Trump Signs 2018 Budget, With Some Big Wins for Healthcare

Alicia Ault

March 23, 2018

After first suggesting he may veto the new budget bill passed by Congress yesterday, President Donald J. Trump signed the huge $1.3 trillion budget bill today that will fund the federal government through the rest of its fiscal 2018 year, including some big increases for health programs and money to fight the opioid crisis, flouting cuts that had been called for by the president.

Trump had threatened to veto the bill because it did not include money for some of his signature requests, including a wall on the border with Mexico and a fix to the Deferred Action for Childhood Arrivals (DACA) program that has allowed some children who were brought to the United States illegally to stay in the country.

The House of Representatives approved the bill by a 256-167 vote yesterday and the Senate approved it 65-32 late last night,  after Sen. Rand Paul (R-KY) relented on his apparent threat to withhold his vote over what he called excessive spending.

Paul forced a brief shutdown when federal money ran out in February. The previous budget agreement — enacted February 9, providing short-term funding for most of the federal government through March 23 — extended many health programs for 2 years, cut Medicare physician fees in fiscal year 2019 (FY19), and added payment for stroke telemedicine services.

The new $1.3 trillion bill funds the federal government through September 30. It includes $700 billion for the military — a $66 billion increase — and $591 billion for domestic spending, which is a $52 billion increase from 2017, according to media reports.

The Department of Health and Human Services (HHS) is set to receive $78 billion, a $10 billion increase. The Centers for Medicare & Medicaid Services (CMS) would receive $4 billion for administrative expenses, which congressional appropriators said  is the same as in 2017, and "sufficient to maintain all core operations and services."

The Office of the National Coordinator for Health Information Technology had been slated for a huge budget cut under the Trump Administration's request for 2018, but Congress instead approved a $60 million budget. The HHS's Office of Civil Rights, which monitors violations of the Health Insurance Portability and Accountability Act, was due to receive $33 million under the Trump request, but the new spending bill gives the office $38.7 million.

The bill does not provide new funding for the Affordable Care Act (ACA) and continues to block the federal government from funding the risk corridor program, which seeks to protect insurance companies from higher than expected costs on the state insurance exchanges.

The bill would also require CMS to notify congressional committees 2 days before any ACA-related data or grant opportunities are released to the public; require the administration to publish ACA-related spending by category since its inception; and require the administration to publish information on the number of employees, contractors, and activities related to the ACA.

Opioid Crisis, Mental Health Big Winners

Funding to address the opioid crisis was given a $2.55 billion, or 244%, increase, to $3.6 billion. Still, that is far less than the $10 billion annually that many healthcare and substance use providers and public health officials have said is necessary.

The Substance Abuse and Mental Health Services Administration (SAMHSA) would receive a $1.3 billion increase in its budget, bringing it to $5 billion. The legislation maintains a prohibition on using federal funds for the purchase of syringes or sterile needles. But it allows communities with rapid increases in cases of HIV infection and hepatitis to use federal money for other activities, including substance-use counseling and treatment referrals.

The SAMHSA budget includes $1.9 billion for the Substance Abuse Block Grant, which is on par with the 2017 level; an $11 million increase in funding for criminal justice activities, bringing that to $89 million, which includes $70 million for drug courts; and $1.7 billion to address opioid and heroin abuse (an increase of $1.5 billion), including $500 million for the state opioid response grants authorized in the 21st Century Cures Act, along with funding for programs authorized in the Comprehensive Addiction and Recovery Act.

One of the new initiatives is $105 million in funding to expand the National Health Service Corps (NHS) to offer opioid and substance use disorder treatment in rural and underserved areas. NHS participants who are substance use disorder counselors will be eligible for loan repayment. Of the $105 million, about $30 million will be devoted to the new Rural Communities Opioid Response initiative within the Office of Rural Health.

Funding for mental health programs will total $3.2 billion, a 17% increase. That includes what Linda Rosenberg, president and CEO of the National Council for Behavioral Health, calls  "a down payment of $100 million" for Certified Community Behavioral Health Clinics.

That program — halfway through a 2-year demonstration program at 67 centers — has been used to help address the opioid crisis.

The bill also increases funding for Mental Health First Aid to $19 million. The program gives first responders training to help connect people having mental health or addiction crises to community help.

According to the National Council for Behavioral Health, funding was maintained for the Primary and Behavioral Healthcare Integration program, which has provided screening and treatment for conditions like diabetes and heart disease for more than 98,000 individuals living with serious mental illness or addiction at more than 213 sites.

House Energy and Commerce Committee Chairman Greg Walden (R-OR) noted that the budget bill will fund 30 sections of mental health provisions within the 21st Century Cures Act, including the Mental Health Block Grant, the National Traumatic Stress Network, the National Child Traumatic Stress Initiative, Mental and Behavioral Health Training Grants, Assisted Outpatient Treatment, and the National Suicide Prevention Lifeline.

NIH, CDC, FDA Get Boosts

The legislation increases funding for the National Institutes of Health (NIH) by $3 billion, bringing the total to $37 billion. It includes the following:

  • $1.8 billion ($414 million increase) for Alzheimer's disease research;

  • $400 million ($140 million increase) for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative;

  • $290 million ($60 million increase) for the All of Us research initiative (formerly called the Precision Medicine Initiative);

  • $10 million ( $8 million increase) for regenerative medicine research;

  • $100 million ($40 million increase) for research to develop a universal flu vaccine;

  • $351 million ($17 million increase) for research on combating antibiotic-resistant bacteria;

  • $543 million ($27 million increase) for Clinical and Translational Science Awards;

  • $351 million ($17 million increase) for Institutional Development Awards;

  • $300 million for the Cancer Moonshot initiative; and

  • $12.6 million for the Gabriella Miller "Kids First" pediatric cancer research initiative.

The Centers for Disease Control and Prevention (CDC) will get a $1.1 billion boost, bringing its budget to $8.3 billion. Most of that increase comes via a raid on the Affordable Care Act's Prevention and Public Health Fund — some $801 million will be taken, along with $240 million from the Nonrecurring Expenses Fund. The CDC's Public Health Preparedness and Response programs will get a $45 million increase, bringing it to $1.45 billion.

The US Food and Drug Administration (FDA) would receive $2.9 billion (a figure that does not include user fees paid by pharmaceutical and medical device companies), which is a $135 million increase, according to the House Appropriations Committee. The budget includes $15 million that will go toward the FDA's new Oncology Center of Excellence.

The Health Resources and Services Administration has been slotted to receive $7 billion, including $315 million for the Children's Hospital Graduate Medical Education program, $110 million for the Healthy Start program, and $652 million for the Maternal and Child Health Block Grant.

A program that had stopped receiving funding in summer 2017 — the Teen Pregnancy Prevention Program — will now get $101 million, according to the publication The Hill. Abstinence-only education would see a $10 million funding boost, and the Sexual Risk Avoidance Education (SRAE) grant program would receive a 67% increase to $25 million. Federal spending on abstinence-only programs would total $100 million in 2018, which The Hill reports as the highest amount devoted to abstinence since the George W. Bush administration.

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