Very early on the morning of Friday, February 9 2018, the U.S. Senate and House of Representatives passed a 2-year bipartisan compromise bill (HR 1892) which has been much discussed in the past week. The vote was originally scheduled for the early evening of Thursday, February 8. However, due to a procedural block by Senator Rand Paul (R-KY) over the size of the government spending increase, the Senate had to wait until 1am on Friday to vote on the bill. The House did not complete voting on it until after 5am. This led to the government shutting down for the duration of that night, making it the second shutdown in 3 weeks, but the shutdown is now over and services have resumed.
The key agreement in the deal is that federal spending is increased by approximately $300 billion over the next 2 years. Specifically, defense spending increases by $80 billion in 2018 and $85 billion in 2019 and domestic spending increases by $63 billion in 2018 and $68 billion in $2019. However, this agreement is only a first step in implementing the 2-year deal. Now that Congress has agreed on how much it will spend overall, it still has to decide which programs get how much within the broad defense and domestic spending categories. This process is known as “appropriations” – and will be completed by passing a large bill known as an “omnibus” that specifies how funding is to be appropriated. Read more here.
Here are health provisions in the bill of which ANCOR is aware at this time:
- $6 billion has been set aside to fight the opioid epidemic and assist mental health initiatives.
- The CHIP program is extended for an additional 4 years on top of the 6 years negotiated in the previous short-term budget deal – this means the program is renewed for a total of 10 years.
- The Maternal Early Childhood Home Visiting Program is renewed for 5 years.
- Community Health Centers are renewed for 2 years.
- The National Health Service Corps is renewed for 2 years.
- Teaching Health Centers are renewed for 2 years.
- The Special Diabetes Program and the Special Diabetes for Indians program are renewed for 2 years.
- The Medicare outpatient therapy cap is permanently repealed.
- Special Needs Plans are now made permanent.
- Medicaid DSH cuts have been delayed for 2 years, with $6 billion in additional DSH reductions in place for FY21-23.
- There have been relatively few offsets for the bill compared to the increase in spending, meaning the bill will add to the deficit. These offsets include a bill to disenroll lottery winners from Medicaid and closing the Medicare Part D “donut hole.”
As ANCOR uncovers more details about the lengthy bill and the upcoming appropriations process, we will let members know should any provisions be particularly relevant to providers.
ANCOR would be remiss if we did not conclude with some situational awareness of difficult topics that remain on the Congressional docket. A bill stabilizing insurance markets was not included in this compromise bill, so the Affordable Care Act (ACA) will remain a topic that will absorb Congressional attention in coming months given the recent repeal of the individual mandate. Similarly with DACA provisions – while the Senate has pledged to hold a vote on the topic, the House has not, so DACA will also absorb Congressional bandwidth as the program expires towards the end of March.