Over the past week, Congress and the Trump Administration have made progress on government funding and budgeting for the coming years. The Bipartisan Budget Act of 2018 was passed into law and Trump released his 2019 proposed budget—which does not carry the rule of law but does highlight the Administration’s priorities in the coming year. Both of these policy documents include significant health care issues.
Government Briefly Funded and Spending Levels Outlined
After the second government shutdown of 2018, President Trump signed the Bipartisan Budget Act of 2018 into law on Friday, February 9 that would fund the government through March 23rd and set overall spending levels for the next two years. Totaling $300 billion in additional federal spending, the bill provided disaster aid and increased both defense and domestic spending. Between now and March 24th, Congress has to enact a full-year omnibus appropriations package with Congressional committees now detailing spending plans for the remainder of the fiscal year ending September 30th.
Major health care impacts of the law include:
- Funding of the Children’s Health Insurance Program (CHIP) for 10 years—an additional 4 years above the six-year extension approved by Congress last month
- Nearly $8 billion in funding to support community health centers for an additional two years
- Funding for the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) which covers millions of home visiting services to low income families.
- $6 billion in funding over two years to combat the opioid crisis and support mental health programs, mostly at state levels
- Reductions to the Prevention and Public Health Fund by $1.35 billion over 10 years
- 2 year delay in planned decrease in payments to Medicaid Disproportionate Share Hospitals (DSH)
- Drug manufacturers will be required to give larger discounts to Medicare beneficiaries with high prescription drug costs who hit the gap in coverage known as the “donut hole” in 2019
- Increase in premiums for Medicare beneficiaries with incomes higher than $500,000 per year or $750,000 for couples
- Elimination of the Independent Payment Advisory Board (IPAB) which was created by the Affordable Care Act (ACA or Obamacare) to control the rising costs of Medicare
President Trump’s 2019 Budget
President Trump released his 2019 budget on Monday, February 12. The $4 trillion plan is not an attempt to balance the budget over the next decade and would result in a $445 billion deficit in a decade. The budget focuses heavily on the military and the nation’s infrastructure. While a Presidential budget does not necessarily indicate policy changes, it does highlight the Administration’s priorities. Spending bills still need 60 votes to pass through the U.S. Senate and generally require bipartisan support. Further, coming on the heels of the bipartisan budget deal referenced above, it is unlikely that the President’s budget will have much of an impact.
Major health care impacts of the budget include:
- $35.5 billion to the National Institutes of Health (NIH) which is a $1.4 billion increase over 2018 levels
- $5.8 billion (with $3.25 billion from taxpayers) to the Food and Drug Administration (FDA) which $473 million over 2018 levels. The FDA would also receive an additional $190 million in new user fee funding for the agency to both increase fees in current programs and create new user programs such as over-the-counter drugs.
- $68.4 billion (21% cut) to discretionary funding at the Departments of Health and Human Services (HHS).
- A call to move the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health and the National Institute on Disability, Independent Living and Rehabilitation Research into NIH. Each agency would see a cut to their individual budgets.
- $1 trillion in savings from repealing and replacing the ACA and reforming welfare programs among other cuts. The plan would rollback Obamacare and replace it with state block grants saving $674.7 billion in a decade. The deepest possible cuts ($1.4 trillion) would be made to Medicaid. However, Congress has not indicated a desire to engage in ACA repeal efforts after several failed attempts in 2017.
- Limits on Medicaid eligibility and aims to address “waste, fraud, and abuse” in the program. These change align with the Administration’s goal of giving states greater freedom in administering the program.
- Cuts to Medicare through reductions in what the federal government pays hospitals and doctors
- Drug pricing proposals that aim to save the government $5.72 billion over a decade but many of which would require legislative action to implement.
- A $10 million boost in spending to combat opioid abuse to the Departments of Health and Human Services (HHS) along with policy changes in Medicare and Medicaid to help curb drug abuse
It is vital for cancer patient advocates to be aware of President Trump’s priorities as the Administration seeks to influence the direction of federal funding. It is also critical to understand the potential repercussions of the Bipartisan Budget Act of 2018. The bill will impact our health care system in significant ways over the coming years. We will keep you posted regarding the impact of these policies and follow up with opportunities for action. Make sure that you are a Cancer Support Community grassroots advocate. You will receive timely updates and opportunities to take action to support cancer patients, survivors, and their loved ones.
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