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House passes new funding bill; here's what it means for federal health agencies

Insurers get no federal funds for cost-sharing reduction payments or a reinsurance program to help stabilize the individual market.

Susan Morse, Managing Editor

The U.S House of Representatives on Thursday voted 256 to 167 to pass a federal spending bill that contains a number of changes from what President Trump proposed, many of them relevant to healthcare providers and payers.   

The bill that funds the government through Sept. 30 now goes to the Senate for debate. Congress is under a deadline of Friday night to approve the bill that Trump has said he would sign. Approval in the House came from 144 Republicans and 112 Democrats.

Congress, in the bill, has shown it understands the importance of interoperability in its proposed $1.3 trillion omnibus spending bill, said Tom Leary, vice president for Government Relations with HIMSS, the parent company of Healthcare IT News and Healthcare Finance News. .

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The budget includes a considerable amount of funding for the U.S. Department of Veterans Affairs to begin the transition to Cerner for its EHR when that contract goes through. 

"That's a good message,"  Leary said "That's a sign from Congress that they're interested in standards-based interoperability."

Department of Health and Human Services Secretary Alex Azar for the past two weeks has been promoting innovation and interoperability and ways his department will seek to improve both.

HHS gets an increase of $10 billion in the bill and authorizes $60 million provided by the 21st Century Cures Act.

"Providers and payers from an IT perspective should feel confident that Congress is meeting the financial requirements they outlined in MACRA and 21st Century Cures," Leary said. "It's maintaining the U.S. on the path to stay as a leader in healthcare research and technology development. Specific to the IT community, it comes down to, they're serious about interoperability, they recognize the seriousness of the ONC."

One concern is that while many HHS programs get a bump-up, the bill only restores funding to flatline levels for the Office of the National Coordinator for Health Information Technology. Still, the $60 million appropriation is better than the cut to $28 million that was originally budgeted.

"It's a real positive for the community given the role ONC has in 21st Century Cures requirements," Leary said. However he said, "I'd like to see ONC not only funded, but getting a plus-up for advancing 21st Century Care."

Another plus in the budget is an increase for the Agency for Healthcare Research and Quality, Leary said. This supports research for best practices. 

"They've been working for the last 12 months to figure out ways to get best practices out faster," Leary said. 

Insurers in the individual Affordable Care Act market promoted funding for cost-sharing reduction payments but were likely not surprised to see no appropriation for the CSRs or a reinsurance program they and providers told Congress were necessary to stabilize and lower premiums. 

"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," America's Health Insurance Plans said by statement. 

State and federal leaders support healthy markets through employer-provided coverage, Medicare Advantage and Medicaid managed care, but not the individual market, AHIP said.

Should the bill pass as is, and with states able to waive many of the requirements of the Affordable Care Act, that market is expected to remain unstable and premiums to remain at least 20 percent higher than if the government had funded the CSRs. Under the ACA, insurers are still required to help pay the deductibles and out-of-pocket costs for qualifying lower income beneficiaries. 

CSRs and reinsurance were part of an amendment to the omnibus bill, the Bipartisan Health Care Stabilization Act of 2018, but Democrats balked at it being tied to the Hyde Amendment to prevent federal funds from going to any insurer offering abortion coverage.

Under the budget, the National Institutes of Health would receive a nearly 9 percent increase to $37.1 billion -- including $100 million toward developing a universal flu vaccine and $500 million to research opioid addiction and alternative pain treatment, according to Politico

The bill would increase the Centers for Disease Control and Prevention budget by $1.1 billion, a rejection of President Donald Trump's plans to drastically cut the public health agency's budget, according to Politico. Under the proposal, the CDC would receive $8.3 billion.

The pharmaceutical industry lost its battle to cut their portion of funding for the gap in the Medicare Part D doughnut hole from 70 to 60 percent.

Twitter: @SusanJMorse
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