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Health Care Largely ‘Wins’ in Latest Budget Deal, Analysts Say
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Health care policy analysts and medical societies are applauding the budget agreement signed last week by President Donald Trump, citing financial support in several critical areas.
“The recent compromise budget bill is largely a win for physicians and health care more broadly,” Philip A. Verhoef, PhD, MD, FAAP, FACP, assistant professor of medicine and pediatrics, University of Chicago, told Healio Family Medicine.
The plan provides the Childrens’ Health Insurance Program, or CHIP, with a total of 10 years of funding, which is 5 years longer than a previous agreement; NIH with $1 billion in funding each year for the next 2 years; states with funding to combat the opioid crisis, renovate and expand Veterans’ Administration hospitals and clinics; and 2 years of funding for community health centers and National Health Service Corps Program funding for 2 years, according to Verhoef.
Another health care policy expert agreed that the bill, which received bipartisan support, is a meaningful one.
“Tucked into the continuing resolution is the most significant piece of health care legislation to pass since the 21st Century Cures Act was enacted in December 2016,” Pari Mody, associate of Arnold & Porter Kaye Scholer LLP, told Healio Family Medicine. “The bill includes several changes that will impact health care providers, including many that providers should count as wins.”
She said this includes the retroactive, 2-year delay of the Medicaid disproportionate share hospital payment reduction that went into effect at the end of September, the aforementioned CHIP funding extension, and many more components.
“The [continuing resolution] also includes purported technical changes to the Quality Payment Program, which were backed by physician associations. Significantly, beginning in 2019, this section makes clear that the Merit-based Incentive Payment (MIPS) score adjustment is limited to ‘covered professional services,’ and excludes Part B drug payments,” she said in the interview. “Other wins in the bill include a temporary, transitional payment system for home infusion therapy services, expansion of telehealth under the Medicare program, funding for community health centers, and permanent repeal of the Medicare therapy cap.”
Robert Greenwald, JD, clinical professor of law and faculty director of the Center for Health Law and Policy Innovation at Harvard Law School, told Healio Family Medicine, “Now that an agreement has been reached, certain vital health programs are safe for the time being. The Children’s Health Insurance Program, which covers over 9 million children, is funded until 2027 and Community Health Centers, which serve the health needs of our nation’s most vulnerable, are funded for the next two years. Going forward, we must continue to prioritize programs that promote and secure the health of U.S individuals and families.”
Both Verhoef and Mody had several caveats regarding the bill.
“Although there is a lot for providers to be happy about ... it’s not all good news,” Mody said. “[The resolution] decreases the Medicare Physician Fee Schedule conversion factor for 2019 and reduces funding to the Prevention and Public Health Fund, which was established under the Affordable Care Act to provide sustained, mandatory public health funding.”
Verhoef called the cut to the Prevention and Public Health Fund “perhaps the biggest drawback of this bill.”
“This means significant cuts to state and local health departments, which are already drastically underfunded,” Verhoef explained. “[In addition], the current appetite for waivers to states to allow work requirements and lifetime caps on Medicaid benefits is ominous, in my opinion, and will only hurt the most vulnerable Americans in those states.”
“Recall that more and more employers are moving away from offering health insurance as a benefit, meaning people are forced to fend for themselves on either the exchanges or in Medicaid (depending on their income),” he continued. “Also recall that low-income Americans have many more medical problems on average, which means that any insurance plans available to them will have unaffordably high premiums or will simply not cover the care that they need (and therefore not shield them from financial ruin due to their medical problems. Medicaid work requirements, then, will hurt the people that need Medicaid the most: not only do they not have a steady income, they will no longer have affordable health care; talk about kicking a horse when it’s down.”
“On top of that, lifetime caps make absolutely no sense: nobody knows how expensive their health care will be in the future because nobody knows what will happen to them in the future,” Verhoef added. “Imagine being diagnosed with a rare cancer, maxing out your coverage, and then being shown the door. Or what of the person who is simply the victim of an accident? Our current health care system effectively forces people into bankruptcy to qualify for long term care through Medicaid; if we then cap that, we will effectively be turning our backs on the most vulnerable in this country,” he concluded.
Medical societies largely support Congress’ action
The AAFP, American College of Physicians and other medical societies lauded many components of the new spending plan.
“The [AAFP] applauds the introduction of the bipartisan budget agreement and urges the Senate and House to quickly approve this legislation. Passage of the budget agreement ensures patients will have access to care, regardless of where they live, and offers a reprieve for vital programs on which the foundation of our health care system is built,” Michael Munger, MD and AAFP president said in a statement released prior to passage.
He pointed positively to the funding extensions of the Teaching Health Center Graduate Medical Education Program, National Health Service Corps, and initiatives that support health care in nonurban areas.
“We’re pleased the legislation supports rural health care with provisions that maintain the financial viability of rural hospitals that are the lifeline for patients in small communities across America,” Munger continued. “The resolution’s greatest impact includes increased inpatient payment for low-volume — and often rural — hospitals, the extension of the Medicare-Dependent Hospital program that supports rural facilities that care for a large number of elderly patients, and the extension of the Geographic Practice Cost Index that ensures rural physicians can continue to provide care to their patients.”
AAFP also expressed appreciation that CHIP and the Independence at Home Medical Practice Demonstration Program received funding reprieves, strengths of the bill that ACP also acknowledged.
“The Home Medical Practice Demonstration Program provides a home-based primary care benefit to high-need Medicare beneficiaries with multiple chronic conditions; allows Medicare Advantage plans to offer a wider array of targeted supplemental benefits to chronically ill enrollees; and beginning in 2021, payments will be authorized to physicians furnishing telehealth consultation services in all areas of the country for the purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, eliminating current geographic restrictions,” Jack Ende, MD, MACP, ACP president said in a statement. “The agreement also expands coverage of telemedicine services by Medicare Advantage Plans and Accountable Care Organizations.”
However, ACP also expressed concern regarding the drop-in allocations to the Prevention and Public Health Fun and that the fate of immigrants covered under the DACA program, scheduled to end March 5, remains unresolved.
Other medical societies lauded the Congressional compromise.
“We are pleased that [Friday’s] budget deal included $6 billion to fight opioid abuse, one of the most critical public health issues facing our nation today. The opioid crisis has taken a heavy toll on millions of families in America. We applaud Congress for approaching these issues in a bipartisan way,” Saul Levin, MD, MPA, American Psychiatric Association CEO and medical director, said in a statement.
“In addition to funding for the opioid crisis, the APA is pleased that this bill extends [CHIP] another four years through 2028, as well as securing additional funding for the critical work done at the National Institutes of Health,” he added.
“This bipartisan budget deal, demonstrating the importance of access to quality health care for all Americans, is one we can all agree on,” Mary Norine Walsh, MD, FACC, American College of Cardiology president said in a statement. “There is no better time than Heart Month to see progress on so many policies the ACC has supported over the years to ensure patient-centered care and achieve our mission to transform cardiovascular care and improve heart health. It is so encouraging to see the inclusion of further funding for CHIP, increased access to cardiac rehab and the easing of significant administrative burdens on clinicians.”
The funding plan approved on Feb. 9 extends short-term funding through March 23 and, at least for now, avoids a federal government shutdown. Congress is expected to pass an omnibus spending bill for the remainder of 2018 in the meantime. – by Janel Miller
Disclosure: Healio Family Medicine was unable to determine neither Verhoef's, Mody's nor Greenwald's relevant financial disclosures prior to publication. Munger is president of the AAFP, Ende is president of the ACP, Levin is CEO and medical director of American Psychiatric Association and Walsh is president of the American College of Cardiology.