Federal Spending Bill Lacks Sought-After ACA Stabilization Measures

Congress proposes to add $3.6 billion in funding to combat the opioid epidemic through the end of FY18.

Note: This story was updated on March 23.

March 22—A bill to fund the federal government through the rest of FY18 includes various healthcare measures but does not incorporate a proposed stabilization plan for the Affordable Care Act’s (ACA’s) insurance markets.

The $1.3 trillion bill passed in the House on Thursday and in the Senate late Thursday night. After tweeting Friday morning that he might veto the bill over concerns that it does not address immigration-related policies, President Trump signed the measure into law Friday afternoon.

The 2,200-page spending bill will fund the federal government through Sept. 30. None of the $88 billion in funding for the U.S. Department of Health & Human Services is designated for stabilization of the individual-insurance markets that were established by the ACA.

Sens. Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine) were among the sponsors of bicameral legislation that would fund cost-sharing reduction (CSR) subsidies for four years, establish a reinsurance program, and simplify the process for states to apply for waivers from ACA regulations. However, citing political disagreements over aspects of the plan, House leaders chose not to include the measure in the spending bill that was sent to the floor this week.

“One of the much-debated healthcare measures that is missing from the bill would have allowed states to put in high-risk pools for high-cost patients,” noted Richard L. Gundling, FHFMA, CMA, senior vice president of Healthcare Financial Practices for HFMA. That measure and support for CSR payments “will need to wait for future bills,” Gundling said.

America’s Health Insurance Plans (AHIP) expressed disappointment with the lack of a stabilization measure in the spending bill. 

“Premium reduction measures in the individual market would have ensured that Americans who buy their own coverage had more affordable choices that offer access to high-quality care,” AHIP stated in a news release. “We are disappointed that Congress was unable to take this opportunity to help reduce premiums for hardworking Americans.”

Tackling the Opioid Epidemic

The bill includes $3.6 billion in funding to be used in efforts to combat the opioid epidemic, an increase of $2.55 billion from the prior year’s budget.

Opioid funding is “targeted toward improving treatment and prevention efforts; finding alternative pain medications; workforce needs, especially in our rural communities; and behavioral health,” according to a Senate Appropriations Committee summary of HHS provisions in the bill.

Of the opioid-related funding, $1 billion is for a new state opioid response grant, of which 15 percent would be targeted to states with the highest mortality rates stemming from opioid-use disorders. In addition, $500 million is for National Institutes of Health (NIH) research on opioid use and $415 million goes to expanding behavioral health and substance use disorder prevention and treatment services.

Increases for Various Agencies

NIH received a $3 billion funding increase. In addition to the $500 million for opioid research, an increase of $414 million is allocated for Alzheimer’s disease research funding.

The spending bill includes a $306 million increase for mental health programs at the Substance Abuse and Mental Health Services Administration (SAMHSA). Among the $1.5 billion total allocation is $100 million in new grants to certified community behavioral health centers that meet prescribed standards and $25 million for mental health programs to address school safety.

Community health centers received $135 million in increased funding to expand behavioral health and substance use disorder prevention and treatment services. These services include treatment for opioid-use disorders and access to overdose reversal drugs and recovery support services.

Rural health programs also received a funding increase of $135 million. Funds will be allocated for programs such as opioid response efforts, collaborative models for delivering care in rural areas, and telehealth. The Rural Hospital Flexibility Grant program would receive an increase of $6 million “to enhance quality and patient outcomes as well as improving financial viability of rural hospitals to ensure access to care for isolated beneficiaries such as Medicare recipients,” according to the Senate summary.

An increase of $15 million in funding for the Children’s Hospital Graduate Medical Education program will be used to further the program’s goal of “providing freestanding children’s hospitals with funding to support the training of pediatric providers,” according to the summary.

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