What's In, What's Out: Healthcare Provisions from the Bipartisan Budget Deal

Several provisions affecting healthcare made it into the two-year omnibus package, while a few were left on the cutting room floor.

Five and a half hours after a second government shutdown in as many months, Congress passed a short-term funding package early Friday morning, with two years of funding for some healthcare programs.

President Donald Trump signed a two-year, $300 billion bipartisan budget deal the Senate leadership reached Wednesday afternoon, which also includes a short-term funding measure to keep the government operating through March 23.

Several federal health programs are impacted by the legislation, including community health centers (CHC), the Children’s Health Insurance Program (CHIP), and the Medicare Independent Patient Advisory Board (IPAB).

Below is a breakdown of what provisions relevant to the healthcare world were included in the bill and those that were not.

Included: Extensions for CHCs, CHIP, and the National Health Service Corps

The omnibus package was filled with significant funding measures for federal health programs seeking long-term solutions, totalling $20 billion overall.

This includes a $7 billion extension for CHCs, which cater to 26 million people from low-income populations. In recent weeks, CHC leaders and advocates expressed concerns about 9 million people losing coverage options due to widespread layoffs and site closures if Congress did not approve additional funding.

A four-year funding extension for CHIP was also included in the legislation, less than a month after Congress approved a six-year extension for the program in a continuing resolution to reopen the government after a three-day shutdown.

Two other federal health programs, including teaching health centers and the National Health Service Corps, secured $363 million and $495 million, respectively.

Eliminated: Medicare spending ‘death panel’ and Medicaid Part D ‘donut holes’

Outside of providing two years’ worth of federal funding to health programs, the budget deal also eliminated the IPAB and the Part D “donut hole.”

IPAB was a 15-member board created through the Affordable Care Act to lower Medicare spending growth. The board, nominated by the president and confirmed by the Senate, would offer recommendations for Medicare spending restrictions if rates rose above a certain level.

Since its inception in 2010, IPAB has been subject of ire from Republicans, most notably when former Alaska Governor Sarah Palin referred to the provision as promoting government-sponsored “death panels.”

Another federal policy impacted by the budget deal is the Medicare “donut hole” loophole, in which individuals paid out-of-pocket costs for prescription drugs until reaching a yearly limit, at which point the costs would be covered by health plans.

The provision passed by Congress moves the deadline for when drug manufacturers take on the bulk of Part D prescription drug costs up from 2020 to 2019. The move is in contradiction to the support expressed by Alex Azar, Secretary of the Department of Health and Human Services, at his confirmation hearing last month.

Excluded: Two bipartisan Obamacare stabilization bills

Omitted from the final legislation were two bipartisan bills aiming to stabilize the federal insurance markets created under the Affordable Care Act.

Both Alexander-Murray and Nelson-Collins seek to lower premiums and keep enrollees covered for the remainder of the year.

The Collins-Nelson proposal focuses on instituting a federal reinsurance program, while Alexander-Murray would the restore cost-sharing reduction (CSR) payments discontinued by the Trump administration in September.

Neither has received a floor vote, and they were not included in the omnibus deal, despite McConnell’s promise to Sen. Susan Collins, R-Maine, that the upper chamber would take up the measure in 2018.