payment advisory board.
"We look forward to continuing to work with Congress to advance health in America for patients and communities," he concluded.
Statement from Susan Peschin, MHS, President & CEO of the Alliance for Aging Research:
"The Alliance for Aging Research is pleased that Congress reached a bipartisan agreement that the president signed into law this morning to finally raise both the defense and non-defense budget caps for FY18 and FY19. The two-year deal is part of another continuing resolution (CR), giving appropriators until March 23 to work out a final omnibus appropriations bill based on higher spending caps. The previous deal had included only an increase in defense spending, which would have decimated funding for vital domestic health and research programs. This bill will increase spending for non-defense programs by more than $130 billion.
"The CR lays out several specific priorities for appropriators, including direction to increase National Institutes of Health (NIH) funding by $2 billion and opioid response and mental health funding by $6 billion over the two-year period. We expect $1 billion to be the NIH "funding floor" appropriators build on when finalizing the FY18 omnibus package. The Alliance will push for additional funding for NIH, as well as for robust funding increases in the budgets of the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and other public health agencies.
"We also thank members of Congress for coming together to reauthorize funding for Community Health Centers for the next two years, increasing the total amount by more than $7 billion. Our nation's community health centers provide high-quality, cost-efficient primary healthcare to our most underserved communities, including high numbers of Medicare patients who are also eligible for Medicaid because of their low incomes. These "dual eligibles" have extensive healthcare needs and are significantly more likely to suffer from multiple chronic conditions, such as diabetes, chronic lung disease, and Alzheimer's disease.
The spending deal also includes $89.3 billion in "emergency supplemental" funding. This funding, which is outside the budget caps, includes $200 million for the Centers for Disease Control and Prevention (CDC), $50 million for NIH, and $7.6 million for FDA, earmarked specifically for hurricane and wildfire recovery activities. Unfortunately, the caps deal cuts $1.3 billion from the Prevention and Public Health Fund (PPHF) to help pay for this supplemental funding. We oppose these cuts to the PPHF and will fight to reinstate this funding. The evidence is strong that one of the most effective strategies in "bending the cost curve" in healthcare is preventing age-related chronic diseases in the first place. Federal funding for medical research, evidence-based clinical care, and older adult social services and supports is more vital than ever as the U.S. population of adults ages 65 and older is projected to nearly double over the next three decades to 88 million by 2050.
"We applaud the Senate and House for passing this measure and the president for signing this important bill quickly. These actions reverse the government shutdown and allow agencies and programs to get back to protecting the health and safety of all Americans. We also look forward to the president's FY19 budget proposal, expected on Monday, and we urge the administration to put forth a budget that continues this positive trend of strong support for medical and health research."