Bipartisan Senate Budget Deal Boosts Health Programs

In a rare show of bipartisanship for the mostly polarized 115th Congress, Republican and Democratic Senate leaders announced a two-year budget deal that will increase federal spending for defense in addition to key domestic priorities, including many health programs.

Not within the deal, for which the road to the president's desk remains unclear, is any bipartisan legislation targeted at shoring in the Affordable Care Act's individual medical health insurance marketplaces. Senate Majority Leader Mitch McConnell (R-Ky.) promised Sen. Susan Collins (R-Maine) a vote on health legislation in return for her vote for the GOP goverment tax bill in December. To date, that vote hasn't materialized.

The deal does appear to include almost every other health priority Democrats happen to be pushing the past many months, including two years of renewed funding for community health centers along with a series of other health programs Congress failed to provide for before they technically expired this past year.

“I believe we've reached a budget deal that neither side loves but each side can be proud of,” said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor. “That's compromise. That's governing.”

Said McConnell, “This bill represents a significant bipartisan step forward.”

Senate leaders are still negotiating last information on the accord, such as the size a cut to the ACA's Prevention and Public Health Fund, which would help counterbalance the costs of the legislation.

According to documents circulating on Capitol Hill, the deal includes $6 billion in funding for treatment of mental health problems and opioid addiction, $2 billion in extra funding for the National Institutes of Health, as well as an additional four-year extension of the Children's Health Insurance Program (CHIP), which develops the six years approved by Congress last month.

In the Medicare program, the offer would accelerate the closing from the “doughnut hole” in Medicare drug coverage that needs seniors to pay thousands of dollars out-of-pocket before catastrophic coverage takes over. It might also repeal the controversial Medicare Independent Payment Advisory Board (IPAB), that is charged with holding down Medicare spending for the authorities whether it exceeds a particular level. Members have never been appointed to the board, however, and its use hasn't so far been triggered by Medicare spending. Both the closure of the doughnut hole and development of the IPAB were part of the ACA.

The agreement would also fund a number of more limited health programs – some of which are known as “extenders” because they often ride along with other, larger health or spending bills.

Those programs include a lot more than $7 billion in funding for the nation's federally funded community health centers. The clinics serve 27 million low-income people and saw their funding lapse last fall – a delay advocates said had already complicated budgeting and staffing decisions for a lot of clinics.

And inside a victory for the physical therapy industry and patient advocates, the accord would permanently repeal a restriction on Medicare's coverage of physical therapy, speech-language pathology and outpatient treatment. Previously, the program capped coverage after $2,010 worth of occupational therapy and the other $2,010 for speech-language therapy and physical rehabilitation combined. But Congress had long taken action to obstruct those caps or provide exemptions – meaning they had never actually taken effect.

According for an analysis by the nonpartisan Congressional Budget Office, permanently repealing the caps would cost about $6.47 billion within the next decade.

Lawmakers would also forestall cuts mandated through the ACA to lessen the instalments designed to so-called Disproportionate Share Hospitals, which serve high rates of low-income patients. Those cuts have been delayed continuously because the law's 2010 passage.

Limited programs are also affected. The offer would fund for five years the Maternal, Infant and Early Childhood Home Visiting Program, a program that can help guide low-income, at-risk mothers in parenting. It served about 160,000 families in fiscal year 2021.

“We are relieved that there is a deal for a 5-year reauthorization of MIECHV,” said Lori Freeman, CEO of advocacy group the Association of Maternal & Child Health Programs, within an emailed statement. “States, home visitors and families will be in limbo for the past many months, and this news will bring the stability they have to continue this successful program.”

And your budget deal funds programs that encourage doctors to rehearse in medically underserved areas, providing just below $500 million over the next two years for the National Health Service Corps and the other $363 million over 2 yrs to the Teaching Health Center Graduate Medical Education program, which places medical residents in Community Health Centers.