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Health Care Policy Changes In The Federal Spending Package

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Signed into Law by President Trump on 12/20/2019 

synopsis from the link ~


The NPR health reporting team took a look at what is in the package and picked out notable highlights, including some surprising policy reverses for Congress.


1.  Repeal of health taxes designed to pay for ACA - many of the taxes designed to cover the cost of expanding health coverage to 20 million people by Obamacare have been derailed.  This isn't new - (see the imbedded link for the history of other income incoming funds that have been derailed and when).


With this legislation, the "Cadillac tax" on generous employer health plans have been permanently nixed, as are taxes on health insurance companies and medical-device makers. 


"It is paid for. It is fiscally responsible," said President Barack Obama as he signed the ACA into law in 2010 but changes to funding sources started in 2011 and have kept going.


The repeal of these (3) taxes alarmed many health policy and budget watchers. It will contribute $373 billion to the deficit, according to an estimate from Congress' Joint Committee on Taxation. 


"So we're cutting the funding out from under Obamacare, but still doing all the spending," says Marc Goldwein, of the nonpartisan Committee for a Responsible Federal Budget. "This whole bill is about reversing the few hard choices that we made to pay for Obamacare."  "Everybody seems to want lower deficit in the abstract, but when it comes time to actually cut spending or raise taxes, there doesn't seem to be the political will in either party at the moment," he adds. Selena Simmons-Duffin, health policy reporter


2.  Raising the age to buy tobacco products to 21

The measure raises the federal age limit from 18 to 21 and would apply to both cigarettes and e-cigarettes.


3.  A foundation for President Trump's plan to end HIV

In his state of the union address in February, President Trump announced a plan to end the HIV epidemic in America by 2030. This year, not a whole lot has happened toward this goal because there hasn't been funding from Congress — until now. The president's budget had called for $291 million, and Congress will overshoot that slightly.


"This is just the foundation — it's the first year of funding," says Carl Schmid of the AIDS Institute and the President's Advisory Council on HIV/AIDS. "It's an excellent start, but to achieve the goal of ending the epidemic, we'll need a lot more money to scale it up for next year and the years to come." —Selena Simmons-Duffin, health policy reporter


4.  Paving the way to develop more generic drugs

The Creating and Restoring Equal Access To Equivalent Samples Act — called the the CREATES Act, for short — aims to make sure branded manufacturers sell samples of their products to companies that want to use them to develop generic versions.


It's not a panacea, but it's definitely an important step forward in providing relief for Americans struggling with high prescription drug costs," says Harvard Medical School instructor Ameet Sarpatwari. The bill has been introduced five times but never managed to pass despite bipartisan sponsorship. The Congressional Budget Office expects CREATES to save taxpayers $3.7 billion over 10 years. —Sydney Lupkin, pharmaceuticals correspondent


5.  First funding for gun violence research since 1996

The budget provides $25 million for research on preventing deaths and injuries from guns, split equally between the National Institutes of Health and the Centers for Disease Control and Prevention.


In 2018, language added to instructions accompanying a spending bill made it clear that the CDC was allowed to conduct research on the causes of gun violence. At that time, Congress provided no funding.  With this legislation, they have named, allocated funding for this purpose.


6.  Shoring up suicide prevention efforts

The budget provides SAMHSA (Substance Abuse and Mental Health Services) with $19 million for the Suicide Prevention Lifeline — this includes an increase of $7 million over last year. 


Most of the federal funds support the Lifeline's national infrastructure. The additional funding "will provide much needed resources to improve consumer access to the National Suicide Lifeline," McGrath wrote in an email. The funds will likely be used to identify areas where there are gaps in coverage and to find ways to fill in those gaps, she adds. Still, she notes that the service is far from fully funded and centers struggle to keep pace with the rise in call volumes. 


The spending package also includes an increase of $7 million for the Zero Suicide Program, which provides a tools, training and outreach to help health care systems adopt effective suicide prevention approaches.


This budget doesn't address funding needs for transitioning to the new 988 number that's in the works. That might come in the next fiscal year, notes McGrath. —Rhitu Chatterjee, health correspondent


7.  Medicaid in the territories, community health clinics, and other "extenders"

The U.S. territories had been facing a dramatic funding cliff this fall. The ACA gave the territories 10 years of additional money for Medicaid, but that ran out in September — causing a potential $1 billion shortfall in 2020. Guam and the Virgin Islands warned they would need to start cutting their Medicaid rolls, and Puerto Rico would have had to cut benefits to account for the funding cliff.

Now, they won't have to — the spending package restores funding to the territories' Medicaid for two years.


Also attached to the budget are several other health "extenders," including funding for community health centers and safety net hospitals. However, those only get funding until May - but May is when many other spending items have been assigned to come forward - the new May deadline might be designed to help push forward legislation on other health priorities like prescription drug prices or surprise billing.

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