House's $1.3T Spending Bill Spurns ACA Stabilization

Despite a bipartisan push, efforts to restore cost-sharing reductions were not included, as Congress looks for compromises to keep the government open.

The U.S. House of Representatives released a 2,200-page spending bill Wednesday night as lawmakers finalize their negotiations ahead of their Friday deadline to avert another government shutdown.

One notable item missing from the $1.3 trillion bill: any part of the Senate’s proposal to stabilize insurance markets under the Affordable Care Act.

A few Democrats and Republicans had come together to push for policies that would restore reinsurance and cost-sharing reduction (CSR) subsidies that President Donald Trump halted last fall. Their parties reached an impasse, however, when abortion-restricting language was added to the mix.

The bipartisan proposal would have increased the budget deficit by more than $19 billion over the next decade and reduced nongroup insurance premiums by about 10% next year, according to estimates released Monday by the Congressional Budget Office.

“It’s deeply disappointing that lawmakers did not include critical market stabilization measures in the omnibus budget bill that would have made coverage more affordable for individuals and families, especially those who are not eligible for assistance in purchasing coverage,” Justine Handelman, senior vice president for Blue Cross Blue Shield Association, said Wednesday after the bill was released, as Forbes reported. 

What made the cut?

Although the ACA stabilization proposal was spurned, a number of other healthcare-related provisions survived, according to House Appropriations Committee Chair Rodney Frelinghuysen, R-N.J.:

• The Department of Health and Human Services (HHS) gets a funding increase of $10 billion under the bill, compared to fiscal year 2017.
• That HHS boost includes a $3 billion increase for the National Institutes of Health (NIH) and a $1.1 billion increase for the Centers for Disease Control and Prevention (CDC).
• Funding for the Centers for Medicare and Medicaid Services (CMS) remains flat at $4 billion for administrative expenses.
• The Agency for Healthcare Research and Quality (AHRQ)—which has repeatedly found itself on the chopping block—escaped with $334 million, an increase of $10 million, in the bill.
• The measure also includes funds earmarked to fight the opioid crisis.

Additionally, observers may disagree as to whether this bill is a win for healthcare IT, as Politico’s Darius Tahir reported. Funding for the Office of the National Coordinator (ONC) remains flat, while other tech items received funding boosts.

Citing the office of House Majority Whip Steve Scalise, CNBC reported that the House expects to vote early Thursday afternoon. If approved, the measure would then go to the Senate.