Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Congress Passes FY 2018 Omnibus, Avoids Government Shutdown

Congress approved a $1.3 trillion omnibus-spending bill last week before adjourning for a two-week recess. H.R. 1625, the Consolidated Appropriations Act (a.k.a., the “omnibus”) funds the government through the end of the current fiscal year (FY) -- September 30, 2018. It includes $695 billion in defense funding and $591 billion in nondefense funding. Lawmakers faced a March 23 deadline to pass a funding package to avoid a partial federal government shutdown. The omnibus passed the House of Representatives on Thursday by a vote of 256-167. The Senate passed the bill in the early hours of Friday morning by a vote of 65-32.

Conservatives threatened to delay proceedings due to concerns about the nation’s rising debt and deficit, criticizing the speed at which the 2,232-page bill was considered. Enough Republicans ultimately opposed the massive spending bill to require the support of Democrats in both chambers for passage. Because the omnibus is one of the final must-pass pieces of legislation before the November midterm elections, the release of the bill was delayed as members attempted to attach other issues to the bill.

Democratic leadership withdrew their previous demands that protections for Dreamers under the Deferred Action for Childhood Arrivals (DACA) program be included as a part of the FY 2018 omnibus. Instead, they called for both Republican and Democratic appropriators to drop all controversial poison-pill riders from the omnibus, like stricter immigration provisions, to avoid another government shutdown.

The U.S. Department of Health and Human Services (HHS) will receive $88.1 billion in FY 2018, a $10 billion increase compared to FY 2017 levels.

The omnibus will increase appropriations for the National Institutes of Health (NIH) to a total of $37 billion in FY 2018. The additional $3 billion is the largest funding increase for the agency in more than 15 years. The budget deal guaranteed at least a $1 billion raise for NIH in FY 2018 and 2019, but lawmakers decided to increase investment in the agency even further. The omnibus includes an additional $414 million for Alzheimer’s research, an additional $40 million for research on a universal flu vaccine, and $140 million more for brain research.

The Centers for Disease Control and Prevention (CDC) will receive $8.3 billion, a $1.1 billion increase over current spending.

The Agency for Healthcare Research and Quality (AHRQ) is provided with $334 million, a $10 million increase over FY 2017 levels. Rather than including the agency within the NIH, as the Trump budget proposed, the bill instead includes language requiring a study of how AHRQ can better coordinate with the federal health services research enterprise. The study will also identify research gaps and areas for consolidation at the agency and is required to be sent to Congress within one year.

The omnibus includes $4 billion to fund prevention, treatment, and enforcement efforts for the opioid epidemic across HHS, Homeland Security, Justice, and Veterans Affairs. This includes $1 billion in new grants for states and tribes, at least $500 million for new opioid research at the NIH, an increase of $350 million for related efforts at the CDC, $130 million for the Rural Communities Opioid Response Program, and a nearly $300 million increase for law enforcement grant funding to combat the epidemic. Congress rejected the White House’s proposal to cut the Office of National Drug Control Policy (ONDCP) by 95 percent.

The omnibus includes more than $2.3 billion in new spending for mental health programs, and will fund nearly 30 mental health provisions contained in 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.

The bill also includes funding for gun-violence prevention measures in schools. Seventy-five million dollars is allocated to train school employees to respond to an attack, purchase metal detectors, and create systems for reporting threats to schools. An additional $100 million will be provided for such purposes between 2019 and 2028. Also included in the legislation was the stand-alone Fix NICS Act, which creates incentives and penalties to increase reporting to the Federal Bureau of Investigation’s (FBI) National Instant Criminal Background Check System (NICS), which is already required under existing law and bars people with severe mental health conditions from purchasing a firearm. The omnibus report language also clarifies that the CDC is permitted to research the causes of gun violence as a public health issue. The agency had restricted research on gun violence as a result of its interpretation of the Dickey Amendment, which has been attached to government funding bills for more than two decades and states “none of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.”

The omnibus package includes $249 million for the Federal Emergency Management Agency’s pre-disaster mitigation program.

The omnibus also requires the Administration to publish information on the number of employees and contractors involved in the implementation and administration of the Affordable Care Act (ACA).

Despite assurances from White House budget director Mick Mulvaney that the measure had the support of the Administration, President Trump threatened to veto the omnibus funding package the morning after Senate passage of the bill, citing the absence of protections for DACA beneficiaries and inclusion of only a fraction of the money requested for border security and construction of a wall between the U.S. and Mexico. Despite the veto threat, President Trump signed the bill just hours later, while also calling on Congress to allow the President to make line-item vetoes on government spending bills and to end the Senate’s filibuster rules.

The Senate is scheduled to reconvene on April 9, and the House of Representatives will return on April 10.

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