The recently passed omnibus appropriations bill includes extensive funding, often at higher amounts than in fiscal year 2017, for many US healthcare agencies as well as new dollars to address the opioid crisis. Marking the eighth anniversary of the Affordable Care Act, the omnibus provides no new funding for the healthcare law.
Following months of delays and multiple short-term spending packages, the massive 2,232-page omnibus appropriations bill was signed into law by US President Donald Trump on March 23, providing $1.3 trillion in federal government funding for the remainder of the 2018 fiscal year.
Congressional leaders were able to break the funding impasse and reach bipartisan compromise by building on their agreement from February, the Bipartisan Budget Act, to raise spending caps on defense and nondefense discretionary spending.
The omnibus reflects both Democratic and Republican priorities, provides much-needed certainty to federal departments and stakeholders, and makes limited, but impactful, policy changes. Most importantly, the omnibus greatly extends and, in many cases, expands government funding to many agencies.
Missing from the omnibus is the GOP-led Affordable Care Act (ACA) stabilization package, which would have funded reinsurance programs and cost-sharing reduction subsidies. A bitter dispute over abortion policy blocked the proposal’s inclusion in the spending bill. The focus now shifts to the states, where efforts to protect consumers against escalating insurance premiums have become more urgent as carriers begin filing their proposed 2019 rates soon.
Marking the eighth anniversary of the Affordable Care Act, the omnibus provides no new funding for the ACA and restricts federal funding for risk corridor payments. It also requires notification by the Centers for Medicare & Medicaid Services (CMS) to Congress before any ACA-related data or grant opportunities are released to the public as well as requires the publication of “ACA-related spending by category since its inception,” including workforce information and activities involved in the administration and enforcement of the healthcare law.
The omnibus spending package includes an additional $3.6 billion, allocated across agencies, for state and local government prevention and treatment initiatives to fight the opioid epidemic, including funds to help rural communities address substance abuse disorders.
In rejecting administration efforts to reduce spending for healthcare programs and agencies, the omnibus provides $88 billion for the US Department of Health and Human Services (HHS), $10 billion above the FY 2017 enacted level. It also provides for a 10% increase in funding for the Food and Drug Administration at $5.1 billion, which is $159 million more than requested.
Appropriations for CMS are equal to the FY 2017 level, and include $745 million for healthcare fraud and abuse control activities (a $20 million increase over FY 2017 but $6 million less than requested) and $182 million to reduce the backlog of more than 500,000 Medicare appeals, a $75 million increase over FY 2017.
The Health Resources & Services Administration (HRSA) also received a boost to $7 billion—9% more than FY 2017 and 21% more than requested. Funding for HRSA programs and activities includes $315 million for children’s hospitals graduate medical education (CHGME) payments, an increase of $15 million, and $1.6 billion for community health centers, $135 million more than FY 2017.
Omnibus funding for the National Institutes of Health (NIH) is at an historic level in actual dollars with $37 billion in appropriations—$3 billion more than FY 2017 and 349% more than requested. The NIH budget increases funding for all NIH research programs including Alzheimer’s research ($1.8 billion), mapping the human brain (BRAIN initiative) ($400 million), the All of US Research precision medicine initiative ($290 million), and the development of a universal flu vaccine ($100 million).
Although the administration previously proposed dissolving the Agency for Healthcare Research and Quality (AHRQ) and folding it into NIH, the omnibus funds AHRQ at $334 million, an increase of $10 million over the prior fiscal year.
The Centers for Disease Control (CDC) received a total of $8.3 billion in funding—14% more than FY 2017 and 38% more than requested. This includes $1.45 billion for public health preparedness and response programs aimed at responses to bioterror attacks and pandemic disease emergencies; $2.3 billion for chronic disease prevention and health promotion including HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention activities; and $480 million for the establishment of a new biosafety level 4 laboratory in support of biodefense research.
The omnibus provides $5 billion for the Substance Abuse & Mental Health Services Administration (SAHMSA), a 37% increase over FY 2017 and 52% more than requested, and includes funding for programs addressing mental health ($1.5 billion) and substance abuse ($3.3 billion).
Funding levels are also maintained for most global health programs including the US President’s Emergency Plan for AIDS Relief and USAID programs.
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