The Senate Appropriations Committee on Thursday approved a budget proposal for the Department of Health and Human Services (HHS) that rejects President Trump’s proposed $15.1 billion in cuts to discretionary spending. The committee recommended that HHS receive $79.4 billion in discretionary funds in fiscal 2018, a $1.7 billion increase from what the department received this fiscal year (FY).
Most areas of discretionary spending are higher than or level with FY 2017 spending in the budget bill. However, funding for the Independent Payment Advisory Board (IPAB), which was authorized by the Affordable Care Act (ACA) but never established, would be eliminated. This appears to be the final nail in the coffin for the IPAB, which conservatives have attacked as a mechanism to ration care.
Under the Senate bill, the National Institutes of Health (NIH) would receive $36.1 billion, a $2 billion increase over FY 2017. That would include $1.8 billion for Alzheimer’s disease research, a $414 million increase; $400 million for the BRAIN Initiative to map the human brain, up $140 million; $290 million for the All of US precision medicine study, up $60 million; $80 million for the National Cancer Institute’s precision medicine program, up $10 million; $513 million for the Combat Antibiotic Resistant Bacteria program, up $50 million; and $533 million for the Clinical and Translational Science Award, up $17 million.
In addition, the Senate measure includes $816 million to combat the nation’s opioid epidemic. That represents an increase of $655 million, or 440%, over the past 2 years. The bill retains $126 million for the opioid prevention programs of the Centers for Disease Control and Prevention (CDC), appropriates $50 million for treatment and prevention in community health centers, maintains funding for the opioid prevention and treatment programs of the Substance Abuse and Mental Health Services Administration (SAMHSA), provides $15 million for a new SAMHSA community prevention program, and appropriates $500 million for state opioid abuse crisis grants authorized by the 21st Century Cures Act.
Other opioid crisis funding includes $1.9 billion to continue the Substance Abuse Prevention and Treatment Block Grant, $94 million in “mandatory funds” for community health centers, and an additional $22.6 million for the National Institute on Drug Abuse.
The bill also appropriates $1.49 billion for the nation’s 10,400 community health centers, the same as this year. Rural health programs would get $160.6 million, a slight increase from FY 2017, with a focus on rural telehealth.
Mental health programs would receive $1.2 billion, level with this year’s funding. Existing chronic disease, preventive care, and immunization programs would be funded at current levels.
The bill would also maintain over $2 billion in current funding for public health preparedness and response programs, including the following:
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Biomedical Advanced Research and Development Authority, $511.7 million;
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Project BioShield, $510 million;
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Public Health Emergency Preparedness, $660 million; and
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Strategic National Stockpile, $575 million.
The Office of Medicare Hearings and Appeals (OMHA) would receive $117.2 million, $10 million more than this year. The number of cases appealed to OMHA has increased 1000% over the past 6 years, according to the bill summary.
Obamacare Provisions
Besides the IPAB provision, the bill contains several other provisions related to the ACA. The risk corridor program, which seeks to protect insurance companies from higher than expected costs on the state insurance exchanges, would be continued in a budget-neutral manner by prohibiting any funds authorized by the bill to be used as payments for this program.
According to the bill summary, “Risk Corridor program claims since 2014 have vastly outpaced collections and have resulted in approximately an $8 billion shortfall that potentially could have been transferred out of priority discretionary HHS programs…to bail out the Risk Corridor program established by the ACA.”
Under the ACA, HHS is supposed to collect funds from health plans with lower than expected claims to make payments to plans with higher than expected claims. The subcommittee did not explain why there has been a shortfall in these payments or whether it would be legal to use HHS funds to pay those amounts.
The bill also directs the Centers for Medicare & Medicaid Services (CMS) to notify Congress 2 days before any ACA-related data or grant opportunities are released to the public. The Trump Administration would be required to publish ACA-related spending by category since the program’s inception, as well as other information on ACA implementation.
The full Senate will consider the appropriations committee bill sometime this fall. Before that happens, President Trump must first sign a bill sent to his desk today that funds the government until December, e raises the debt limit, and authorizes $15 billion in Hurricane Harvey disaster relief.
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