Following a brief government shutdown in the early morning hours of Feb. 9, Congress passed the large bipartisan budget deal that it has been negotiating for months. The two-year budget package for fiscal years 2018 and 2019 raises strict funding caps for all federal programs, funds the government until March 23, 2018 and raises the debt ceiling through March 2019. In addition, the legislation includes a number of important health provisions of interest to the ATS.
Final Senate passage of the bill was delayed due to objections from Sen. Rand Paul (R-KY) over the bill’s increase in deficit spending, which caused the five-hour government shutdown, but ultimately the bill passed with bipartisan support (71-28). The legislation also faced opposition from some House Democrats, including House Minority Leader Nancy Pelosi (D-CA), who are seeking a vote on legislation to protect immigrant Deferred Action for Childhood Arrivals (DACA) recipients. The bill passed the House (240 – 186) and was signed into law by the President early on Feb. 9.
The budget deal provides relief from further budget “sequestration” funding reductions to all government programs and increases spending for non-defense discretionary programs by $63 billion in fiscal year (FY) 2018 and $68 billion in FY 2019, or about 10 percent. These spending increases will enable Congress to provide the NIH with funding increases of at least $1 billion in both FY2018 and FY2019. Earlier this year, the Senate Appropriations Committee proposed a $2 billion funding increase for the NIH in FY2018. The House Appropriations Committee proposed an FY2018 $1.1 billion NIH increase, but subcommittee chairman Rep. Tom Cole (R-OK) later expressed support for NIH funding above the House level. So, NIH can be expected to see a funding increase of somewhere between $1.1 and $2 billion once FY2018 spending is finalized on March 23, 2018.
Among the budget deal’s other important health-related measures, the bill:
- Extends Children’s Health Insurance Program (CHIP) funding through 2028. The earlier short-term funding bill had funded the CHIP program through 2023. This bill adds an additional five years of CHIP funding through 2028. This funding extension will provide long-term stability for all state CHIP programs which insure nearly nine million children in the U.S.
- Provides a two–year funding renewal for community health centers
- Renews the National Health Service Corps. Program funding for two years
- Provides additional Medicaid funding for Puerto Rico and U.S. Virgin Islands
- Repeals the Independent Payment Advisory Board – a board created by the Affordable Care Act that, under certain circumstances, was delegated authority to make reductions in Medicare payment reimbursement rates.
The bill also creates an “agreement” for Congress to make the following investments
- $6 billion for the opioid crisis – mostly through grants to states
- $4 billion renovating and expanding VA hospitals and clinics
- $2 billion increase in the NIH funding.
The actual funding for the above “agreed” spending increases will transpire in a subsequent appropriations bill that will fund the federal government for the remainder of fiscal year 2018.
On the downside, in order to pay for the spending increases in the budget package, the bill will cut the Prevention and Public Health Fund (PPHF) by $1.35 billion, or just under 20 percent over 10 years, although this cut is significantly less than reductions proposed by the House. The PPHF, set up under the Affordable Care Act, funds state chronic disease prevention efforts and is a key funding source for state tobacco cessation and education programs.
With enactment of the two-year budget deal, Congress must still finalize federal FY2018 spending and now has a deadline of March 23, 2018, to accomplish this.
